Adult ASD Diagnostic Interview – ADI-R + CAT-Q Integrated Script

Administrative And Consent

What prompted you to pursue an autism assessment at this point in your life?

Experiencing severe burnout following a recent promotion into a team management role. Noted lifelong difficulties with social exhaustion, sensory overload, and motor coordination, which became more apparent after attending musculoskeletal physiotherapy for chronic neck tension and discussing sensory-motor patterns with the clinician.

Who referred you, and what would you like to gain from the assessment?

Referred by GP (Dr H. Patel) on 14/02/2026. Aims to gain self-understanding, formal confirmation of neurodivergent traits, and access to appropriate workplace occupational health adjustments.

Have people close to you, such as relatives, a partner, or friends, commented on your social or behavioural patterns? Long-term partner frequently notes that the patient is overly literal, struggles to read subtle emotional cues, relies heavily on rigid daily routines, and requires hours of solitary recovery after social events.

Can any of them provide information today or at a later time?

Mother (Mrs Margaret Vance) and partner (Mr David Sterling) are both available to complete collateral informant questionnaires and attend a follow-up virtual call.

Have you previously had psychological, educational, or other relevant assessments? Assessed by an educational psychologist at age 9 (1999) for handwriting and coordination difficulties; diagnosed with developmental coordination disorder (dyspraxia). Completed a course of CBT for generalised anxiety in 2019.

Developmental And Personal History

What do you know about your early years, including pregnancy, birth, and infancy? Full-term pregnancy, uncomplicated vaginal delivery, birth weight 3.4 kg. No neonatal intensive care required.

Were there early complications or delays, for example with speech, walking, or toileting? Speech developed early with advanced vocabulary by age 2. Walking was delayed until 17 months; described as clumsy with frequent falls. Toilet training was delayed until age 4 due to distress around sensory aspects of using the toilet.

Did you lose any abilities that you had already acquired?

Nil developmental regression reported.

How was your early temperament characterised—for example, calm, anxious, active, or withdrawn? Characterised as a quiet, observant, and anxious child who preferred solitary, structured activities and became easily distressed in noisy environments.

As a baby or child, were there problems with feeding, sleeping, or settling?

Difficult to settle in infancy; rarely slept for more than 3 hours consecutively until age 3. Highly selective eater as a toddler, refusing mixed textures or wet foods.

Have those early characteristics persisted or changed into adulthood?

Sensory sensitivities, motor clumsiness, and anxiety around unexpected change have persisted into adulthood, though overt behavioural distress is now internalised.

How would you compare your current personality and behaviour with how you were when younger? Remains detail-oriented and routine-bound, but has developed extensive learned social strategies to appear outgoing in professional settings, leading to higher levels of internal fatigue compared to childhood.

Is there any significant medical history, hospital admission, or concern involving sensory or motor coordination? History of dyspraxia, hypermobility spectrum disorder, and chronic cervicogenic headaches managed via physiotherapy. No major hospital admissions. Ongoing poor proprioception, frequent bruising from bumping into doorframes, and difficulty with fine motor tasks under time pressure.

Family Background

Who brought you up, and what was home life like while you were growing up?

Raised by both biological parents in a quiet, highly structured household in Surrey. Home life was predictable and calm.

What was the emotional nature of your relationship with your parents or carers? Supportive and practical, though emotionally reserved. Parents accommodated routines without questioning them.

Did siblings or other children live with you, and how did you relate to them? One younger brother (3 years younger). Relationship was parallel; rarely played together in childhood as the patient disliked the brother's unpredictable play style.

Has anyone in your family been diagnosed with autism, ADHD, or a mental health condition? Maternal nephew diagnosed with ASD at age 6. Father has no formal diagnosis but exhibits strong traits of rigidity and restricted interests (train timetables). Mother has a history of recurrent depressive disorder.

What are your family relationships like now?

Maintains positive, regular contact with parents via scheduled Sunday afternoon phone calls. Amicable relationship with brother, seeing him at structured family gatherings.

Social Communication (DSM-5 A1–A3 / ICD-11 Core)

When you were a child, how did you communicate your needs and interests?

Communicated basic needs clearly using formal language, or by leading adults by the hand when overwhelmed. Shared interests by delivering lengthy monologues about dinosaurs or space without checking if the listener was engaged.

Did you tend to begin conversations, or mainly respond to others?

Mainly responded to others; only initiated interaction to ask factual questions or share specific facts about personal interests.

Did people ever comment that your speech had an unusual tone, pitch, or rhythm? Peers and teachers frequently remarked that speech sounded flat, overly formal, or "like a textbook".

How do you experience eye contact and reading facial expressions at present?

