ADI-R Assessment Form

Autism Diagnostic Interview - Revised (Complete Version)

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Section I: Background & Introductory Questions

Basic information about the subject and family

Psychologist Information

Child Information

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years months

Age will be automatically calculated from Date of Birth and Interview Date, or enter manually

Parent Information

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Informant Information

Family Members / Family History

Interview Questions: "To begin, perhaps you could give me an idea of who's who in [subject]'s family. Does s/he have any brothers or sisters? Could you tell me their names and ages? Do all of them have the same birth parents? Have any of the brothers or sisters been delayed in their development? Did either of [subject]'s parents have any developmental difficulties (or late walking or talking)?"
Name DOB/Age Sex Relationship Same Bio Parents? Developmental Difficulties

Subject's Education History

Interview Questions: "Now I'd like to ask about what sort of programs, playgroups, and schools [subject] has attended. Was this a regular playgroup or school? How long did s/he attend? Did s/he need any special help/remedial help?"
School/Program Name Type Dates Attended Special Help Needed

Introductory Questions

Interview Questions: "Can you tell me a little about [subject]? How would you describe [subject]'s behavior to me if I had to pick her/him out in a group of other children/young people the same age? What kinds of things does s/he do when left to her/his own devices? When is s/he at her/his best?"
Q1
Interview Questions: "Do you have any concerns about [subject]'s behavior or development now? What are they?"

Note: No coding needed - record details for clinical reference

Section II: Early Development

Developmental milestones and early concerns (Q2-Q8)

Q2
Interview Questions: "How old was [subject] when you first wondered if there might be something not quite right with her/his development?"

Enter age in months, OR use special codes:
991 = Parents not concerned (child referred by professional)
992 = Worried since birth
996 = Can't recall, but before 3 years
997 = Can't recall, but 3 years or later
998 = N/A
999 = N/K or not asked

Q3
Interview Questions: "What was it that gave you concern at that time?"

Note: No coding needed - record details

Q4
Interview Questions: "Looking back with hindsight, when do you think s/he first showed any problems or difficulties in development or behavior? Do you think that everything was alright before then?"
Q5
Interview Questions: "At what age did [subject] walk without holding on?"

Enter age in months, OR use special codes:
995 = Still not reached
996 = N/K (not known), but apparently normal
997 = N/K, but apparently delayed
998 = N/A
999 = N/K or not asked

Q6
Interview Questions: "Is [subject] dry during the day? How old was s/he when this was first achieved? When was s/he first dry for 12 months without accidents?"

Enter age in months when milestone reached (dry for 12 months), OR use special codes:
993 = Trained for 12 months, then relapsed
994 = Never achieved continence
995 = Still not reached
998 = N/A
999 = N/K or not asked

Q7
Interview Questions: "Is [subject] dry at night? How old was s/he when s/he first remained dry at night? When was s/he first dry for 12 months without an accident?"

Enter age in months when milestone reached, OR use special codes:
993 = Trained for 12 months, then relapsed
994 = Never achieved continence
995 = Still not reached
998 = N/A
999 = N/K or not asked

Q8
Interview Questions: "Does [subject] soil himself/herself at all? How old was s/he when s/he first got full control of her/his bowels?"

Enter age in months when milestone reached, OR use special codes:
993 = Achieved control, then relapsed
994 = Never achieved continence
995 = Still not reached
998 = N/A
999 = N/K or not asked

Section III: Acquisition & Loss of Language - Part 1

Language milestones (Q9-Q12)

Q9
Interview Questions: "How old was s/he when s/he first used words meaningfully, apart from 'mama' and 'dada'? What were her/his first words? How did s/he show that s/he knew their meaning?"

Enter age in months, OR use special codes:
993 = Had words, then lost
994 = Milestone not reached
996 = N/K, but apparently normal
997 = N/K, but apparently delayed
999 = N/K or not asked

Q10
Interview Questions: "How old was s/he when s/he first said something that involved putting words together meaningfully (i.e., using two- or three-word phrases)? What did s/he say?"

Enter age in months, OR use special codes:
993 = Had phrases, then lost
994 = Milestone not reached
996 = N/K, but apparently normal
997 = N/K, but apparently delayed
999 = N/K or not asked

Q11
Interview Questions: "Were you ever concerned that [subject] might have lost language skills during the first years of her/his life? Was there ever a time that s/he stopped speaking for some months after having learned to talk?"
Q12
Interview Questions: "How much language did [subject] have before losing it? What was s/he able to say before the change occurred?"

Only complete if Q11 = Yes (language loss occurred)

Section III: Acquisition & Loss of Language - Part 2

Type and extent of language skills lost (Q13-Q19)

Note: Complete Q13-Q19 only if language loss occurred (Q11 = Yes)
Interview Questions for Q13-Q16: "What aspects of language did [subject] lose? Did s/he stop using meaningful words spontaneously? What about use of grammar? Was her/his pronunciation of words affected?"
Q13
Q14
Q15
Q16
Q17
Interview Questions: "How old was [subject] when s/he first began to lose her/his language?"

