The Crisis in Adult Autism Assessment: Are We Diagnosing or Just Guessing? - Why Appropriate Training and Experience is Necessary for Your Evaluator

Something remarkable has happened in mental health care over the last decade. Adults — often well into their twenties, thirties, and beyond — are seeking autism diagnoses in record numbers, and many of them are finally getting answers that reshape their entire understanding of themselves. It's a genuine breakthrough. For countless people who spent years feeling like they were fundamentally broken, out of step with the world, or simply "too much" for the people around them, an autism diagnosis can be profoundly liberating.

But as with so many things in healthcare, the surge in demand has outpaced the infrastructure to meet it responsibly. And according to psychologist, professor, and autism researcher Chris Dabbs, the consequences are serious, not just for individual patients, but for the integrity of autism diagnosis as a whole.

In a detailed and unflinching post on his website, Dabbs, who is himself autistic and was diagnosed at 29, makes the case that we are in the middle of an epidemic of inadequate adult autism assessment. The diagnosis boom is real, the need is real, but too many providers are cutting corners in ways that do real harm to the very people they're trying to help.

The Numbers Behind the Boom

The scale of the shift is hard to overstate. Dabbs cites research showing a 450% increase in autism diagnostic rates among the 26-to-34 age group between 2011 and 2022. This isn't a statistical blip: it reflects a genuine sea change driven by several converging forces: updated diagnostic criteria that capture a wider range of presentations, greater awareness of how autism looks in people who were previously overlooked (particularly women and high-masking individuals), better diagnostic tools, and slowly decreasing social stigma.

The clients Dabbs sees reflect this shift. They tend to be working professionals in their mid-twenties to mid-thirties, high-masking, and demographically skewed toward women; a group historically underdiagnosed because autism research was, for decades, built almost entirely around young boys.

Dabbs is clear that he celebrates this progress. The growing accessibility of adult autism diagnosis is, in his view, one of the most meaningful developments in mental health care in recent years. But celebration shouldn't mean complacency. And right now, he argues, there are foundational cracks forming that threaten to undermine everything this progress has achieved.

Testing Is Not the Same as Assessment

One of the most important, and most overlooked, points in Dabbs's post is a distinction that sounds technical but has enormous practical implications: the difference between *testing* and *assessment*.

Testing, in the psychological sense, is a standardized process that produces quantifiable data. It's the administration of specific instruments; questionnaires, rating scales, structured tasks, according to precise protocols. Assessment, on the other hand, is the broader process of making meaning from that data: integrating test results with a person's history, behavioral observations, collateral information, and clinical judgment to arrive at a coherent clinical picture.

As Dabbs explains it, testing gives you raw numbers. Assessment tells you what those numbers mean for this particular human being, in the context of their particular life. Both require distinct skill sets. Both are necessary. And conflating them, treating a set of completed questionnaires as equivalent to a real assessment, is where things start to go wrong.

This distinction matters because, in the current landscape, many clinicians are doing testing without assessment. They're handing clients self-report autism screeners and, based largely on the results, issuing a diagnosis. It's fast. It's cheap. And it is, in Dabbs's words, not an evaluation: it's malpractice.

The Scope Creep Problem

So how did we get here? Part of the answer lies in what Dabbs describes as "scope creep": the gradual expansion of one profession's practice into territory traditionally held by another.

Psychological testing and assessment have historically been the domain of psychologists, who receive extensive graduate-level training in psychometrics, diagnostic reasoning, and the administration and interpretation of specialized instruments. But the mental health field is broad, and professionals including licensed counselors, social workers, and marriage and family therapists have increasingly moved into assessment roles; sometimes with adequate training, and sometimes without.

This isn't inherently a problem. Dabbs is careful to say he is not arguing that only psychologists should conduct psychological assessments. With appropriate training and supervised experience, master's-level clinicians are perfectly capable of performing high-quality assessments. Several states and Canadian provinces already license master's-level psychologists. Dabbs himself holds a master's degree in counseling and went on to earn a Ph.D. in counseling psychology, building his expertise in adult autism and ADHD assessment through dedicated pre- and post-doctoral training.

The problem is when clinicians move into assessment practice without that training, and when the professional and legal standards that are supposed to govern this are so vague as to be nearly meaningless.

Dabbs points to accreditation standards for counseling programs that reference "assessment" without specifying what kinds of testing are actually within scope. He contrasts states like California and Texas, which spell out explicitly what assessment *does not* include for licensed counselors (neuropsychological testing, projective personality assessment, batteries designed to diagnose psychosis or dementia), with states where the language is broad enough to permit almost anything. The result is a patchwork of standards that leaves patients unprotected and providers confused.

Complicating this further: psychologists were formally banned from serving as core faculty in counseling programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) in 2013. This means that in many master's-level training programs, the professionals best equipped to teach rigorous psychological assessment are explicitly excluded from doing so. The people being trained to offer assessments are increasingly being trained by people who were not themselves trained in assessment at a high level.

Why Adult Autism Diagnosis Is Especially Demanding

Even for a highly trained clinician, diagnosing autism in adults is one of the most technically challenging tasks in psychological assessment. Dabbs is emphatic on this point, and it's worth dwelling on.

