Autism screening and diagnosis involves specific sets of questions, and they differ significantly depending on age. For toddlers, pediatricians use a 20-question checklist filled out by parents. For older children, clinicians conduct structured interviews with caregivers and observe the child directly. For adults seeking a diagnosis, the process includes self-report questionnaires and conversational assessments with a trained professional. Here’s what to expect at each stage.
Toddler Screening: The M-CHAT-R
The American Academy of Pediatrics recommends that all children be screened for autism at 18 and 24 months. The standard tool is the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), a 20-question yes-or-no checklist that parents fill out in the waiting room. The questions focus on social behaviors, communication, and sensory responses that are typical at that age. They include:
- If you point at something across the room, does your child look at it?
- Does your child play pretend or make-believe (for example, pretend to drink from an empty cup or feed a stuffed animal)?
- Does your child point with one finger to show you something interesting, like an airplane in the sky?
- Does your child respond when you call his or her name?
- When you smile at your child, does he or she smile back?
- Does your child look you in the eye when you are talking, playing, or getting dressed?
- Does your child try to copy what you do (wave bye-bye, clap, make a funny noise)?
- Is your child interested in other children?
- Does your child show you things by bringing them to you or holding them up, not to get help, but just to share?
- Does your child make unusual finger movements near his or her eyes?
- Does your child get upset by everyday noises like a vacuum cleaner or loud music?
Scoring breaks into three tiers. A score of 0 to 2 is low risk, and no further action is needed unless other concerns arise. A score of 3 to 7 is medium risk, which triggers a follow-up set of questions to clarify the initial answers. If the follow-up score stays at 2 or higher, the child is referred for a full diagnostic evaluation. A score of 8 to 20 is high risk, and the child is typically referred immediately without the follow-up step.
It’s worth noting that a positive screen is not a diagnosis. It means more evaluation is warranted. Many children who screen positive on the M-CHAT-R do not end up with an autism diagnosis.
Questions Clinicians Ask Parents
When a child is referred for a full evaluation, one of the primary tools is the Autism Diagnostic Interview-Revised (ADI-R), a detailed interview conducted with a caregiver by a trained clinician. It covers three core domains: social behavior, communication (both verbal and nonverbal), and restricted or repetitive behaviors.
The interview is semi-structured, meaning the clinician has specific areas to probe but can follow up naturally based on the caregiver’s answers. For questions about social skills and nonverbal communication, the clinician focuses on the child’s most notable behaviors during the 4-to-5 age window, looking at the development (or absence) of social behaviors like sharing enjoyment, showing interest in peers, and using gestures. For questions about unusual speech patterns and repetitive behaviors, the clinician asks whether these have ever occurred at any point in the child’s life. This distinction matters because some behaviors come and go, and a “has this ever happened” frame catches things a parent might otherwise forget to mention.
Typical areas of questioning include whether the child uses another person’s body to communicate (like pushing a parent’s hand toward a desired object), whether they show a range of facial expressions, and whether they engage in repetitive physical movements or insist on rigid routines.
What a Direct Observation Looks Like
Alongside the parent interview, clinicians typically observe the person directly using the Autism Diagnostic Observation Schedule (ADOS-2). This isn’t a written questionnaire. It’s a structured interaction where the clinician creates social situations and notes how the person responds. For verbally fluent adolescents and adults, Module 4 of the ADOS-2 is used, and it looks a lot like a conversation.
The clinician is scoring specific behaviors during that conversation: whether the person makes typical eye contact, uses gestures for emphasis, shows a range of facial expressions, initiates social exchanges naturally, describes their own emotions, and demonstrates insight into their social experiences. The clinician also notes whether the person fixates on highly specific topics in a way that crowds out typical back-and-forth. Two domains are scored: social affect (covering communication and social interaction) and restricted, repetitive behaviors.
From the outside, it can feel like a casual chat. But every conversational prompt is designed to give the person opportunities to demonstrate (or not demonstrate) specific social behaviors.