Enter age in months. Use 998 for N/A, 999 for N/K or not asked.

Q18
Interview Questions: "Was the loss of language associated with any illness or medical event?"
Q19
Interview Questions: "How long was it before language began to come back? How long was it before s/he reached the level s/he had been at before the loss took place?"

Enter duration in months. Use 995 if language has not returned. Use 998 for N/A, 999 for N/K or not asked.

Section III: Loss of Other Skills

Assessment of skill regression (Q20-Q28)

Q20
Interview Questions: "Has there ever been a period when [subject] seemed to get markedly worse or dropped further behind in her/his development? When was this? What skills did [subject] lose?"
Note: Complete Q21-Q28 only if general skill loss occurred (Q20 = 1 or 2)
Interview Questions for Q21-Q25: "What skills did [subject] lose? Did it affect her/his ability to look after her/himself? Did it affect her/his play? What about coordination?"
Q21
Q22
Q23
Q24
Q25
Q26
Interview Questions: "How old was [subject] when s/he first began to lose these skills?"

Enter age in months. Use 998 for N/A, 999 for N/K or not asked.

Q27
Interview Questions: "Was the loss of skills associated with any illness or medical event?"
Q28
Interview Questions: "How long was it before these skills began to come back?"

Enter duration in months. Use 995 if skills have not returned. Use 8 for no loss, 999 for N/K or not asked.

Section IV: Language & Communication - Part 1

Language comprehension and usage (Q29-Q33)

Q29
Interview Questions: "How much language do you think [subject] understands if you don't gesture? What about when s/he can't tell from the situation what is going to happen? For example, can you send her/him into another room to get something like her/his shoes or blanket? Could you ask her/him to put them somewhere, other than the usual place? Could s/he deliver a simple message? Could s/he follow an instruction with an 'if' and a 'then'? Does s/he understand if you say 'no' without gesturing? How about 'yes' or 'okay'?"

Current

Age 4-5 (or Ever)

Q30
Interview Questions: "How much speech does [subject] have now? Does s/he have phrases with at least three words that s/he uses every day? Do they ever include verbs? Do other people understand?"

This question determines which subsequent language items to code

Q31
Interview Questions: "Did s/he ever show you what s/he wanted by taking your hand or wrist or some other part of your body? Did s/he ever use your hand as if it were a tool or an extension of her/his own arm (such as pointing with your hand or getting your hand to turn a door knob)? Did s/he look at you when doing this?"

Current

Age 4-5 (or Ever)

Q32
Interview Questions: "What is her/his pronunciation like? Are there any words or sounds s/he doesn't get quite right? Do other people understand her/him easily? What about people outside the family?"

Current

Age 4-5 (or Ever)

Q33
Interview Questions: "Has s/he ever tended to use rather odd phrases or say the same thing over and over in almost exactly the same way? That is, either phrases s/he has heard other people use or ones s/he has made up (e.g., 'It's bad to bite your wrist'; 'Does this look like a traffic light?')? Does s/he ever give a running commentary on what s/he is doing?"

Current

Ever

Section IV: Language & Communication - Part 2

Social communication and conversational abilities (Q34-Q41)

Q34
Interview Questions: "Would [subject] ever talk with you just to participate in some form of language interchange? Sort of 'small talk'—such as saying 'It never stops raining' or 'The telephone is ringing again!'?"

Current

Age 4-5

Q35
Interview Questions: "Can you have a conversation with [subject]? That is, if you say something to her/him, without asking a direct question, what will [subject] usually do? Will s/he ever ask you a question or build on what you have said... so that the conversation will continue?"

Current

Age 4-5

Q36
Interview Questions: "Are there times when [subject] uses socially inappropriate questions or statements? For example, does s/he regularly ask personal questions or make personal comments at awkward times?"

Current

Ever

Q37
Interview Questions: "Has [subject] ever got her/his personal pronouns the wrong way round? For example, has [subject] ever mixed up 'you' and 'I'?"

Current

Ever

Q38
Interview Questions: "Does s/he ever use words that s/he seems to have invented or made up? Does [subject] ever put things in odd, indirect ways, or have idiosyncratic ways of saying things?"

Current

Ever

Q39
Interview Questions: "Does s/he ever say the same thing over and over in exactly the same way or insist on you saying the same things over and over again? What happens if you interrupt her/him or refuse to comply?"

Current

Ever

Q40
Interview Questions: "Is there anything unusual about the way [subject] speaks? Too loud or too quiet? What about the rate and rhythm? Intonation or pitch?"

