MIGDAS-2 Autism Assessment – Individuals With Limited to No Verbal Fluency

Diagnostic Interview For Individuals With Limited To No Verbal Fluency

People Present

• Individual assessed: Jake Brown
• Also present: Sandra Brown (mother)

Sensory Use and Interests

Jake immediately oriented towards materials with visual and movement properties, including a spinning top, and repeated the spinning action each time the item was removed. He showed little interest in stationary materials. When auditory materials were introduced, Jake vocalised and rocked in his seat. The clinician noted brief ear-covering in response to a louder noise outside the room, suggesting both sensory seeking and sensitivity. Jake avoided rough textured fabric on contact. Sandra reported that clothing texture sensitivity affects dressing routines at home.

When a toy train was introduced as a preferred interest item, Jake’s engagement increased markedly. He examined the wheels closely and repeated a rolling motion along the table edge for an extended period. Throughout the session, Jake displayed hand-flapping when excited, rhythmic rocking during quieter periods, and toe-walking when moving around the room.

Language and Communication

Jake produced open vowel sounds and a recurring “eee” vocalisation that appeared communicative, particularly when seeking to continue an activity. No recognisable words were produced. Sandra reported that Jake used a small number of single words between ages two and three, which were not regained following a regression at approximately three and a half years. Jake communicated primarily through reaching and extending his arm towards desired objects. He did not point, wave, or use other conventional gestures.

Social Relationships and Emotional Responses

Jake made brief eye contact on two occasions when the clinician animated the train, but did not make eye contact in response to his name or during direct social bids. Sandra noted more frequent eye contact at home when Jake is seeking food or comfort. Jake displayed clear affect — smiling when the train was introduced and becoming distressed when it was removed — but did not orient towards or mirror the clinician’s expressions. Transition-related distress was observed when materials were changed, with increased vocalisation and motor stereotypies. Jake did not follow the clinician’s point or gaze shift, and preferred solitary engagement over shared play.

Pattern of Observations

Sensory Use and Interests

• Jake’s responses to visual and movement materials are consistent with autism. His intense, repetitive engagement with the spinning top and interest in wheel movement reflect restricted sensory-motor engagement characteristic of autism.
• Jake’s responses to auditory materials are consistent with autism. Sensory-seeking responses to music alongside sensitivity to unexpected sounds reflect mixed hyper- and hyporeactivity consistent with DSM-5-TR Criterion B4.
• Jake’s responses to tactile materials are consistent with autism. Avoidance of rough textures and reported clothing sensitivity are consistent with tactile hypersensitivity commonly observed in autism.
• Jake’s responses to preferred interest materials are consistent with autism. His markedly elevated and repetitive engagement with the train is consistent with highly restricted, fixated interests of abnormal intensity (DSM-5-TR Criterion B3).
• Jake’s body movements and mannerisms are consistent with autism. Hand-flapping, rocking, and toe-walking are consistent with stereotyped and repetitive motor movements described in DSM-5-TR Criterion B1.

Language and Communication

• Jake’s vocalisations are consistent with autism. Functional communicative intent is present; however, the absence of verbal language alongside early regression is a documented presentation pattern in autism.
• Jake’s use of emerging language is consistent with autism. Loss of early words is a recognised developmental pattern in autism and is relevant to the diagnostic formulation.
• Jake’s nonverbal communication is consistent with autism. The absence of pointing and conventional gestures alongside reaching and leading reflects deficits in nonverbal communicative behaviours (DSM-5-TR Criterion A2).

Social Relationships and Emotional Responses

• Jake’s eye contact is consistent with autism. Fleeting gaze occurring primarily in functional rather than social contexts is consistent with DSM-5-TR Criterion A2.
• Jake’s facial expression use is consistent with autism. Contextually appropriate affect without social referencing or expression sharing is consistent with autism.
• Jake’s anxiety and agitation are consistent with autism. Transition-related distress is consistent with insistence on sameness and inflexible routines (DSM-5-TR Criterion B2).
• Jake’s joint attention is consistent with autism. Absence of pointing, gaze following, and social referencing, alongside preference for solitary engagement, is consistent with DSM-5-TR Criterion A1.

Behavioural Profile Summary

Sensory Use and Interests

Jake’s strong engagement with movement-based materials and preferred objects provides reliable motivational contexts for therapeutic and educational work. His responsiveness to preferred music may also support regulation strategies.

Jake’s sensory profile includes tactile hypersensitivity and mixed auditory reactivity, impacting dressing routines and tolerance of group environments. Individualised environmental planning is indicated.