Eye contact feels unnatural and distracting; usually looks at the bridge of the nose or mouth. Can identify extreme facial expressions (e.g., crying, anger) but struggles to interpret neutral or subtle expressions, often misinterpreting tiredness as hostility.

Does conversation feel spontaneous, or do you have to work out what to say?

Requires conscious, manual calculation. Relies on a mental flowchart of appropriate responses and small-talk questions.

Have people told you that you speak at length, move off topic, or provide excessive detail? Colleagues and partner frequently note a tendency to over-explain background details and struggle to summarise key points concisely.

How do you interpret sarcasm, humour, and indirect suggestions?

Takes indirect requests literally (e.g., failing to realise "It's cold in here" is a request to close a window). Understands dry or pre-signalled humour, but often misses spontaneous sarcasm in group settings.

Do you ever unintentionally copy or reflect the speech or behaviour of other people? Frequently absorbs and repeats phrases, accents, or vocal intonations from colleagues or television characters without realising until pointed out.

Do you mentally prepare what to say before social encounters?

Rehearses conversations extensively prior to meetings, phone calls, and medical appointments, drafting bullet points for even minor interactions.

CAT-Q Integration – Compensation

Do you deliberately observe other people’s behaviour so that you can imitate it or fit in? Actively studies socially successful colleagues in the office to copy their posture, greeting styles, and phrasing during team meetings.

Do you decide beforehand what you will say to reduce awkwardness or errors?

Pre-plans three to four safe small-talk topics (e.g., weather, weekend plans) before entering the staff kitchen.

Have you developed techniques such as smiling, nodding, or mirroring to look more socially typical? Uses a timed rule for eye contact (look for 3 seconds, glance at notes) and consciously forces a slight smile and nodding rhythm to signal active listening.

How much thinking does this require, and how do you feel afterwards—for example, depleted or anxious? Requires continuous high-level cognitive effort; results in severe mental depletion, tension headaches, and ruminative anxiety afterwards regarding whether the performance was convincing.

Have you noticed occasions when your outward social behaviour differs from your internal feelings? Frequently appears calm, agreeable, and engaged externally during work events whilst experiencing severe internal sensory overload and distress.

Social Interaction And Imagination

What kinds of play did you prefer as a child—playing alone, make-believe, or playing with others? Preferred solitary play. Arranged toys, Lego, and books by colour, size, and category rather than engaging in cooperative play with peers.

Did you invent stories or imaginary settings?

Did not invent original imaginary worlds; instead, recreated exact scenes from favourite books or documentaries with rigid adherence to the original plot.

When young, how readily could you understand other people’s feelings and intentions? Struggled significantly; often confused when peers became upset during games and failed to recognise when being teased by classmates.

How do you currently make sense of other people’s emotions?

Uses cognitive deduction based on context clues, vocal tone shifts, and past patterns rather than intuitive recognition.

Does showing empathy or responding emotionally feel instinctive or effortful? Feels deep internal concern when others are distressed (affective empathy), but knowing how to offer comfort verbally or physically feels awkward, scripted, and effortful.

Do you need time by yourself to recover after social contact?

Requires 1 to 2 hours of complete silence in a darkened room after a standard workday, and a full day alone to recover after a social gathering.

How do you form and sustain friendships and relationships now?

Maintains a small circle of two close friends met through shared structured hobbies (board gaming club). Sustains relationships via asynchronous text messaging rather than regular in-person meetups.

What aspects of relationships tend to be difficult or exhausting for you?

Unscheduled phone calls, group socialising, unspoken expectations, and navigating emotional conflict.

CAT-Q Integration – Masking

Do you conceal aspects of your personality or inhibit natural behaviours to avoid criticism? Suppresses hand-tapping and postural shifting in public, and avoids talking about intense interests to avoid being perceived as eccentric.

Have you acted as though you were more socially at ease or self-assured than you felt? Adopts a confident, outgoing "professional persona" when delivering presentations or meeting clients, despite high baseline social anxiety.

In public, do you deliberately alter your voice, gestures, or facial expressions to seem “normal”? Consciously modulates vocal pitch to sound warmer and more varied, and sits on hands or holds a pen tightly to prevent visibly fidgeting.

What effect does this have on your energy, mood, or feeling of being genuine afterwards? Leads to physical exhaustion, increased musculoskeletal jaw and neck tension, low mood, and a sense of alienation from one's authentic self.

Are there particular settings or people with whom you mask more intensely?

Masks most intensely in open-plan office environments, with senior management, and around extended in-laws. Masks least when alone or with long-term partner at home.

Restricted, Repetitive And Stereotyped Behaviours (DSM-5 B1–B4)

In childhood, did you make repetitive movements such as rocking, pacing, or moving your hands? Rocked back and forth while reading and flicked fingers near peripheral vision when excited.

