Individualizing Autism Evaluations: The Visual Framework

When it comes to evaluating a child who falls somewhere on the autism spectrum, traditional assessments, while helpful, oftentimes do not give clinicians and other professionals enough information to form an effective treatment plan. According to Marilyn J. Monteiro, Ph.D., in her article “Autism Evaluations: Tools to Individualize the Diagnosis,” these general clinical assessments are limited and can sometimes produce conflicting results, which leaves the evaluator with the task of trying to piece together the results in such a way to form some sort of conclusion—even if that conclusion isn’t completely accurate.

Because of this, more emphasis is being placed on creating individualized evaluations that give a more complete picture of a child’s autism brain style. Dr. Monteiro argues that taking the time to get a more individualized understanding of a child is essential to helping them achieve their full potential, because it provides insight to the different strengths and challenges they face in terms of communicating, socializing, expressing emotions, and more. These strengths and challenges can then be evaluated in a way that leads to an individual understanding of that child’s specific needs.

The Visual Framework for Evaluation

To avoid condensing a child’s experience with ASD into a collection of “rating scales and checklists,” Dr. Monteiro suggests incorporating the use of what she calls the Visual Framework.  She defines this framework as “a way to translate the global diagnostic criteria into descriptive, accessible terms for parents and teachers, emphasizing the use of positive language.” In other words, it takes the possible outcomes or observations of clinical assessments and turns them into plain language that parents and teachers can use to better explain a child’s unique ASD experiences.

How does the application of the Visual Framework look in action? It should be used to foster a conversation—using positive terms—to discuss the individual. The three main areas of discussion should be:

  • Language and communication
  • Social relationships and emotions
  • Sensory use and interests


Consider a child with repetitive behaviors such as an intense focus on drawing the same picture. This behavior is a perfect opportunity to discuss sensory use and interests. Instead of focusing on the singular behavior as a negative outcome of their ASD, consider how the act of drawing this shape could actually benefit their ability to understand visual shapes, behavior regulation, and more.

By having this discussion with those who know the child using the Visual Framework, instead of relying strictly on results from a clinical assessment, a more accurate evaluation of the individual’s condition can be made. Choosing to report observations in positive, descriptive language will help lay the groundwork for successful coping strategies.

The MIGDAS-2 is a wonderful tool for helping parents, teachers, and clinicians understand how to facilitate a sensory-based interview and use the descriptive language that can be used to compare a child’s behavior in each of the three key areas previously discussed.

Assessments That Work with the Visual Framework

Dr. Monteiro acknowledges that a balance between conversation, observation, and assessments will provide the best way to evaluate an individual on the autism spectrum. One such assessment that takes into account the importance of observation and dialogue in aligning a person with global ASD criteria is the ADOS-2. This assessment has five modules to help evaluate persons from one year to adulthood by having the individual engage in a variety of situations to demonstrate their strengths and challenges.

This assessment is highly respected by clinicians and is an excellent choice for working in conjunction with Dr. Monteiro’s Visual Framework for individualized ASD evaluation.