An autism assessment report, or ASD diagnostic report, sets out what the team found: the history, the tools used, how the child meets each DSM-5-TR criterion, the support levels, and what happens next. Copy the free template, see a 3-year-old with limited speech and a 9-year-old girl who masked at school, and check what each part needs.
Blank autism assessment report template
FreeAUTISM ASSESSMENT REPORT Confidential Child: [Name, date of birth, age at assessment, pronouns] Dates of assessment: [Each date, setting, and total hours] Date of report: [Date] Assessment team: [Each clinician's name, discipline, and credentials] Referred by: [Referrer, and date of referral] Parents or caregivers: [Names, relationship, language used, interpreter if any] REASON FOR REFERRAL Concerns: [What the family, school, or referrer noticed, in their own words] Questions to answer: [Does the child meet criteria for autism; what support does the child need] Screening before referral: [Tool, age, and result, such as the M-CHAT-R/F total and likelihood band; or none] SOURCES OF INFORMATION Parent interview: [Who took part, the date, and the interview used, such as the ADI-R or a developmental history interview] School or childcare: [Teacher questionnaires, rating scales, or a visit, with dates] Direct observation: [Structured observation, play or conversation in clinic, home or school visit] Records reviewed: [Earlier screens, hearing and vision results, speech, school, or medical reports] DEVELOPMENTAL HISTORY Pregnancy and birth: [Gestation, complications, newborn course] Early development: [Motor milestones, first words and phrases, pointing, response to name, pretend play] Loss of skills: [Words or social skills lost, the age, and what happened since; or none] Health: [Hearing, vision, sleep, eating, seizures, medications, genetic testing] Family history: [Autism, language delay, ADHD, anxiety, intellectual disability, or other conditions in relatives] Family and culture: [Household, languages spoken, childcare or school, what matters to the family] Strengths and interests: [What the child enjoys, does well, and finds calming] ASSESSMENT TOOLS AND RESULTS Autism observation: [ADOS-2 module, classification, and comparison score; or the tool used] Parent interview results: [ADI-R domains against the cutoffs; or a summary of the interview] Rating scales: [Each scale, who completed it, the score, and its range] Cognitive testing: [Test, composite or index scores, descriptive ranges; or not done, and why] Language: [Test and scores, and the child's current level of spoken language] Adaptive skills: [Test such as the Vineland-3, composite and domain scores] Validity: [Engagement, breaks, language of testing, and anything that limits the results] BEHAVIOR OBSERVED Social communication: [Eye contact, gestures, shared attention, back-and-forth, response to name and to bids] Play, behavior, and senses: [Play style, repetitive behavior, sensory responses, transitions] Other settings: [What was seen at school, childcare, or home] DSM-5-TR CRITERIA A1 Social-emotional reciprocity: [Examples, now or by history, and the source] A2 Nonverbal communication: [Examples and source] A3 Relationships: [Examples and source] B1 Repetitive movements, use of objects, or speech: [Examples, or not present] B2 Sameness, routines, and rituals: [Examples, or not present] B3 Intense or restricted interests: [Examples, or not present] B4 Sensory reactivity: [Examples, or not present] C Early onset: [Evidence the features were present in early childhood, and any masking] D Impact: [How the features affect daily life at home, school, and with peers] E Not better explained: [Why intellectual disability or global developmental delay does not account for the picture] DIAGNOSIS Diagnosis: [Autism spectrum disorder, with the code where you use codes; or criteria not met] Support level, social communication: [Level 1, 2, or 3, and the reason] Support level, restricted and repetitive behaviors: [Level 1, 2, or 3, and the reason] Specifiers: [With or without intellectual impairment; with or without language impairment, and current language level; any associated genetic or medical condition, or neurodevelopmental, mental, or behavioral problem; catatonia if present] DIFFERENTIAL AND CO-OCCURRING CONDITIONS Considered and ruled out: [Each condition, such as hearing loss, language disorder, global delay, social anxiety, or ADHD, and why it fits less well] Co-occurring conditions: [Anxiety, ADHD, sleep, eating, or medical conditions, and how each was assessed] FEEDBACK Feedback session: [Date, who attended, and how the diagnosis was explained] Family's questions: [What the family asked, and the answers given] Child's feedback: [What the child was told, in