Can Autism ADI‑R Miss High‑Functioning Autism?

PostedNovember 11, 2025

UpdatedNovember 11, 2025

ByMy Patient Advice

Author: Lucia Alvarez, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, ADI-R and high-functioning autism don’t always align perfectly. While the ADI-R (Autism Diagnostic Interview-Revised) is a gold-standard tool used to diagnose autism, it can sometimes miss more nuanced presentations. In cases of high-functioning autism, where individuals may show strong language skills or coping mechanisms, certain traits may not stand out during the structured interview.

Why the ADI-R Might Miss High-Functioning Autism

Here’s how diagnostic challenges can occur in individuals with high-functioning autism:

Subtle Symptoms:

People with high-functioning autism often have more refined social skills and language abilities, which can mask deeper difficulties. These subtle symptoms might not emerge clearly in the interview, leading to an underestimation of their struggles.

Mild Traits:

The ADI-R focuses on core autism traits that are usually more visible in early development. However, mild traits like social fatigue, sensory sensitivities, or internal distress, can go unnoticed if the person has learned to mask or manage them in certain environments.

Diagnostic Gaps:

The structured format of the ADI-R may not fully capture the complexity of an individual’s daily challenges. These diagnostic gaps can result in missed or delayed diagnoses, especially in older children or adults who have adapted to social expectations over time.

To ensure a well-rounded assessment, professionals often pair the ADI-R with observational tools and clinical judgement. For clearer insight and support, visit providers like Autism Detect for tailored consultations.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Autism Diagnostic Tools (e.g., ADI-R, ADOS-2).

Lucia Alvarez, MSc

Author

Lucia Alvarez is a clinical psychologist with a Master’s in Clinical Psychology and extensive experience providing evidence-based therapy and psychological assessment to children, adolescents, and adults. Skilled in CBT, DBT, and other therapeutic interventions, she has worked in hospital, community, and residential care settings. Her expertise includes grief counseling, anxiety management, and resilience-building, with a strong focus on creating safe, supportive environments to improve mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.