Many people feel their whole lives that they function differently, though they cannot name it. Harder relationships, sensory overload, exhaustion after social contact. In adulthood the question arises, could this be the autism spectrum. ACIA is a tool that helps to search for the answer reliably.
What is ACIA?
ACIA is a structured diagnostic interview used in assessing the autism spectrum in adults. It orders the conversation so that we can learn the developmental history and current functioning of the person assessed consistently and thoroughly. Instead of a loose chat we have a considered set of areas and questions, so that nothing important slips away and the conclusions rest on concrete examples from life.
Why is a diagnosis in adulthood difficult?
Adults on the spectrum spend years learning to cope with difficulties. They develop strategies, copy other people's behaviour, mask their reactions. We call this phenomenon masking, and we write about it more in the article on masking in the spectrum. Masking means the symptoms become less visible, and classic tools, designed mainly with children in mind, may not catch them. That is why, in assessing adults, we need an approach that takes into account life history and subtler signals.
Who is ACIA for?
The interview is helpful for adults who:
- suspect they are on the autism spectrum and want to check this reliably,
- have long felt that they function differently but were never assessed,
- experience sensory overload, difficulties in relationships or after social contact,
- previously received other diagnoses that do not explain the whole of their difficulties,
- want to understand themselves better and consciously care for their needs.
For many adults, recognising the spectrum is a relief rather than a verdict. It gives a language to talk about their needs, allows them to stop blaming themselves for difficulties and to plan support consciously.
What does the interview look like, step by step?
ACIA is conducted by a trained diagnostician in a calm, safe atmosphere. The conversation covers, among others:
- Developmental history. Early childhood, speech, play, relationships and signals that may have appeared even then.
- Communication and relationships. The way of communicating, understanding social situations, building and maintaining relationships.
- Patterns of behaviour and interests. Routines, the need for predictability, intense interests, sensory sensitivity.
- Everyday functioning. Work, study, independence, coping with stress and overload.
Why an interview with an informant?
In assessing the spectrum, the perspective of someone who knows the person assessed from another side is very helpful, for example a parent who knows the developmental history or a partner who observes everyday life. We call such a person an informant. Their account complements the picture, because some behaviours are hard to describe oneself, and some patterns are only visible from the outside. We arrange the informant's participation individually, always with the consent of the person assessed.
ACIA, ADOS-2 and ADI-R
No single tool is enough to make a spectrum diagnosis. That is why we treat ACIA as one element of a process, which we most often combine with clinical observation and a second interview. The ADOS-2 assessment is a structured observation of behaviour in direct contact, and the ADI-R interview deepens the developmental history. ACIA, ADOS-2 and ADI-R complement one another, giving a picture from several sides, so that the diagnosis is fuller and more certain.
A reliable spectrum diagnosis rests on several sources of information at once, observation, interview and developmental history. A single result never decides on its own.
What happens after the interview?
We analyse the information gathered against the diagnostic criteria and known patterns of functioning on the spectrum. We then prepare a written diagnosis or opinion, which we discuss during a meeting. We explain what the result means in practice and consider the next steps together, from psychoeducation, through psychological support, to concrete everyday strategies.
Why get a diagnosis as an adult?
A natural question arises, why a diagnosis if one has functioned somehow for years. The answer is simple, "somehow" usually means an enormous, invisible cost. A diagnosis allows that cost to be lowered. It gives an understanding of one's own reactions, removes the burden of self-blame, makes conversation with loved ones and an employer easier, and helps choose support that truly fits. Many people say that only after a diagnosis did they begin to treat themselves with more kindness.
Frequently asked questions
Is ACIA enough to recognise autism?
No. ACIA is an important element, but a full diagnosis is made on the basis of the whole clinical picture, most often combining the interview with observation and information from a close person.
How long does the interview take?
It depends on the amount of information and the individual situation. We usually plan the whole adult spectrum assessment across several meetings, the details of which we agree at the start.
Do I have to come with a parent?
Not always. An informant's participation can be very helpful, but is not always necessary. We agree this together, respecting your decision and privacy.
Considering a spectrum assessment?
Book a consultation. We will calmly talk through your doubts and suggest what the assessment process might look like.
This article is for information only and does not replace a consultation or assessment. For an individual assessment, see the ADOS-2 assessment and ADI-R interview pages.