Language and Communication

Jake demonstrates communicative intent through reaching and vocalisation, indicating a foundational capacity that can be developed. His consistent use of these strategies with familiar caregivers suggests some communication is established within preferred relationships.

Jake does not use verbal language or conventional gestures, significantly limiting his ability to express needs and participate socially. AAC strategies are indicated to support expressive communication development.

Social Relationships and Emotional Responses

Jake shows clear emotional responsiveness to preferred and non-preferred stimuli and demonstrates capacity for social attachment with his primary caregiver. His increased eye contact with Sandra at home suggests emotional connection within established relationships.

Jake’s difficulties with joint attention, social referencing, and shared engagement significantly limit reciprocal interaction across settings. Transition-related distress and limited shared play tolerance require consistent, targeted support.

Diagnostic Impressions

The clinician indicated that Jake’s presentation is consistent with Autism Spectrum Disorder across both DSM-5-TR Criteria A and B, with symptoms present from early development and a level of support need consistent with significant adaptive and communication differences. A cognitive and adaptive behaviour assessment was recommended to further clarify Jake’s developmental profile.

Educational / Intervention Recommendations

• AAC strategies, including PECS or a speech-generating device, are recommended given the absence of functional verbal language. A speech pathology assessment is strongly recommended, with implementation across home and school.
• Social engagement goals should be embedded within preferred activities using a DIR/Floortime framework, beginning with one-on-one interaction before progressing to peer settings.
• Visual schedules and first-then boards are recommended across all environments to reduce transition-related distress and support predictability.
• An occupational therapy sensory assessment is recommended to develop an individualised sensory profile and guide environmental modifications.
• Parent-mediated intervention training (e.g., More Than Words or ESDM parent coaching) is recommended to support communication and interaction strategies within the home.

Summary Notes

Psychometric Assessment

No psychometric assessments were administered during this session.

Findings According to DSM-5-TR Criteria A

A1

Jake did not initiate social engagement with the clinician and did not respond to social bids, including attempts at shared play. He did not share enjoyment or direct the clinician’s attention to preferred activities. Sandra reported that social engagement at home is largely caregiver-initiated.

A2

Eye contact was fleeting and functionally rather than socially motivated. Jake did not use pointing, waving, or other conventional gestures. His reaching and vocalisation, while communicatively intentioned, do not constitute integrated verbal-nonverbal communication.

A3

Jake does not have friendships with same-age peers. Sandra reported that peer interaction at his specialist school setting is minimal, with Jake engaging in parallel or solitary play. Primary social relationships are with immediate family members.

Findings According to DSM-5-TR Criteria B

B1

Jake displayed hand-flapping, rhythmic rocking, repetitive rolling of the train, and toe-walking during the session. Sandra confirmed these movements are present consistently across settings.

B2

Distress during activity transitions was observed, characterised by vocalisation and increased motor stereotypies. Sandra reported that unexpected changes to routine consistently produce distress at home and school.

B3

Jake’s interest in trains is highly focused and of notable intensity, engaging with train-related materials daily for extended periods over more than two years with little interest in other play categories.

B4

Jake displays both hyperreactivity (sensory-seeking for movement and music) and hyporeactivity (avoidance of rough textures and unexpected sounds), affecting daily functioning across dressing, transitions, and group participation.

Findings According to DSM-5-TR Criteria C

Sandra reported that developmental differences were first noted before age two, including delayed speech and limited social responsiveness. Language regression at approximately three and a half years and persistent repetitive behaviours from early childhood indicate symptom presence in the early developmental period.

Findings According to DSM-5-TR Criteria D

Jake’s communication differences restrict his ability to express needs and access educational content. Sensory sensitivities and transition-related distress affect daily living and community participation. Limited social engagement affects peer interaction and independent functioning across home, school, and community settings.

Findings According to DSM-5-TR Criteria E

Jake’s adaptive functioning and developmental history are consistent with possible co-occurring intellectual disability or global developmental delay, and the clinician recommended a formal assessment to clarify this. Jake’s social functioning is significantly below expectations for his chronological age.

Risk

No suicidal ideation, self-harm, or harm to others was identified. Jake’s communication limitations restrict direct disclosure; however, no behavioural indicators of self-harm were observed. Jake is at elevated risk of social isolation and of being a target of bullying in less-supported environments. Protective factors include a stable and engaged family, Sandra’s strong advocacy, and attendance at a specialist school setting.

Recommendations and Next Steps

• Recommended referral to a paediatrician to review Jake’s overall developmental profile and consider assessment for intellectual disability or global developmental delay.
• Referral to a speech pathologist for an AAC assessment and to an occupational therapist for a sensory assessment were both recommended.
• Next appointment: Tuesday, 11 March 2026.