What should be in an autism diagnostic report? A guide for families

Getting an autism evaluation can feel like a major milestone. It’s not uncommon for families to wait months for an appointment, spend hours completing questionnaires and interviews, participate in testing, and then wait to receive their results.

But not all comprehensive diagnostic reports are created equal. An autism evaluation is not simply one test. The Centers for Disease Control and Prevention states that no single tool should be used as the basis for diagnosis. Diagnosis generally draws on information about the child’s development as well as a professional’s observation and formal assessment of the child’s behavior.

That distinction matters because families may hear that their child is scheduled for an “ADOS” or another autism assessment and understandably assume that the test itself is the diagnostic evaluation. In reality, a standardized assessment can be an important part of the evaluation without being the entire evaluation.

Why the written report matters

The diagnostic report creates a record of how the clinician reached the diagnosis. It may also be reviewed later by other doctors, teachers, or therapy providers. It is also what an insurance plan or public program looks at when a family applies for services related to an autism diagnosis, such as speech therapy, occupational therapy, and ABA therapy. What each one asks for is set out in its own published policy.

Exactly what must be documented depends on the child’s circumstances, the payer, the state, and the services being requested. There is not one universal checklist that applies to every child or every insurance plan.

Texas Medicaid, for example, defines a comprehensive diagnostic evaluation as the entire process of gathering information necessary to determine a diagnosis and requires that the process include a reliable, valid, standardized diagnostic assessment tool or tools (Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, §2.3.2). A comprehensive diagnostic report for autism typically includes:

1. Observation of the client and notes on their behavior from the diagnostician.
2. At least one formal assessment (most commonly the ADOS-2 or the CARS-2, but others may also be utilized).
3. A clearly confirmed diagnosis, including the child’s current level of support needs (e.g. requiring support, substantial support, or very substantial support).
4. A recommendation for future services from the diagnostician. Based on their observations, they may recommend several different kinds of support, such as ABA therapy and speech therapy in conjunction.

In other words: the assessment tool is part of the evaluation. It is not, by itself, the entire evaluation.

What families should look for in an autism diagnostic report

1. A clear diagnostic conclusion

You should be able to tell from the report whether the clinician determined that your child meets criteria for autism spectrum disorder.

A report should therefore give families more information than simply a test score. It should explain the clinician’s diagnostic conclusion in the context of the child’s overall evaluation. You should not have to determine that yourself by interpreting a test score. It should be clearly stated.

2. Documentation of the DSM criteria

For families seeking ABA services, this is especially important.

Programs that fund autism services commonly ask that the evaluation document the diagnostic criteria and symptom severity level according to the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Texas Medicaid’s version of that requirement is at §2.3.2 of its Children’s Services Handbook.

The CDC’s summary of DSM-5 criteria explains that an autism diagnosis requires evidence across both core domains, and each domain has its own threshold:

Persistent deficits in social communication and social interaction. All three of:

• social-emotional reciprocity
• nonverbal communicative behaviors used for social interaction
• developing, maintaining, and understanding relationships

Restricted, repetitive patterns of behavior, interests, or activities. At least two of these four:

• repetitive movements, use of objects, or speech
• insistence on sameness, or inflexible routines
• highly restricted, fixated interests
• unusual responses to sensory input

The criteria also address early developmental onset, clinically significant impairment, and whether the presentation is better explained by intellectual disability or global developmental delay.

For parents, the practical question is simple: does the report clearly document why my child meets the diagnostic criteria for autism?

3. DSM severity levels

The DSM describes autism severity via a level system.

• Level 1: Requires support
• Level 2: Requires substantial support
• Level 3: Requires very substantial support

Two things about these levels matter. The DSM specifies current severity, so a level describes the support a child needs now rather than a prediction about later. And severity is rated separately for each of the two domains, so a complete report may list two levels rather than one.

If you are reviewing your child’s report, look for language identifying the severity or support level associated with the diagnosis rather than assuming that a score from an autism assessment serves the same purpose.

4. A standardized diagnostic assessment

Standardized assessment tools give clinicians structured ways to gather information relevant to diagnosis.

A comprehensive diagnostic evaluation includes at least one reliable, valid, standardized diagnostic assessment tool that is current, clinically and age appropriate, and designated by its publisher for diagnostic purposes. Some programs ask for more than one.

Examples include:

• Autism Diagnostic Observation Schedule (ADOS)
• Autism Diagnostic Interview-Revised (ADI-R)
• Childhood Autism Rating Scale (CARS)

A tool satisfies this component and nothing beyond it. An instrument’s result is not a DSM diagnosis and does not stand in for the other items on this list.

5. Developmental and behavioral history

An autism diagnosis involves much more than how a child behaves during one appointment. Autism diagnosis usually relies on both caregiver descriptions of the child’s development and professional observation of the child’s behavior, which is why you may be asked to fill out questionnaires or information packets regarding your child’s medical and personal history.

AAP guidance states that an autism diagnosis should be made in the context of a complete history and developmental assessment and may draw on detailed parent interviews, rating scales, and structured behavioral observations (Hyman, Levy and Myers, Pediatrics, 2020).

This means families should expect to be asked about topics such as development, communication, social interaction, behavior, daily functioning, and when concerns first became noticeable.