words that fit their age; or not appropriate yet] RECOMMENDATIONS Speech and language: [Service, focus, and frequency] Occupational therapy: [Sensory, motor, eating, or daily living goals] Developmental and behavioral supports: [Approach, setting, and parent coaching] School or childcare: [Accommodations and support plan, shared with consent] Family support: [Parent education, support groups, respite, funding or services programs] Medical follow-up: [Genetic testing, hearing, sleep, or other referrals] Review: [When to reassess, and what would prompt an earlier review] Report shared with: [Each recipient, with consent for each] Signed: [Each clinician's name, credentials, registration or license number, date]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Child development clinic, team assessment over two visits: developmental pediatrician, psychologist, and speech-language pathologist
Minh, 3 years 2 months, referred by his pediatrician at 30 months after an M-CHAT-R/F total of 9, high likelihood, and his parents’ concern about speech. Questions: does Minh meet criteria for autism, and what support does he need? Sources: ADI-R with both parents, in English, on Oct 14; daycare teacher questionnaire and a 1-hour daycare visit on Oct 20; ADOS-2 and play-based observation in clinic on Oct 21; records from his pediatrician, and a hearing test at 34 months.
Born at 39 weeks after an uncomplicated pregnancy. Sat at 6 months, walked at 13 months. First words at 18 months; now about 15 words in Vietnamese and English, mostly to ask for food or favorite things; no two-word phrases. Has never pointed to show something or waved. No loss of words or skills. Hearing normal in both ears at 34 months. Takes about 90 minutes to fall asleep most nights. Eats about 9 foods, mostly crunchy; growth along his curves. No seizures or medications. A paternal uncle did not talk until age 4; no known autism in the family. Lives with his parents and 5-year-old sister; at daycare full time since 18 months. Strengths: finishes puzzles well above his age, knows the route to his grandmother’s house, laughs and seeks out chase and tickle games with his father, loves wheels, fans, and water play.
ADOS-2, Module 1, Some Words algorithm: classification Autism; comparison score 8, a high level of autism-related features. ADI-R: met the cutoffs for social interaction, communication, and restricted and repetitive behavior, with differences noted before age 3. Mullen Scales of Early Learning: visual reception and fine motor in the average range; receptive and expressive language very low, at about a 14-month level. PLS-5: Auditory Comprehension 62, Expressive Communication 59. Vineland-3 with his mother: Adaptive Behavior Composite 71; Communication 62, Daily Living Skills 79, Socialization 68. Validity: engaged for about 40 minutes with breaks and his father in the room; results match home and daycare reports.
Went straight to a toy car and spun its wheels close to his eyes for long stretches. Did not look up when his name was called four times; turned on the fifth with a touch on his shoulder. Brief eye contact, not paired with sounds or gestures. Did not follow a point to a toy across the room. To get the bubbles, pulled the examiner’s hand to the jar without looking at her face. Smiled at his father during a tickle game and asked for “more” with a word and a reach, his clearest moment of shared enjoyment. No pretend play with the doll or tea set. Flapped his hands as balls ran down the ramp. Covered his ears at the hand dryer in the hallway. At daycare: played alone at the water table, did not join circle time, and cried and dropped to the floor when the class went outside.
A1: rarely shares enjoyment or brings things to show; does not respond when other children approach; back-and-forth only in physical games with his father. A2: brief eye contact not combined with gestures; no pointing, showing, or waving; does not follow a point. A3: plays beside, not with, other children at daycare; no pretend play; little interest in his sister’s games. B1: lines up cars and spins wheels; flaps his hands when excited; repeats a line from a cartoon. B2: screams if the route to daycare changes; closes the doors at home in the same order each night. B3: wheels and fans, with an intensity well beyond other play. B4: covers his ears at the vacuum and hand dryer; sniffs toys; watches spinning objects from the corner of his eye. C: present since at least 18 months by his parents’ account, and flagged by the screen at 30 months. D: limits how he communicates at home, and he needs an adult beside him to take part in group activities at daycare. E: social communication is well below his nonverbal problem solving, which is average for his age.