Self-Assessment Questions for Adults
Adults exploring whether they might be autistic often encounter self-report questionnaires, either through a clinician or online. The most validated of these is the RAADS-R (Ritvo Autism Asperger Diagnostic Scale-Revised), an 80-question assessment designed to assist diagnosis in adults. Its questions fall into four categories:
- Social relatedness (39 questions): Difficulty understanding social expectations, challenges maintaining friendships, feeling disconnected in group settings
- Sensory and motor differences (20 questions): Strong reactions to textures, sounds, or lights; unusual movement patterns; physical clumsiness
- Circumscribed interests (14 questions): Intense, narrow focus on specific subjects; difficulty shifting attention between topics
- Language (7 questions): Taking things too literally, missing implied meaning, difficulty with figures of speech
A typical question reads: “I take things too literally so I often miss what people are trying to say.” Participants rate each statement based on whether it applies now, applied only in childhood, applied both in childhood and now, or has never applied. Some items are reversed, describing neurotypical experiences like “I am a sympathetic person,” to check for response consistency.
Questions About Masking and Camouflaging
Many autistic people, particularly women and those diagnosed later in life, learn to hide their traits through conscious effort. This is called masking or camouflaging, and it can make diagnosis harder because the person appears socially fluent on the surface. The Camouflaging Autistic Traits Questionnaire (CAT-Q) was developed specifically to measure this. Its 25 questions cover three strategies:
Compensation questions ask whether you’ve actively studied social rules to get by: “I have researched the rules of social interactions to improve my own social skills,” “I have developed a script to follow in social situations,” and “I learn how people use their bodies and faces to interact by watching television or films.”
Masking questions focus on real-time performance: “I monitor my body language or facial expressions so that I appear relaxed,” “I adjust my body language or facial expressions so that I appear interested by the person I am interacting with,” and “I always think about the impression I make on other people.”
Assimilation questions capture the emotional toll: “In social situations, I feel like I’m performing rather than being myself,” “I have to force myself to interact with people,” and “In social situations, I feel like I am pretending to be normal.” The CAT-Q isn’t a diagnostic tool on its own, but high scores can help a clinician understand why someone’s traits haven’t been caught before.
Sensory Questions in Autism Evaluations
Sensory differences are one of the four diagnostic criteria for autism, and evaluations often include detailed sensory questionnaires. The Sensory Profile 2 is widely used for children, with caregivers rating how often their child shows specific responses to sound, light, touch, and movement. These questions illustrate what clinicians are looking for:
For sound sensitivity: “Reacts strongly to unexpected or loud noises,” “holds hands over ears to protect them from sound,” and “struggles to complete tasks when music or TV is on.” On the opposite end, low registration of sound looks like seeming not to hear when called by name, even though hearing tests come back normal.
For touch: “Shows distress during grooming (fights or cries during haircutting, face washing, fingernail cutting),” “becomes irritated by wearing shoes or socks,” and “shows an emotional or aggressive response to being touched.” Low registration of touch shows up as seeming unaware of pain or temperature changes, or being unbothered by messy hands or face.
For visual input: “Is more bothered by bright lights than other same-aged children” or “is bothered by bright lights, such as hiding from sunlight through a car window.” Some children instead seek visual input intensely, staring at patterns, details in objects, or people moving around a room.
For movement: Some children are cautious and hesitant on stairs or curbs, while others pursue movement to the point it interferes with daily routines, constantly fidgeting, rocking, or becoming visibly excited during physical activity.
What Ties All These Questions Together
Regardless of the specific tool or age group, every autism evaluation is probing the same two core areas defined by the DSM-5. The first is persistent differences in social communication and interaction: difficulty with back-and-forth conversation, reduced sharing of emotions or interests, atypical eye contact or gestures, and challenges forming or maintaining relationships. All three of these social areas must be present for a diagnosis.
The second area is restricted, repetitive patterns of behavior or interests. At least two of the following four must be present: repetitive movements or speech (like lining up objects or echoing phrases), rigid adherence to routines or extreme distress at small changes, intensely focused interests that are unusual in their depth or subject, and heightened or reduced sensitivity to sensory input. These patterns can be present now or documented at any point in the person’s history.
The screening questionnaires, parent interviews, observational assessments, and self-report tools are all different lenses on these same two domains. No single question or score determines a diagnosis. Clinicians look at the overall pattern across multiple sources of information, combined with a developmental history, to reach a conclusion.