MIGDAS-2 Autism Assessment – Adults With Verbal Fluency

MIGDAS-2 Diagnostic Interview for Adults With Verbal Fluency

People Present

• Individual being assessed: James Brown
• Support person: Linda Brown (mother)

Introduction

• James  self-referred following online research into autism, identifying strongly with accounts shared in autistic adult communities.
• He described a lifelong sense of being “different” and increasing difficulty managing workplace social expectations.
• Linda confirmed James had always been “intense and particular” and expressed relief the assessment was finally taking place.

Interests

Current

• James spends most free time researching railway history and building scale models, estimating 3–4 hours daily.
• Transitioning away is difficult; he becomes irritable when interrupted. Modelling is strongly calming, describing it as “the only time my head goes quiet.”
• Sleep is occasionally delayed and social obligations are frequently declined in favour of modelling. His partner has raised concerns about the time it occupies.
• Linda noted he had always needed “a project on the go” and became dysregulated without one.

History of Interests

• Intense focus on dinosaurs from age 4–10 shifted in adolescence to trains, which has remained his primary interest into adulthood.
• Linda confirmed the intensity was consistent across development.

Sensory

Visual Details

• Readily notices visual details others overlook and has strong recall for written material. Becomes unsettled when items in his workspace are moved; Linda noted this was prominent in childhood.

Noises

• Open-plan office noise causes significant distraction and irritability; steady rhythmic sounds are calming.
• Linda recalled childhood distress in busy public environments.

Smells

• Strong artificial fragrances cause physical discomfort; he avoids affected spaces. Sensitivity has been consistent throughout his life.

Touch

• Prefers firm, predictable touch; finds light or unexpected touch and certain synthetic fabrics aversive.

Food

• Prefers plain, predictable textures; mixed textures are strongly aversive.
• Linda confirmed a restricted childhood diet and frequent mealtime conflicts.

Clothing

• Exclusively wears soft, seamless clothing; removes all tags. These preferences have been consistent since childhood.

Sleep

• Difficulty initiating sleep, lying awake 45–60 minutes ruminating. Rarely feels rested; difficulties have worsened during periods of work stress.

Body Boundaries

• Sensitive to personal space encroachment; prefers firm handshakes and avoids casual touch. Plans travel to avoid peak-hour public transport.

Pain

• High pain threshold; recalled breaking a finger during sport without noticing until the following day. Linda confirmed this pattern.

Changes in Routine

• Interruptions cause irritability and difficulty re-engaging; unexpected changes produce marked anxiety. Advance notice helps but remains effortful.

Body Movements

• Rhythmic finger tapping when thinking; pacing when anxious. Suppresses these in professional settings, which he finds tiring. Present since childhood.

Sensory Issues in Daily Life

• Sensory sensitivities meaningfully impact workplace functioning; managing sensory input in open-plan environments accounts for significant daily cognitive load.

Communication

• Does not initiate conversations with unfamiliar people; strongly prefers others to begin. Speaks at length on preferred topics; others’ redirection of these conversations is frustrating.
• Can maintain conversations on other topics but finds it effortful. Needs more processing time in group discussions and prefers literal language, describing confusion with indirect workplace expressions.
• Linda described him as very literal in childhood, often causing confusion with peers and teachers.

Social

• Closest connections are his partner and mother; two friends from a railway enthusiast group, both older, seen monthly.
• Prefers structured, activity-based socialising and views solitary time as essential rather than optional.

Emotional

• Ambiguous social communication causes frustration; typically withdraws but occasionally responds sharply.
• Anxiety triggers include unplanned changes, crowded environments, and work performance expectations. When highly anxious, becomes very quiet and disengages.
• Learned to suppress emotional dysregulation as an adult, which he finds exhausting. Describes his strengths as reliability, attention to detail, and loyalty.
• Linda described him as “devoted, honest, and incredibly knowledgeable” and noted his difficulties had caused significant pain in employment and relationships.

Health

• No diagnosed physical health conditions; no current medications.

Employment / Academic Details

For Adults Who Work

• Data analyst at a logistics company for four years. Enjoys structured datasets and detailed reports; dislikes team meetings and open-ended briefs.
• Ideal role would be sole-contributor, technically focused, with minimal meetings and remote work options.
• Relationship with manager is strained due to her indirect communication style; limited co-worker interaction, aware this is perceived negatively.
• Drives to work; manages finances independently via detailed spreadsheet. Linda hoped a diagnosis might support workplace accommodations.

Independent Living

• Lives with long-term partner; relationship stable but partner finds rigidity around routines and limited social engagement challenging.
• Manages daily tasks independently via fixed routines; deviation causes disproportionate stress.
• In five years, would like to work remotely in a less socially demanding role with a dedicated space for modelling.

Closing

• Has read extensively about autism and is knowledgeable about diagnostic criteria. Asked whether a diagnosis would guarantee workplace accommodations.
• Noted a history of being told he was “just introverted,” which delayed his pursuit of assessment. Linda added she had suspected autism since childhood but was told he was “just quirky.”