When you receive the report, check that it accurately reflects the history you provided. If something important appears incorrect or is missing, ask the evaluator about it.

6. Co-occurring conditions and other areas of development

Children with autism may also have other developmental, behavioral, mental health, or medical needs.

The AAP recommends considering multiple areas of development when children are evaluated for autism and notes that co-occurring conditions can include intellectual disability, language disorders, ADHD, anxiety, and other conditions.

Known comorbid behavioral or physical health conditions are a separately documented item in some programs’ requirements, including Texas Medicaid’s.

For families, this part of the report can be particularly useful. A diagnosis tells you whether your child meets criteria for autism, but a thorough evaluation can also help clarify your child’s broader strengths and needs based on other conditions.

7. Basic diagnostic information

Some programs also ask that the documentation include:

• the child’s or youth’s age;
• the date of the initial autism diagnosis;
• known comorbid behavioral or physical health disorders; and
• trauma history.

These may seem like small administrative details, but they can become important when documentation is reviewed for services.

Some programs also ask that the diagnosis, with current DSM criteria and symptom severity level, have been made or reconfirmed within a set number of years. Texas Medicaid’s window is three years. If your child’s diagnosis is older than that, it is worth checking your plan’s own policy before a renewal comes up.

Screening is not the same as diagnosis

Families may encounter several autism questionnaires before reaching the diagnostic evaluation. These can be extremely useful, but screening and diagnosis are different processes.

Screening is used to identify children who may be at increased likelihood for autism and who should receive further evaluation. Diagnosis requires additional evaluation of the child’s development and behavior. The CDC puts it plainly: screening tools do not result in diagnoses, and a positive screening result should be followed by a thorough assessment. The AAP recommends autism-specific screening for every child at 18 and 24 months.

So if your child “screened positive” for autism, that does not necessarily mean the diagnostic process is finished. It usually means further evaluation is warranted.

The two are easy to confuse by name alone.

Before the evaluation: questions families can ask

You do not need to become an expert in autism assessment before your child’s appointment. A few practical questions can help you understand what to expect:

• “Will this appointment result in a comprehensive autism diagnostic evaluation and written diagnostic report?”
• “What information will you need from me about my child’s developmental history?”
• “Which standardized autism assessment tool or tools do you typically use?”
• “Will the report document whether my child meets DSM criteria for autism?”
• “Will the report include the DSM severity or support levels?”
• “Will the report address other developmental, behavioral, or medical concerns identified during the evaluation?”

And if you are seeking ABA or another insurance-funded service: “Does your diagnostic report generally include the documentation required by my child’s insurance plan?” That last question can be especially valuable because requirements are not identical across payers.

When you receive the report: a parent-friendly checklist

Before filing the report away, take a few minutes to review it. Look for:

• A clear statement of the diagnostic conclusion
• An explanation of how your child meets, or does not meet, DSM autism criteria
• DSM severity/support levels, when required
• The standardized diagnostic assessment tool or tools used
• Information about your child’s developmental and behavioral history
• Discussion of relevant developmental, medical, behavioral, or mental health concerns
• Recommendations and next steps
• The evaluator’s name and professional credentials

If something is missing or unclear, it does not necessarily mean the evaluation was performed incorrectly. Requirements differ, and clinicians may organize reports differently. Instead, contact the evaluator and ask whether the information is documented elsewhere or whether the report needs clarification.

The most important thing to remember

An autism diagnosis is a clinical conclusion based on multiple sources of information, not the result of a single test.

The CDC specifically notes that no single assessment tool should be used as the basis for diagnosis. The AAP likewise describes diagnosis as involving clinical evaluation, history, observation, and standardized approaches.

So when you are scheduling an evaluation, it can be helpful to ask whether you are receiving a comprehensive diagnostic evaluation with a written report, rather than asking only whether a particular test, such as the ADOS, will be administered.

Knowing what to expect ahead of time can make the process less confusing and help you leave the evaluation with documentation that clearly explains your child’s diagnosis, strengths, needs, and possible next steps.

Not sure whether your child’s report has what it needs?

Our care team can help you understand what information is typically needed to begin the ABA process and what your next steps may look like.

Check your coverage →

Forta provides Online ABA therapy in 43 states, and In-Home ABA therapy in select cities including Houston, TX.

Sources

1. Centers for Disease Control and Prevention, “Clinical Testing and Diagnosis for Autism Spectrum Disorder.” Last reviewed 8 May 2025. Link
2. Centers for Disease Control and Prevention, “Clinical Screening for Autism Spectrum Disorder.” Last reviewed 15 April 2025. Link
3. Hyman SL, Levy SE, Myers SM; AAP Council on Children with Disabilities. “Identification, Evaluation, and Management of Children With Autism Spectrum Disorder.” Pediatrics, 2020;145(1):e20193447. Link
4. Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, §2.3 Autism Services, August 2026 edition. Link

About this article

Written by Kimberly Sadovich, MA, BCBA, Senior Clinical Director · Clinically reviewed by Janelle Deveau, MA, BCBA, LBA · 2026-08-13

What this is. General educational information written by a BCBA and reviewed by a second BCBA. It is not medical or clinical advice about your child. Autism evaluations and insurance requirements vary by child, provider, payer, and state. Families should speak with their child’s diagnosing clinician and insurance plan about requirements that apply to their individual situation.