Do you notice any such behaviours now, such as fidgeting, tapping, repeated phrases, or fixed postures? Taps fingers in symmetrical rhythmic patterns, clenches jaw, picks at skin around thumbnails, and sits with legs tightly crossed in fixed postures.

Do you follow daily routines or rituals, and what is your response when they are interrupted? Follows a strict morning and evening routine (exact same breakfast, commute route, and evening wind-down sequence). Interruption causes immediate irritability, panic, and an inability to transition to the next task.

How do you cope when plans or surroundings change?

Struggles with last-minute changes (e.g., cancelled trains or room changes at work); requires time to recalibrate and relies on backup plans to manage distress.

Which subjects or activities capture your attention very intensely?

Historical cartography, biomechanics/ergonomics, and complex strategy board games.

How much time do these interests occupy?

Spends 2 to 3 hours daily researching or engaging with these topics, and up to 8 hours per day on weekends, occasionally forgetting to eat or drink when hyperfocused.

What is your experience of sounds, lighting, smells, touch, and textures?

Hypersensitive to overhead fluorescent lighting (triggers migraines), overlapping background conversations, chewing sounds, strong artificial fragrances, and clothing tags. Seeks deep pressure input (uses a 7 kg weighted blanket).

Do you avoid or seek particular environments because they feel more or less comfortable to your senses? Avoids supermarkets during peak hours, busy pubs, and brightly lit retail stores. Seeks out quiet green spaces and dimly lit rooms.

Education And Employment

How was school for you in terms of learning and relationships?

Academically high-achieving in science, maths, and history. Socially isolated; spent breaktimes in the school library to avoid the playground noise.

Were you characterised as quiet, easily distracted, or oppositional?

Consistently described on school reports as "quiet, conscientious, and living in their own world".

Were changes between activities, group assignments, or unstructured periods difficult? Found group projects and unstructured lunch periods highly stressful; strongly preferred individual written assignments with clear marking rubrics.

How did teachers respond to the way you learned?

Teachers generally praised academic output and allowed the patient to work independently, though PE teachers were critical of poor ball skills and motor coordination.

As an adult, which subjects or work settings have suited you best?

Completed a BSc in Geography. Best suited to data analysis, GIS mapping, and remote or quiet solo working environments.

Have you required workplace changes, such as a quiet area or flexible hours?

Informally uses noise-cancelling headphones and works from home 3 days per week; currently seeking formal occupational health recommendations for a permanent desk in a quiet corner away from fluorescent tubes.

How do you handle organisation, punctuality, and deciding which tasks come first? Always punctual (typically 15 minutes early) due to anxiety about lateness. Uses detailed spreadsheets for organisation, but struggles with task prioritisation when given multiple competing verbal instructions without clear deadlines.

What tends to produce stress or overload during work or study?

Open-plan office noise, ambiguous project briefs, unexpected video calls, and managing interpersonal dynamics within the team.

CAT-Q Integration – Assimilation

Do you make efforts to blend in so that others do not see your differences?

Dresses in neutral, conventional office attire and forces participation in workplace social rituals (e.g., Friday pub trips for exactly one drink) to avoid standing out.

Have you concealed difficulties or avoided discussing autistic traits at work or in social situations? Conceals sensory discomfort and processing delays at work, attributing need for quiet rooms to "migraines" rather than sensory overload.

Do you fear judgement or rejection if people become aware of your difficulties? Worries that disclosing neurodivergent traits will lead management to view them as less capable of leadership or professionally unreliable.

Do you sometimes adopt others’ opinions or behaviour to avoid drawing attention? Frequently agrees with group consensus during casual office discussions to end the interaction quickly and avoid debate.

How do you feel when you are unable to maintain that social “performance”?

Feels exposed, embarrassed, and inadequate if fatigue causes the mask to slip (e.g., speaking too bluntly or going completely quiet in a meeting).

How might life feel if masking or assimilation were no longer necessary?

Believes it would significantly reduce chronic physical tension, free up cognitive energy for productive work and hobbies, and improve overall mental wellbeing.

Health, Sleep, Appetite And Medication

What is your sleep pattern at present?

Takes 60 to 90 minutes to fall asleep due to racing thoughts and sensory decompression. Averages 6 hours of sleep per night (00:30 to 06:30).

Did you have sleep difficulties as a child?

Severe initial insomnia throughout childhood; required a rigid bedtime routine and white noise from a fan to fall asleep.

How would you describe your appetite and your relationship with eating?

Eats predominantly for function rather than pleasure; relies on a narrow rotation of "safe", predictable meals and often misses lunch due to poor interoceptive awareness of hunger cues.