Current

Ever

Q41
Interview Questions: "How does [subject] now use the words s/he has? Does s/he ever tell you about things that are not present?"

Current

Age 4-5

Section IV: Non-Verbal Communication & Play

Gestures, pointing, and imaginative play (Q42-Q49)

Q42
Interview Questions: "Does [subject] ever spontaneously point at things around her/him? With a finger or sort of a hand extended, like reaching? Does s/he ever point at things at a distance, such as out a window at home or in a car or bus?"

Current

Age 4-5

Q43
Interview Questions: "Does [subject] nod her/his head to mean 'yes'?"

Current

Age 4-5

Q44
Interview Questions: "Does [subject] shake her/his head to mean 'no'?"

Current

Age 4-5

Q45
Interview Questions: "Does [subject] wave good-bye? Does s/he ever use other common gestures, such as blowing a kiss...? Does s/he use gestures... to let you know what s/he wants?"

Current

Age 4-5

Q46
Interview Questions: "If you come into a room and start talking to [subject] without calling her/his name, what does s/he do? Does s/he look up and pay attention to you?"

Current

Age 4-5

Q47
Interview Questions: "Does [subject] imitate you or other people in the family? How about when you are not trying to get her/him to do so?"

Current

Age 4-5

Q48
Interview Questions: "Does [subject] play any pretend games? Dolls/action figures? Has s/he ever used the doll/action figure as the initiator?"

Current

Age 4-5

Q49
Interview Questions: "Does [subject] ever play imaginative games with someone else? Do they seem to understand what each other is pretending?"

Current

Age 4-5

Section V: Social Development - Part 1

Eye gaze, smiling, and sharing behaviors (Q50-Q56)

Q50
Interview Questions: "Does [subject] look you directly in the face when doing things with you or talking with you? Can you catch her/his eye? Does s/he sometimes watch you as you walk into the room?"

Current

Age 4-5

Q51
Interview Questions: "When [subject] is approaching someone... does [subject] smile in greeting? What does s/he do if someone else smiles at her/him?"

Current

Age 4-5

Q52
Interview Questions: "Does s/he ever show you things that interest her/him? Would s/he bring a new toy for you to see...?"

Current

Age 4-5

Q53
Interview Questions: "Does [subject] ever offer to share things, that is, food or toys or favorite objects, with you?"

Current

Age 4-5

Q54
Interview Questions: "Does [subject] ever seem to want you to share in her/his enjoyment of something? Will s/he let you know about her/his excitement by smiling or talking?"

Current

Age 4-5

Q55
Interview Questions: "Does [subject] ever try to comfort you if you are sad, hurt, or ill? Would her/his facial expression change as s/he does this?"

Current

Age 4-5

Q56
Interview Questions: "When s/he wants something or wants help, how does s/he try to get your attention? Does s/he look at the object or you?"

Current

Age 4-5

Q57
Interview Questions: "Does [subject] show a normal range of facial expression? Frown, pout, look embarrassed, guilty, surprised?"

Current

Age 4-5

Q58
Interview Questions: "Does [subject]'s facial expression usually seem appropriate to the particular situation? Does s/he ever laugh or smile in situations that do not seem funny to most people?"

Current

Age 4-5

Section V: Social Development - Part 2

Social responses, play, peer relationships, and friendships (Q59-Q66)

Q59
Focus: The focus of this item is on how the subject responds when adults other than parents attempt to interact with her/him in everyday, but nonroutine situations.
Interview Questions: "Now can we turn to how [subject] responds to what other people say or do? Does s/he consistently respond to the approaches of others in familiar situations? How does s/he respond if a friend of yours whom s/he doesn't know well approaches and speaks to her/him? What about someone s/he really likes? How does s/he respond if someone unfamiliar (such as at church or in a shop) appropriately talks to her/him or tries to attract her/his attention? Does s/he look directly at her/him? Does s/he smile or show pleasure? Would s/he show other reactions, such as interest or tentativeness? (GET EXAMPLES. PROBE TO DETERMINE CONSISTENCY AND CIRCUMSTANCES. IF THE CHILD SOUNDS SHY, SEEK FURTHER EXAMPLES OF PEOPLE WHO ARE MORE FAMILIAR.)"

Current

Most Abnormal (Age 4.0-5.0)

Q60
Interview Questions: "How good is [subject] at organizing her/his own play or activities without your help?"

Current

Age 4-5

Q61
Interview Questions: "As a young child, did [subject] enter into the spirit of social games such as 'Here We Go Round the Mulberry Bush'? What about teasing games such as 'I'm going to get you!'?"

Current

Age 4-5

Q62
Interview Questions: "What does [subject] think about other children of approximately the same age whom s/he does not know? Is s/he interested in them?"

Current

Age 4-5

Q63
Interview Questions: "What about if another child approaches her/him? Does s/he ever actively avoid other children?"

