What is the ADI-R, and why do we ask about early childhood?

What is the ADI-R?

The ADI-R is an interview in which, as its UK distributor puts it, “an experienced clinical interviewer questions a parent or carer who is familiar with the developmental history and current behaviour” of the person being assessed.

It has 93 questions, or items, across three areas, which the distributor lists as: “Language and Communication; Reciprocal Social Interactions; Restricted, Repetitive and Stereotyped Behaviours and Interests”. Reciprocal social interaction means the back-and-forth of relating to other people: sharing, responding, making friends.

It can be used for children and for adults, and it’s often used alongside the ADOS-2 observation session, as it is in our assessment.

Why do we ask about early childhood?

Autism isn’t something that starts in later childhood or adulthood. The National Autistic Society explains that the core characteristics of autism “must be present (and must have been present throughout a person’s life) for an autism diagnosis to be made”.

Early childhood is often when differences first show: how a child began to communicate, how they played with others, how they reacted to change. Later, many people learn ways to cope with or mask their differences, so the early years help the team understand the whole picture, not just how things look today.

That’s why the ADI-R asks about early development and milestones, as well as about how things are now.

Who takes part?

For a child, a parent or carer who knows them well takes part. For an adult, it’s ideally someone who knew you well growing up, such as a parent or an older sibling, and a partner can join too.

The person being assessed doesn’t need to be in the room. For a child, it’s often easier if they’re not, so you can talk freely, for example while they’re at school.

Who carries out the interview?

A clinician from our team who is trained in the ADI-R carries out the interview, online. CHECK: training certificates seen for the claims register (D1) They’ll explain how the session works at the start, and you can ask questions at any point.

If English isn’t your family’s first language, or you’d find it easier to have someone with you, tell us beforehand so we can plan how to make the interview work for you.

What kind of questions are asked?

The interviewer asks about things like:

• how speech and communication developed, including early words and gestures
• how the person played, on their own and with others, and how they made friends
• how they coped with changes to routine, and any intense interests or repeated movements
• how they reacted to sounds, textures, tastes and other sensory experiences
• how things are now, at home, at school or at work

Because it’s a structured interview, the questions follow a set order and wording, so they’re asked in the same way for everyone. The interviewer may ask for examples, because a specific memory often tells more than a general impression.

How is the ADI-R different from the ADOS-2?

They look at the same areas from two directions. The ADI-R is an interview about the person’s history, usually with a parent or carer, so it covers years of everyday life that no single appointment could show. The ADOS-2 is an observation of the person themselves, today, through activities and conversation.

Each fills gaps in the other. A child might seem settled in one short session but have found playtimes hard for years; an adult might have masked at school but find it harder now. That’s why the distributor describes the ADI-R as “frequently used alongside the ADOS-2”, and why we use both.

How long does it take?

At Oakwell, the developmental history session is online and takes up to 2 hours. The UK distributor gives a typical time of 1.5 to 2.5 hours including scoring, so it’s normal for it to feel long. You can ask for a break at any point.

How can I prepare for the session?

• Choose a quiet space where you won’t be interrupted for up to 2 hours, with a drink nearby.
• If you can, talk to other people who knew the person as a young child, such as grandparents, older siblings or a childminder, and note down anything they remember.
• Jot down examples as they come to you in the days before: a specific moment often helps more than a general description.
• Keep any documents you’ve found close by, so you can check a date or a detail.
• Plan something restful for afterwards. It’s a long conversation.

CHECK: preparation advice with Hans (§21a)

What if I don’t know, or can’t remember?

That’s very common, and it’s fine to say “I don’t know” or “I’m not sure”. A rough answer is still useful when you say it’s a guess, and the team brings the interview together with everything else in the assessment.

It can help to look through anything you already have before the session, such as your child’s red book (the personal child health record), photos or videos, school reports, or earlier assessments. The NHS notes that assessment teams may ask adults for documents “such as school reports or assessments you’ve had at work”. CHECK: what Oakwell asks families and adults to have ready (§21a)

What if no one who knew you as a child can take part?

You can still be assessed. The National Autistic Society notes that for adults, “most information will be provided by you”. If nobody is available, we agree other ways to gather the same information with you. CHECK: which other ways, for example school reports or your own recollections (§1)

If your parents have died, are unwell or you aren’t in touch, you don’t have to explain why. Tell us what’s possible, and we’ll plan around it. Our page on adult assessment when early history is missing has more.

Can talking about the past be emotional?

Yes, and that’s normal. Parents sometimes find that looking back brings up worry, guilt or relief, especially when they recognise things they didn’t notice at the time. Adults being assessed can feel the same about their own childhood.

There’s no judgement about what anyone did or didn’t notice. The aim is to understand, not to find fault. You can take a break at any time, and the feedback appointment and follow-up call are there for the questions that come up afterwards.

Is the ADI-R something you can pass or fail?

No. It’s a way of gathering information, not a test. No single tool decides whether someone is autistic: the National Autistic Society says a diagnosis should be informed by “a range of sources, together with clinical judgement”.

Our whole team reviews the developmental history alongside the observation session, the questionnaires and, for children, school’s view, and compares it all with the DSM-5 criteria.

What happens after the developmental history?

Next comes the observation session using the ADOS-2, then the team review, a feedback appointment, your written report and a follow-up call. The assessment journey page explains each step, with how long it takes and who is there.