Are particular tastes or textures difficult for you?

Strong aversion to slimy, gelatinous, or mixed textures (e.g., mushrooms, porridge, casseroles with visible onions). Prefers dry, crunchy, and plain foods.

Do you have any long-term physical health conditions?

Developmental coordination disorder (dyspraxia), hypermobility spectrum disorder, and episodic tension-type headaches.

Which medicines or supplements do you take, and what effects do they have?

• sertraline 50 mg PO OD (reduces baseline generalised anxiety and rumination)
• sumatriptan 50 mg PO PRN (effective for acute migraines)
• colecalciferol (vitamin D3) 1,000 IU PO OD (maintenance supplement, nil side effects)

What is your use of caffeine, alcohol, nicotine, or other substances?

Drinks 2 cups of filter coffee before 11:00 daily. Alcohol: 1 to 2 units per month socially. Non-smoker; nil recreational substance use.

Mental Health And Emotional Regulation

Have you explicitly been diagnosed with anxiety, depression, or another mental health condition? Diagnosed with generalised anxiety disorder (GAD) and moderate depressive episode by GP in 2019.

What do you do when you are stressed or emotionally triggered?

Withdraws from interaction, seeks a quiet space, and engages in cataloguing or organising tasks to regain a sense of control.

Have you had experiences of meltdowns or shutdowns?

Experiences shutdowns approximately once or twice a month following cumulative overload: becomes non-verbal, feels physically heavy/immobile, and retreats to bed for several hours. Had occasional crying/shouting meltdowns in childhood when routines were disrupted.

Can you identify early indications that you are becoming overloaded?

Increased neck and shoulder muscle stiffness, heightened irritability to small sounds, difficulty finding words, and clumsy motor control (dropping objects).

What helps you return to your usual state?

Dim lighting, silence, deep pressure from a weighted blanket, Gentle stretching exercises prescribed by physiotherapist, and engaging with cartography books.

Have you experienced trauma, bullying, or rejection?

Experienced sustained verbal teasing and social exclusion during secondary school (ages 11 to 14) for being "weird" and uncoordinated in sports.

Have you noticed whether masking is followed by exhaustion or low mood?

Direct correlation noted: days requiring high levels of social masking (e.g., all-day workshops) are consistently followed by severe physical fatigue, low mood, and shutdowns the following evening.

Risk And Safeguarding

Have you ever had thoughts about self-harm or suicide?

Experienced passive suicidal ideation ("wishing to go to sleep and not wake up") during a period of severe occupational burnout in late 2019. Nil history of self-harm.

Have you acted on those thoughts or sought assistance?

Never acted on thoughts; sought help from GP in 2019, commenced sertraline, and engaged in talking therapy.

Have you been involved in physical fights, arrests, or official warnings?

Nil forensic history, arrests, warnings, or physical altercations.

Have you ever felt unsafe or been exploited by others?

Was financially taken advantage of by a university acquaintance who borrowed £400 and never returned it due to the patient's difficulty refusing direct requests.

Do you feel at risk currently?

Nil current thoughts of self-harm or suicide; feels safe at home.

What people, services, or other supports help you feel safe?

Supportive partner (David), understanding parents, regular physiotherapy sessions, and stable housing.

Strengths, Interests, Values And Goals

Which personal strengths and abilities do you appreciate in yourself?

High attention to detail, pattern recognition, reliability, loyalty in relationships, and strong analytical problem-solving skills.

Which interests or activities bring you pleasure or calm?

Collecting and studying antique maps, solo trail walking, strategy board games, and assembling intricate scale models.

What principles or values influence your choices?

Honesty, fairness, accuracy, and autonomy.

What would you like to achieve in the short and long term?

Short-term: secure workplace adjustments and reduce daily sensory/cognitive overload. Long-term: transition into a specialist technical advisor role without line-management responsibilities, and maintain sustainable energy levels outside of work.

What does fulfilment or success mean to you?

Having a predictable, peaceful life with enough energy after work to enjoy personal interests and spend quality time with their partner without feeling chronically exhausted.

Is there anything else you consider important to mention?

Wants to emphasise that outward articulacy and professional qualifications have often led professionals to underestimate the severity of their daily internal struggles and sensory-motor fatigue.

Clinician Observation And Notes (To Be Completed Post-Session)

"Observe social reciprocity, eye contact, affect, tone, body language, and sensory behaviours."

"Note masking indicators: social rehearsing, imitation, delayed fatigue, self-conscious adjustments."

"Rate domains (0 = Typical, 1 = Mild, 2 = Clear, 3 = Marked/Impairing)."

"Record any evidence of compensatory or camouflaging behaviour during session."