Autism spectrum disorder, F84.0. Social communication: level 2, requiring substantial support; marked differences in spoken and nonverbal communication that show even with an adult’s help, and he rarely starts an interaction. Restricted and repetitive behaviors: level 2, requiring substantial support; repetitive play and distress at change are seen in every setting and are hard to redirect. Specifiers: with accompanying language impairment, single words and no phrase speech, with understanding well below his age; without accompanying intellectual impairment, based on average nonverbal skills, to be retested before school entry; no known associated genetic or medical condition, with genetic testing pending.
Considered: hearing loss, ruled out by normal testing at 34 months; language disorder alone, which would not explain his absent gestures, limited shared attention, and repetitive play; global developmental delay, not supported with nonverbal skills in the average range; learning two languages, which does not cause delay, and his language is equally delayed in both. Co-occurring: selective eating, 9 accepted foods with normal growth; about 90 minutes to fall asleep.
Feedback with both parents on Oct 28, in person, with the developmental pediatrician and psychologist. Began with what the team enjoyed about Minh: his puzzles, his memory for routes, and his laugh in chase games. Explained autism as a different way of developing communication, play, and senses, and that the support levels describe what he needs now, not his future. His mother asked whether he will talk: explained that many autistic children gain words with support, that no one can predict it at 3, and that pictures or a speech device help speech rather than replace it. His father asked whether speaking two languages caused it: it did not, and they should keep using both. Written summary and local family resources given.
Speech and language: weekly speech-language therapy through early intervention, with parent coaching on waiting, modeling words, and turn-taking; a trial of picture exchange or a speech-generating device alongside speech. Occupational therapy: eating assessment, and sensory strategies for noise and transitions. Developmental and behavioral supports: an early intervention program using a naturalistic developmental behavioral approach, with weekly parent coaching. Childcare: with consent, report shared with his daycare; a visual schedule, warnings before transitions, a quiet corner, and an adult to support group time; referral to the local school system for preschool support planning. Family: a parent program for newly diagnosed families, a local autism family organization, respite, and the autism funding or services programs where they live. Medical: chromosomal microarray and fragile X testing through his pediatrician, with his parents’ consent; sleep plan to review with his pediatrician. Review: language, cognition, and support needs before school entry at about age 5, or sooner if he loses words or skills.
Child psychology practice, three sessions and a school visit
Sofia, 9 years 4 months, in fourth grade, referred by her family physician after her parents raised meltdowns after school, constant worry, and trouble keeping friends. Her school reported no concerns. Questions: is Sofia autistic, does anxiety explain her difficulties, and what support does she need at school and at home? Sources: ADI-R with her mother on Sept 29; two interviews with Sofia; parent and teacher rating scales; a classroom and recess visit on Oct 6; ADOS-2 and cognitive testing on Oct 8 and 15; report cards from first to third grade.
Born at term; no concerns in infancy. Walked at 12 months; spoke in sentences by age 2, with an adult-like vocabulary early. As a toddler, lined up her plush animals by size and was distressed if they were moved; preferred adults to other children; hid under the table at birthday parties. No loss of skills. Vision and hearing normal on school screening. Takes about an hour to fall asleep on school nights. No medications. Her father describes himself as “very routine-bound” and was never assessed; a maternal aunt has an anxiety disorder. Lives with her parents and 6-year-old brother. Strengths: reads two years above grade level, knows horse breeds and their care in remarkable depth, draws detailed horses, is gentle with younger children, and is very honest.
ADOS-2, Module 3: classification Autism Spectrum; comparison score 5, a low level of autism-related features, read alongside her history because she worked hard to manage the session. ADI-R: met the cutoffs for social interaction and for restricted and repetitive behavior, just below the cutoff for communication; differences noted before age 3. SRS-2: parent T-score 76, severe range; teacher T-score 57, within normal limits. WISC-V: Full Scale IQ 112, high average; Verbal Comprehension 121, very high; Processing Speed 88, low average. SCARED: child report 36 and parent report 41, both above 25, the cutoff that suggests an anxiety disorder. Validity: cooperative, asked often whether her answers were right, rested in a quiet room between tasks; results judged valid.
