Improving access to autism evaluations: Development of a specialty diagnostic evaluation clinic for youth in foster care

Youth in foster care experience high rates of developmental, behavioral, and mental health disorders, yet face barriers to assessment and intervention services. These challenges are exacerbated when Autism Spectrum Disorder (ASD) is a diagnostic consideration, given the overlap between ASD symptoms and those associated with trauma and other mental health disorders. Misdiagnosis can delay access to services and contribute to inappropriate placements or treatment plans. To address these gaps, the Foster Care Autism Diagnostic Entry Clinic (FC-ADEC), a trauma-informed specialty assessment clinic, was established to evaluate youth in foster care for suspected ASD and other neurodevelopmental and mental health conditions. Clinic protocols were developed and refined through pilot implementation and stakeholder feedback, integrating flexible test planning, multi-informant interviews, and diagnostic parsimony. Data were drawn from the first 18 months of clinic operation, during which 34 youth in state custody completed comprehensive evaluations. Following FC-ADEC evaluation, patients’ number of diagnoses decreased from 2.97 prior to the evaluation to 2.65. Neurodevelopmental disorders were identified in 94% of patients, most commonly ADHD (59%) and ASD (35%). Trauma- and stressor-related disorders were also prevalent (50%), with posttraumatic stress disorder present in 41% of cases. Notably, 58% of youth diagnosed with ASD also met criteria for PTSD, underscoring the need for trauma-informed assessment. The findings highlight the clinical value of a specialized diagnostic model for foster youth, characterized by interdisciplinary collaboration, expanded information gathering, and attention to both neurodevelopmental and psychosocial contexts.