Current

Age 4-5

Q64
Interview Questions: "How does [subject] play with others of her/his age when there are more than two together? Does [subject] play cooperatively in games that need some form of joining in...?"

Current

Age 4-5

Q65
Interview Questions: "Does s/he have any particular friends or a best friend? In what way does s/he show that they are her/his friends? Does s/he ever go out with them? Do they share interests?"

Current

Age 4-5

Q66
Interview Questions: "Does [subject] vary in her/his behavior according to whom s/he is with or where s/he is? Is s/he ever cheeky or rude, or even inappropriately friendly to strangers? Does s/he seem aware of social cues?"

Current

Age 4-5

Section VI: Interests and Behaviors - Part 1

Preoccupations, repetitive behaviors, and sensory issues (Q67-Q76)

Q67
Interview Questions: "Does [subject] have any unusual or peculiar interests—I mean ones that preoccupy her/him even when the focus of interest is not physically present and might seem odd to other people? Does this interfere with her/his other activities or with family life?"

Current

Ever

Q68
Interview Questions: "Does [subject] have any special hobbies/interests that are unusual in their intensity? Does it interfere with her/his doing things?"

Current

Ever

Q69
Interview Questions: "Will s/he play with the whole toy or does s/he seem to be more interested in a certain part of the toy (e.g., spinning the wheels of a car)? Does s/he ever line things up or do the same thing over and over with them?"

Current

Ever

Q70
Interview Questions: "Are there things that [subject] seems to have to do in a very particular way or order? What happens if you interrupt her/him or refuse to comply?"

Current

Ever

Q71
Interview Questions: "Does s/he seem particularly interested in the sight, feel, sound, taste, or smell of things or people?"

Current

Ever

Q72
Interview Questions: "Has s/he ever seemed oversensitive to noise? Has s/he ever deliberately and regularly put her/his hands over her/his ears in response to ordinary sounds?"

Current

Ever

Q73
Interview Questions: "Does [subject] ever get unusually upset or irritated by particular sounds such as people coughing or a baby crying? Does [subject] ever react in an unusual, but predictable, way to other sensations?"

Current

Ever

Q74
Interview Questions: "Is [subject] bothered by minor changes in her/his routine? Or in the way her/his personal things are arranged?"

Current

Ever

Q75
Interview Questions: "How does [subject] react to changes about the house, or to changes in small details of her/his environment (e.g., changes in someone else's daily routine, how furniture is arranged)?"

Current

Ever

Q76
Interview Questions: "Does [subject] have anything to which s/he is particularly attached... like a piece of pipe or a stone?"

Current

Ever

Section VI: Interests and Behaviors - Part 2

Mannerisms and motor behaviors (Q77-Q79)

Q77
Interview Questions: "Does [subject] have any mannerisms or odd ways of moving her/his hands or fingers? Such as twisting or flicking her/his fingers in front of her/his eyes?"

Current

Ever

Q78
Interview Questions: "Does [subject] have any complicated movements of her/his whole body, such as spinning or repeatedly bouncing up and down?"

Current

Ever

Q79
Interview Questions: "Does s/he have any particular ways of moving her/his hands in front of her/his body—for example, hand wringing?"

Current

Ever

Section VII: General Behaviors

Gait, aggression, self-injury, and developmental onset (Q80-Q87)

Q80
Interview Questions: "Is there anything unusual about the way [subject] walks (e.g., bouncing, exaggeration of toe-heel, up on toes)?"

Current

Age 4-5

Q81
Interview Questions: "Have there been times when [subject] has been aggressive toward other people within the family?"

Current

Age 4-5

Q82
Interview Questions: "What about aggression toward people outside the family?"

Current

Age 4-5

Q83
Interview Questions: "Does [subject] ever injure himself/herself deliberately, such as by biting her/his arm or banging her/his head?"

Current

Age 4-5

Q84
Interview Questions: "Does [subject] ever breathe in deeply with repeated rapid breaths?"
Q85
Interview Questions: "Has [subject] ever fainted or had a fit/seizure/convulsion?"
Q86
Interview Questions: "Could you tell what [subject] was like about the time of her/his third birthday? Working back again just to check: what about at age 1 year and at age 2 years?"
Q87
Code age in months when developmental abnormalities first became apparent based on all information gathered.

Special Isolated Skills & Concluding Comments

Assessment of special abilities (Q88-Q93) and final notes

Interview Questions for Q88-Q93: "Does [subject] have any unusually marked special skills? Are there any things that s/he seems to be very good at? Is s/he particularly good with shapes? What about her/his memory? Musical skills? Drawing? Reading? Computations?"
Q88
Q89
Q90
Q91
Q92
Q93
Interview Questions: "Are there any other aspects of [subject]'s behavior that particularly concern you? Is there anything else you would like to tell me about that we haven't covered?"