Greeted me with a rehearsed-sounding “Nice to meet you, how are you today?” and steady eye contact that she later said she “makes herself do.” Conversation flowed when it was about horses; on other topics she answered but rarely asked anything back. Told a picture story through its details and missed what the characters felt. Took “break a leg” literally and asked why anyone would say it. At school: quiet and on task in class; at recess walked the edge of the field alone, then copied a classmate’s game from a distance; ate lunch in the library. Her teacher described a capable, well-behaved student and was surprised by the referral.
A1: conversations follow her interests, with few questions back; opening lines scripted from watching classmates. A2: eye contact effortful and timed; flat expression when others are excited; misses tone and sarcasm. A3: wants friends, but each friendship has ended after arguments over the rules of play; unsure why classmates laugh; prefers adults and younger children. B1: flaps her hands and paces when excited at home; holds her hands still under her desk at school. B2: same lunch every day; meltdowns when plans change without warning. B3: horses, in depth far beyond her peers, the center of her play, reading, and drawing. B4: cuts the tags from her clothes, covers her ears in the gym and cafeteria, avoids sticky textures. C: early differences by her mother’s account and the ADI-R; at school, hidden by copying peers and rehearsing what to say, which explains the teacher’s ratings. D: meltdowns of up to 45 minutes after school 3 or 4 days a week, Sunday-night stomachaches with pleas to stay home, and no close friend this year. E: high average cognitive skills.
Autism spectrum disorder, F84.0, associated with generalized anxiety disorder. Social communication: level 1, requiring support; without support she struggles to start and keep up conversations and friendships, and copes at school only through effortful copying. Restricted and repetitive behaviors: level 1, requiring support; inflexibility about plans causes daily distress at home and some trouble switching tasks at school. Specifiers: without accompanying intellectual impairment; without accompanying language impairment. Generalized anxiety disorder, F41.1: excessive, hard-to-control worry most days for over a year about school, changes in plans, and her family’s health, with poor sleep and stomachaches.
Considered: social anxiety disorder alone, which would not explain her lifelong differences in conversation, nonverbal communication, and play, or her repetitive behaviors and sensory responses, all present with family as well as peers; ADHD, not supported, with steady attention across testing and teacher ratings in the normal range; obsessive-compulsive disorder, not supported, as her routines bring comfort rather than relieve unwanted thoughts. Co-occurring: generalized anxiety disorder, as above; delayed sleep onset on school nights.
Feedback with both parents on Oct 22, then with Sofia and her mother. Shared her strengths first: her reading, her knowledge of horses, and her kindness. Explained masking, copying others and holding back her own reactions to fit in, and that it uses up energy, which is why she comes home exhausted. Her parents asked whether the school would accept the diagnosis given the teacher’s ratings: explained how masking keeps differences out of sight, and offered to meet the school team. With Sofia: explained autism as a brain that notices details deeply, feels sounds and textures strongly, and finds unwritten social rules harder to read. She asked whether she has to tell her friends: that is her choice. She said, “That explains a lot.”
School: with her parents’ consent, report shared with the school team and a planning meeting booked; a quiet place for lunch and recess when she chooses, advance notice of schedule changes, a named adult for a daily check-in, written instructions, assigned roles in group work, noise-reducing headphones for assemblies and gym, and a break pass. Explain masking to her teachers, and do not require eye contact. Anxiety: weekly CBT adapted for autistic children, with a parent in part of each session, for 12 to 16 sessions; repeat the SCARED at 3 months. Peers: a group for autistic girls her age, or a riding program built on her interest. Family: 30 to 45 minutes of quiet time after school before homework; a visual weekly calendar; parent education on autism and anxiety, including resources written by autistic adults. Medical: family physician to review sleep, and a medication review if anxiety has not improved after 12 weeks of therapy. Review: in 12 months, or before her move to middle school.
Why the child was referred, the questions the assessment answers, and every source of information, so a reader can see the diagnosis rests on more than one view.
