MIGDAS-2 Autism Assessment – Children and Adolescents With Verbal Fluency

MIGDAS-2 Diagnostic Interview for Children and Adolescents With Verbal Fluency

People Present

• Individual assessed: Liam Brown (age 10)
• Also present: Sandra Brown (mother)

Sensory Use and Interests

• Liam immediately moved closer to the spinning visual materials and tracked the movement with sustained, intense focus, returning to the spinner repeatedly without prompting.
• Liam flinched and covered both ears when an auditory stimulus was activated, stating “that’s too loud,” and remained alert to ambient sounds for several minutes afterwards.
• Liam hesitated before touching the textured materials, using only his fingertips before withdrawing. He declined to hold the sandpaper sample, stating he “doesn’t like rough things.”
• When Minecraft was introduced, Liam’s posture shifted and his speech rate increased markedly. He provided an extended, detailed description of a redstone circuit, sustaining this independently for several minutes.
• Liam periodically clenched and released his hands during transitions and rocked slightly in his seat during extended listening.

Language and Communication

• Liam’s speech had a slightly formal, consistent cadence with limited prosodic variation throughout the session.
• When discussing Minecraft, Liam shifted to a self-directed narrative, not orienting toward the clinician or pausing for their input even when the clinician attempted to interject.
• Liam’s language was most fluent on preferred topics. When redirected to social themes, his responses shortened and processing time increased noticeably.
• Exchanges had a question-answer quality; Liam responded to direct questions but did not build on the clinician’s contributions or initiate shared conversational turns.
• When the clinician used the expression “keep your eyes peeled,” Liam asked, “Why would you peel your eyes?” and did not recognise the figurative meaning without clarification.
• Liam recited a memorised joke when invited to do so, without adapting his delivery to the clinician’s reactions.

Social Relationships and Emotional Responses

• Liam made brief, intermittent eye contact during direct questioning; gaze was more frequently directed at materials or a fixed point in the room.
• Liam maintained a largely neutral facial expression throughout, with a brief smile when discussing Minecraft but limited variation in response to the clinician’s affect.
• Liam provided brief, factual responses when prompted to discuss peers and family. He required two prompts before posing a question to the clinician (“Do you like games?”), delivered without apparent curiosity.
• Agitation increased when the clinician interrupted Liam’s preferred narrative or introduced social topics, and was lowest when Liam directed the conversation.
• Liam accurately identified anger triggers including loud environments and mid-task interruptions. Sandra Brown confirmed these were consistent with his behaviour at home.
• During the feelings cards activity, Liam gave definitional responses without spontaneous personal examples. He wished for unlimited Minecraft diamonds, described himself as “pretty smart,” and said he would make the school library quieter.

Pattern of Observations

Sensory Use and Interests

• Consistent with autism. Sustained, intense focus on the visual stimulus and repeated unprompted return to it reflect restricted and repetitive engagement with sensory materials.
• Consistent with autism. Flinching, ear-covering, and prolonged alertness to ambient sound are consistent with sensory hypersensitivity per DSM-5-TR criterion B4.
• Consistent with autism. Hesitation, minimal contact, and refusal to handle certain textures reflect tactile hypersensitivity consistent with DSM-5-TR criterion B4.
• Consistent with autism. The marked increase in engagement and one-directional quality of speech on preferred topics is consistent with circumscribed, intensely focused interests per DSM-5-TR criterion B3.
• Consistent with autism. Periodic hand clenching and body rocking are consistent with stereotyped or repetitive motor movements per DSM-5-TR criterion B1.

Language and Communication

• Consistent with autism. Monotonous prosody with limited inflectional variation is a common atypicality in autistic speech.
• Consistent with autism. The self-directed, exclusionary quality of speech on preferred topics is consistent with reduced social communicative reciprocity per DSM-5-TR criterion A1.
• Consistent with autism. Reduced fluency and increased processing time on social topics is consistent with reduced communicative ease outside preferred domains.
• Consistent with autism. Limited initiation of shared conversational turns and question-answer exchanges are consistent with reduced back-and-forth conversation per DSM-5-TR criterion A1.
• Consistent with autism. Literal interpretation of the idiom without recognising its figurative meaning is consistent with concrete language processing common in autistic individuals.
• Unclear. Liam produced a scripted joke, which may reflect rote learning. The absence of audience-adapted delivery may be consistent with autism but cannot be determined from available information alone.

Social Relationships and Emotional Responses

• Consistent with autism. Fleeting, non-communicative eye contact is consistent with reduced use of eye contact for social referencing per DSM-5-TR criterion A2.
• Consistent with autism. Predominantly neutral affect with limited responsiveness to the clinician’s expressions is consistent with reduced non-verbal communication integration per DSM-5-TR criterion A2.
• Consistent with autism. Repeated prompting required to engage with social topics and flat, factual responses are consistent with reduced social-emotional reciprocity per DSM-5-TR criterion A1.
• Consistent with autism. Elevated agitation when the clinician directed conversation is consistent with distress in response to disrupted preferred patterns of engagement.
• Not clearly consistent with autism in isolation. Liam showed reasonable self-awareness of his triggers, which does not in itself indicate autism, though it is consistent with his broader profile.
• Consistent with autism. Rote, definitional responses to feelings cards without spontaneous personal examples are consistent with surface-level emotional language without deeper social-emotional integration.

Behavioural Profile Summary

Sensory Use and Interests

Liam demonstrates clearly defined special interests and notable capacity for sustained attention and detailed knowledge within preferred topics. His ability to articulate technical content is a meaningful strength.

Liam presents with sensory sensitivities across auditory and tactile domains and a strong draw toward visual-movement stimulation, which appear to have a functional impact in unpredictable sensory environments. Repetitive motor behaviours were observed during transitions and passive listening.

Language and Communication

Liam has well-developed expressive vocabulary and communicates with clarity and detail on topics of interest.

Liam’s speech has limited prosodic variation, his conversational reciprocity is reduced, and language fluency decreases on social or unfamiliar topics. He tends toward literal interpretation of figurative language and his spontaneous communication is most effectively directed toward preferred topics.

Social Relationships and Emotional Responses

Liam was cooperative throughout and demonstrated some capacity to identify his own emotional triggers, supporting self-advocacy. He engaged willingly with structured activities.

Liam’s eye contact was limited and functionally non-communicative, his facial affect was largely neutral, and he required repeated prompting to engage with social topics. He showed increased agitation when conversations were clinician-directed. His understanding of feelings was present at a definitional level but lacked the spontaneous personalisation typical of same-age peers.

Diagnostic Impressions

Based on the MIGDAS-2 interview, Liam presents with a behavioural profile consistent with Autism Spectrum Disorder (Level 1, DSM-5-TR), with differences across social communication and restricted/repetitive behaviour domains. Co-occurring anxiety appears likely given his sensory reactivity and agitation in less-structured contexts.

Educational / Intervention Recommendations

• Visual supports and social communication groups focused on turn-taking are recommended to scaffold reciprocal exchanges and build on Liam’s verbal strengths. Explicit teaching of figurative language is also recommended.
• Structured peer interaction programs beginning with shared interest activities may reduce anxiety and support social engagement.
• Visual schedules and advance notice of transitions are recommended to support organisational functioning and reduce agitation-related behaviour.
• An occupational therapy sensory profile assessment is recommended, along with access to a low-stimulus space during periods of high sensory demand.
• Psychoeducation for Sandra Brown regarding Liam’s sensory and communication profile is recommended, along with home strategies for managing transitions predictably.