Children come to the assessment process with relatively short histories. Adults do not. By the time an adult seeks an autism diagnosis, they've typically spent decades developing compensatory strategies, masking their autistic traits, accumulating other diagnoses (many of which may be accurate, and many of which may not be), and building a complex psychological profile that can easily obscure an underlying autism diagnosis, or mimic one.

Research backs this up. Dabbs cites Lord et al. (2018) noting that brief self-report measures alone do not have adequate specificity to diagnose autism in adults, and Maddox et al. (2017) emphasizing that even the Autism Diagnostic Observation Schedule (ADOS-2), one of the gold-standard instruments in autism assessment, was never designed to be used as a standalone diagnostic measure. Around half of adults seeking a first-time autism diagnosis have a lifetime history of at least one other diagnosis (Pehlivanidis et al., 2020).

The goal of adult autism assessment, Dabbs explains, is not simply to confirm autism; it's to systematically rule out every other plausible explanation while gathering positive evidence to support the diagnosis. ADHD, social anxiety disorder, obsessive-compulsive disorder, social pragmatic communication disorder, personality disorders, and several other conditions can all produce presentations that overlap substantially with autism. Treating these as separate problems to solve after the autism diagnosis is confirmed misses the point entirely. They need to be assessed concurrently.

This is why Dabbs's own assessment battery is so comprehensive. It includes multiple screening instruments targeting anxiety, depression, mood disorders, PTSD, ADHD, and OCD, alongside autism-specific tools. It incorporates structured and semi-structured interviews, cognitive and executive functioning measures, personality assessment inventories, and contingent assessments based on emerging findings during the process. His reports run ten to twenty single-spaced pages. Not because he is being exhaustive for its own sake, but because the population he serves demands it.

The Personal Stakes

What makes Dabbs's argument particularly compelling is that he grounds it in lived experience; his own.

At 14, after instances of self-harm, he was diagnosed with major depressive disorder. He lived with that diagnosis for years. Medication didn't work. Therapy helped somewhat but never resolved the chronic fatigue, the difficulty with basic self-care, the irritability, the amotivation. It wasn't until he began to understand himself as autistic that he encountered the concept of autistic burnout — a state of cognitive and emotional overwhelm that develops when autistic people live for extended periods in environments that don't accommodate their needs.

When he began accommodating those needs, the "depression" lifted. He was, he believes, never clinically depressed in the way the diagnosis implied. He was an undiagnosed autistic person living in sustained burnout, being treated for a condition he didn't have.

This is the real-world cost of diagnostic imprecision. Wrong diagnosis leads to wrong treatment. Wrong treatment means wasted years, unnecessary suffering, and a continued failure to address what's actually going on. For autistic adults, many of whom have already spent their lives being misunderstood, dismissed, and pathologized, the stakes of getting the assessment right are not abstract. They are deeply personal.

What Good Assessment Looks Like

Dabbs does not merely criticize — he offers a model. His published battery is one of the most transparent accounts of rigorous adult autism assessment practice available from a working clinician, and it's worth reading in full on his website for anyone seeking assessment or providing it.

The key principles underlying his approach are applicable beyond the specifics of any particular instrument list. First: no single tool is sufficient. Self-report measures, structured interviews, standardized behavioral observations, and cognitive testing all capture different facets of a complex picture, and none should be used in isolation. Second: ruling things out is as important as ruling things in. A thorough differential diagnosis is not a bureaucratic formality — it's the core of the work. Third: the assessment must result in a genuinely integrated report that synthesizes quantitative findings with qualitative clinical reasoning in language the client can actually understand and use.

He also makes a pointed structural argument: providers who want to specialize in adult autism assessment should be required to seek appropriate training. Postgraduate specialization is entirely reasonable to expect. What is not acceptable is simply deciding to offer autism assessments because there is demand for them, without the preparation to do them well.

A Field at a Crossroads

Dabbs frames the current moment as a critical juncture. The progress made in adult autism awareness and diagnosis accessibility is genuinely meaningful — and genuinely fragile. If low-quality assessments become the norm rather than the exception, the consequences will ripple outward: misdiagnosed individuals who don't receive appropriate support, correctly diagnosed individuals whose diagnoses are doubted because the bar has been set so low, and an erosion of public and professional trust in autism diagnosis as a credible clinical process.

The autistic community has fought hard, over a long time, for recognition — for the acknowledgment that their experiences are real, that their needs are real, and that they deserve care that is actually calibrated to those needs. Shoddy assessments that rubber-stamp diagnoses based on a $100 screener session do not honor that fight. They undermine it.

Dabbs closes with a challenge that is both professional and personal: "We have waited long enough for recognition; we should not have to settle for recognition that is incomplete or imprecise."

It's a standard worth holding.

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*This post is based on "The Epidemic of Inadequate Adult Autism Assessment" by Chris Dabbs, MA, PhD, published May 6, 2025 at [chrisdabbs.com](https://www.chrisdabbs.com/post/the-epidemic-of-inadequate-adult-autism-assessment). Dabbs is a psychology professor, psychological diagnostician, and autism researcher. He is also autistic. Research references cited within his original post include Lord et al. (2018), Maddox et al. (2017), Pehlivanidis et al. (2020), Hogan (2018), Meyer et al. (2001), and Hus & Lord (2015), among others. Standards references include the joint Standards for Educational and Psychological Testing (AERA, APA, & NCME) and accreditation standards from CACREP and CSWE.*