Avoid: Relying on one setting. Gather information from home and from school or childcare, and note where the accounts differ.
The story of the child’s development, from birth to now, that shows the features began early and what else could explain them.
Avoid: Leaving out strengths. They shape the recommendations and how the family hears the rest of the report.
Each tool by name and edition, with its result category or score. The tools inform the diagnosis; they don’t make it.
Avoid: Copying test items, protocols, or norms into the report. Name each tool and edition, and give the result.
How the child meets each criterion, with real examples. A diagnosis needs all three social communication criteria, A1 to A3, and at least two of the four restricted and repetitive behavior criteria, B1 to B4, now or by history, plus C, D, and E.
Avoid: Ticking criteria with no examples. Say what the child does, and whether it comes from history, a report, or your own observation.
The diagnosis in full: a support level for each of the two domains, and every specifier that applies.
Avoid: One support level for the whole child. Rate each domain on its own, and note that levels describe the support needed now and can change.
What else could explain the picture and why it fits less well, and what else is present alongside autism.
Avoid: Stopping at autism. Anxiety, ADHD, sleep, and eating problems often come with it, and each needs its own plan.
How the family and child heard the result, and a plan they can act on, area by area.
Avoid: “Speech therapy recommended.” Name the service, the focus, how often, and who sends the referral.
The ADOS-2 is one structured observation on one day. The diagnosis rests on the DSM-5-TR criteria across history, informants, and observation, and a low comparison score in a child who masks doesn’t rule autism out.
Some children, often girls and children with strong language, hide their differences at school by copying peers and rehearsing what to say, then fall apart at home. Ask about exhaustion and meltdowns after school, and observe at recess, not only in class.
Levels describe how much support a child needs in each domain now. They are not a measure of intelligence, they can differ between the two domains, and they can change.
A report that lists only what a child can’t do is hard for a family to read and hard to plan from. Name strengths and interests, describe behavior plainly, and use the words the family prefers, such as “autistic” or “has autism.”
Every child with a language delay needs a formal hearing test before the diagnosis. Offer genetic testing as local guidance recommends, and ask about sleep, eating, and seizures.
Vero Scribe drafts the autism assessment report in your template from the parent interview and feedback session, with the family’s consent, or from your dictation. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
The reason for referral and the questions to answer; every source of information; the developmental history; each tool with its result; how the child meets each DSM-5-TR criterion, with examples; the diagnosis, with a support level for each domain and the specifiers; other conditions considered and any co-occurring ones; the feedback to the family; and recommendations with a review date.
A screen, such as the M-CHAT-R/F, is a short parent checklist that flags which toddlers need a closer look. A diagnostic assessment brings together the history, a structured observation such as the ADOS-2, information from home and school, and clinical judgment against the DSM-5-TR criteria, and ends in this report.
The DSM-5-TR asks for one level for social communication and one for restricted and repetitive behaviors: level 1, requiring support; level 2, requiring substantial support; level 3, requiring very substantial support. They describe the support a child needs now in each domain, can differ between the two, and can change over time.
Ask about the gap between school and home: exhaustion and meltdowns after school, scripted conversation, copying peers, and stimming held back in class. Compare parent and teacher ratings, observe during unstructured time such as recess, and read a low ADOS-2 score alongside the history. Record the masking under criterion C, which allows for features hidden by learned strategies.
Yes. Copy it, or download it as a Word or text file. No account needed.
The sick-visit SOAP note for children, with caregiver history, hydration, and weight-based doses.
Growth, development, screening, vaccines, and safety guidance, with 12-month and 5-year examples.
Milestones by domain, ASQ-3 and M-CHAT-R/F results, corrected age, and the refer-or-rescreen decision.
Well-baby visits from birth to 5, organized like the Rourke Baby Record, with a BC 2-month and an Ontario 18-month example.
The preventive visit from 6 to 17, organized like the Greig Health Record, with an Ontario and a BC example.
Assessments, well visits, and family letters, drafted for your review.
How to score the toddler screen that often leads to this assessment.
The child and parent anxiety screen used for co-occurring anxiety.
The codes used most often in pediatrics.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
No credit card required. 10 free actions every month.