The Role of Structured Clinical Interviews in Autism Assessments: Are the ADOS and MIGDAS Still Fit for Purpose?
- Amanda Moses Psychology
- Apr 17
- 3 min read
Structured clinical interviews have long been a cornerstone of autism assessment. Tools like the ADOS are often viewed as the “gold standard.” But here’s the uncomfortable truth: many of these tools weren’t designed with internalised, masked, or adult presentations in mind.
If you’re assessing clients who you suspect are autistic—particularly those who are female, AFAB, or who have learned to camouflage their traits—there’s a good chance that structured interviews relying heavily on checklist-style behaviours, on their own, won’t capture the full picture.
So, are these tools still fit for purpose in today’s clinical landscape?
Let’s explore.
What Are Structured Clinical Interviews?
Structured clinical interviews are tools that guide clinicians through a set sequence of questions or observations. The goal is consistency—ensuring that core areas are assessed and that results are reliable across assessors.
Common structured tools used in autism assessments include:
ADOS-2 (Autism Diagnostic Observation Schedule): Often considered a research gold standard, the ADOS involves a series of tasks designed to elicit observable social, communication, and behavioural responses. It relies heavily on what can be seen in the assessment setting.
MIGDAS-2 (Monteiro Interview Guidelines for Diagnosing the Autism Spectrum): A more sensory-informed, conversational tool that explores the client’s developmental history, sensory profile, and social communication across different contexts.
But even tools with strong psychometric properties have limitations—particularly when used with clients whose presentations weren’t well represented in validation samples.
Masking, Camouflaging, and Internalised Presentations
Many autistic adults—especially those assigned female at birth—have spent years (or decades) developing ways to mask their traits. These clients may present as articulate, socially competent, and high-achieving. Structured interviews may show “no evidence” of autism simply because the traits aren’t visible in that short window of observation.
Autism is not just about what someone can see. It’s a difference in neurology that shapes how a person experiences the world.
Here’s what this can look like in practice:
A client maintains eye contact because they’ve trained themselves to, even though it feels uncomfortable.
They laugh at jokes and appear to understand figurative language, but only because they’ve memorised patterns or scripts through years of social learning.
Sensory distress may not be obvious unless you ask about shutdowns, fatigue, or avoidance behaviours.
💡 These are the clients who often “fail” structured tools—and are incorrectly told they don’t meet criteria.
This is exactly why I advocate for using tools like the MIGDAS-2 alongside more flexible, narrative-informed methods.
Why I Use the MIGDAS-2 (But Still Add More)
I use the MIGDAS-2 in my assessments because it provides richer, more qualitative data than rigid tools like the ADOS. It integrates sensory profiling, developmental context, and clinical judgement. But like any tool, it has limitations.
That’s why I supplement it with:
A comprehensive intake process that screens for internalised traits, camouflaging, and less stereotypical expressions of autism (including around special interests, routines, and social communication).
Open-ended interviews with clients and, where appropriate, informants.
Collateral information such as school reports, medical history, or family observations—particularly from childhood.
Self-report measures focused on masking, sensory needs, and emotional regulation—used with a clear understanding of their limitations.
If you’re already using the MIGDAS or considering adopting it, my MIGDAS training is designed specifically for psychologists who want to feel confident assessing autism in internalised, high-masking clients. I walk you through how to adapt the tool, how to use narrative and sensory data, and how to explain the process to clients and referrers. You’ll also get access to demonstration videos of real MIGDAS sessions.
Don’t Skip the Intake: It’s a Goldmine of Data
One of the most overlooked components of an autism assessment is the intake process. If your intake form doesn’t explicitly screen for camouflaging, sensory needs, and less stereotyped expressions of traits, you’re likely to miss key diagnostic indicators—especially in clients who weren’t flagged in childhood.
I’ve created customisable, editable autism intake forms that do exactly this. They cover subtle developmental signs, internalised experiences, social burnout, and sensory profiles—all designed with late-identified and less stereotypical autistic clients in mind.
They’re suitable for both clinician- and client-completion and support a more collaborative, affirming assessment experience. You can check them out here:
Final Thoughts: Structured Interviews Need Clinical Context
Structured interviews like the MIGDAS-2 can absolutely be helpful—but only when used as part of a broader, multi-method assessment strategy. On their own, they may miss the very clients who’ve been overlooked their entire lives.
If you’re working with adults, women, or clients from neurodivergent communities who present in nuanced or internalised ways, it’s time to rethink how we use structured tools.
💡 Want to feel more confident in assessing autism beyond the textbook presentation?
Check out my MIGDAS Training and autism intake forms designed for internalised, masked profiles.