Diagnostic Interview Profile

Sensory Use

• James presents with highly developed, specific interests that have been consistent from childhood into adulthood, occupying significant time and serving a clear regulatory function, consistent with the restricted and repetitive interests dimension of autism.
• He reports pervasive sensory sensitivity across multiple modalities since early childhood, with reactions notably intense relative to stimuli, consistent with hyper-reactivity as specified in DSM-5-TR Criterion B4.
• Repetitive motor behaviours including finger tapping and pacing serve a self-regulatory function; effortful suppression in professional settings is consistent with masking behaviour in autistic adults.

Language and Communication

• Speech was formal, precise, and measured throughout, with little prosodic variation regardless of topic, consistent with atypical prosody in autistic adults.
• Language became more driven and self-directed when discussing preferred topics, requiring active clinician redirection, consistent with language patterns associated with focused interests in autism.
• Conversational reciprocity was reduced on non-preferred topics; consistent preference for literal language and confusion with idioms align with DSM-5-TR Criterion A2.

Social Relationships and Emotional Responses

• Eye contact was intermittent and appeared deliberate rather than natural, consistent with atypical nonverbal communicative behaviour in autistic adults.
• Facial expression range was narrow with limited modulation; emotional responses were conveyed primarily through verbal rather than nonverbal channels.
• Responses about friends and family required structured prompting and remained descriptive; anxiety is directly linked to sensory overload and social unpredictability, with limited emotional introspection consistent with alexithymic features.

Pattern of Observations

For each item below: consistent with autism, not consistent, or unclear — with rationale

Sensory Use and Interests

• Sensory-seeking routines: Consistent. Narrowly focused, historically stable interests serving a regulatory function align with DSM-5-TR Criterion B3.
• Sensory sensitivities: Consistent. Atypical, pervasive, and longstanding responses across multiple modalities align with DSM-5-TR Criterion B4.
• Body movements and mannerisms: Consistent. Repetitive motor behaviours with a self-regulatory function present since childhood align with DSM-5-TR Criterion B1.

Language and Communication

• Intonation and inflection: Consistent. Formal, unvarying prosody aligns with atypical nonverbal communicative behaviour in DSM-5-TR Criterion A2.
• Language variation on preferred topics: Consistent. Shift to detailed, self-directed narration with reduced clinician participation is characteristic of autism.
• Quality and relevance of language: Consistent. Clear on factual topics; effortful and tangential on social content, consistent with social communication differences.
• Speech reciprocity: Consistent. Reduced reciprocity and reliance on clinician prompting align with DSM-5-TR Criterion A1.
• Understanding of nonliteral language: Consistent. Preference for literal communication and confusion with idioms align with DSM-5-TR Criterion A2.

Social Relationships and Emotional Responses

• Eye contact and gaze: Consistent. Deliberate, intermittent eye contact with gaze aversion during emotional content aligns with DSM-5-TR Criterion A2.
• Facial expression use and response: Consistent. Narrow expression range and primarily verbal emotional communication align with reduced affective expression in autism.
• Response to prompts about peers and family: Consistent. Factual, prompted responses with limited emotional elaboration align with DSM-5-TR Criterion A1.
• Anxiety during social interaction: Consistent. Anxiety linked to sensory overload and social unpredictability is characteristic of autistic adults.
• Self-awareness of anxiety triggers: Consistent. Awareness of external triggers with limited emotional introspection is consistent with alexithymic features in autism.

Behavioural Profile Summary

Sensory Use and Interests

• James’s deep expertise and focused engagement in areas of interest serve important regulatory and identity functions, and his attention to detail is a meaningful cognitive strength in professional contexts.
• Pervasive sensory sensitivity across multiple modalities impacts daily functioning, and effortful masking of regulatory behaviours contributes to fatigue and emotional depletion.

Language and Communication

• James communicates with precision and clarity on structured topics, an asset in his technical professional role.
• Reduced conversational reciprocity and a consistent preference for literal language create miscommunication in social and professional contexts; compensatory strategies are effortful and inconsistently effective.

Social Relationships and Emotional Responses

• James maintains stable relationships with a small number of trusted people and demonstrates loyalty and genuine motivation to understand his interpersonal difficulties.
• Difficulty with social reciprocity, limited facial expressiveness, and a strong preference for solitude contribute to social isolation and ongoing distress.

Diagnostic Impressions

James presents with a profile consistent with Autism Spectrum Disorder (ASD) per DSM-5-TR criteria, meeting criteria across both core domains: persistent deficits in social communication and interaction (Criterion A) and restricted, repetitive patterns of behaviour, interests, and activities (Criterion B). Symptoms are present across multiple contexts since early childhood and cause clinically significant functional impairment. Co-occurring anxiety and likely alexithymia are noted; masking since adolescence has likely contributed to delayed identification.

Educational / Intervention Recommendations

• Psychoeducation about his autistic profile, including masking, sensory processing, and emotional regulation, to support self-understanding and self-advocacy. Connection with autistic peer networks may reduce isolation.
• Referral to a speech pathologist experienced with autistic adults to support communication strategies for professional environments, including navigating indirect communication and group conversations.
• Sensory accommodations such as noise-cancelling headphones and a structured workspace are recommended. Occupational therapy consultation may assist in identifying practical adjustments across home and work settings.
• Workplace disclosure and pursuit of reasonable adjustments, including remote work and written communication protocols, should be explored. Vocational support to identify roles aligned with his strengths and sensory needs may be beneficial.
• Psychoeducation for James’s partner and mother about masking fatigue, sensory needs, and communication differences may support mutual understanding and reduce relational friction.