What is the MIGDAS-2 Autism Assessment? What to expect before, during, and after.
For a lot of people, the journey towards their autism assessment doesn’t start with certainty. It starts with exhaustion, going down the Google rabbit hole at 2 a.m., or feeling “different” but not having words for it. It’s years of masking, adapting, performing, compensating, over-explaining, and misunderstanding.
And the idea of finally being evaluated can be both terrifying and relieving.
Many people come into the process carrying the fear that they’re about to be analyzed, judged, reduced to a checklist, or told that they’re “not autistic” because they’ve gotten so good at hiding it. That’s part of why the MIGDAS-2 assessment feels different for so many people.
But, it isn’t designed to catch you doing autism “wrong”, it was created to understand how you experience the world.
What is the MIGDAS-2?
The MIGDAS-2 (short for the Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition) is a sensory-based autism assessment tool used with children, adolescents, and adults. Rather than relying entirely on rigid testing and observation tasks, it uses conversation, sensory experiences, and qualitative interview to build a fuller picture of someone’s internal experiences and relational patterns.
In simpler terms, it’s an assessment that cares about how autism feels from the inside, not just how it looks from the outside.
The process explores three primarily areas commonly associated with autism:
Sensory experiences and interests
Communication and language style
Social and emotional patterns
Unlike some older models of assessment that focus heavily on deficits or “abnormal” behaviors”, the MIGDAS-2 is often described as more neurodiversity-affirming and strengths-based.
For many adults (especially women, LGBTQ+ individuals, highly masking people, or those who were overlooked in childhood) this difference matters deeply.
Why Some Clinicians Use the MIGDAS-2
Autism doesn’t look the same in every person. The MIGDAS-2 allows clinicians to gather information in a more flexible and individualized way. It includes interviews with the person being evaluated, and often caregivers, teachers, partners, or family members when appropriate.
Instead of asking someone to fit neatly into a standardized performance, the clinician is looking for patterns like:
sensory processing differences
communication style
emotional regulation
relationship patterns
special interests
masking behaviors
internal experiences that may not be outwardly obvious
For many people, especially adults who have spent years “passing,” this approach can feel more approachable.
What Happens Before a MIGDAS-2 Autism Assessment?
The “before” part is often emotionally heavier than people expect. Because once you start seriously considering autism, a lot of memories begin rearranging themselves. Childhood experiences suddenly look different, burnout can start making more sense, relationships can make more sense, and exhaustion can make more sense.
Some people feel relief before the assessment. Others feel grief. Some feel both at the exact same time!
Practically speaking, before the assessment you may be asked to:
complete questionnaires
fill out developmental history forms
provide school records or prior evaluations
identify patterns from childhood to adulthood
invite caregivers, parents, partners, or teachers to provide observations when possible
This part can bring up complicated feelings, especially for adults who:
don’t have supportive family members
were misunderstood growing up
experienced trauma
learned to hide their needs early
don’t remember childhood clearly
A good clinician understands this.
What Happens During the Assessment?
The MIGDAS-2 assessment itself is typically conversational and interactive. Depending on age and communication style, the clinician may use:
open-ended discussion
storytelling
sensory materials
visual prompts
questions about interests, relationships, routines, communication, and sensory experiences
For children, this may look more play-based and for adults, it often feels more like an in-depth guided conversation.
It’s important to note that there usually are not “right” answers and the clinician is not grading your personality. They are looking at patterns:
how you describe experiences
how you process emotions
how sensory input affects you
how communication feels internally
how relationships function for you
where effort, confusion, masking, or overwhelm show up
For many autistic adults, this can feel unexpectedly emotional because it may be one of the first times someone is asking questions that actually reflect their lived reality. Questions like:
“What does eye contact feel like for you?”
“How do you recover after social interaction?”
“What sensory experiences feel overwhelming or regulating?”
“How do you know what people mean in conversation?”
“What happens internally when routines change?”
What Happens After the Assessment?
Afterward, the clinician reviews the information gathered and compares & contrasts how the person’s traits are similar or different to the general experience of those on the autism spectrum.determines whether the person meets diagnostic criteria for autism spectrum disorder.
Many clinicians using the MIGDAS-2 create narrative-style reports that describe the person’s unique “brain style” and lived experience, rather than only listing symptoms or deficits.
Depending on the provider, feedback sessions may include:
diagnostic conclusions
explanation of findings
recommendations for support or accommodations
discussion of sensory needs
therapy recommendations
educational or workplace accommodations
resources for autistic adults, teens, children, or families
Emotionally, the aftermath can sometimes be complicated.
Even when the diagnosis feels validating, people often experience:
relief
grief
anger
clarity
exhaustion
sadness for younger versions of themselves
confusion about identity
a deep sense of recognition
This could leave you saying “I finally understand myself” or “I don’t know who I am without masking.”
This Doesn’t Change Who You Are
The MIGDAS-2 test is not a diagnosis and can be done completely separate from the diagnostic process. It is an insight into your traits and how they compare with someone on the autism spectrum.
Whether or not the MIGDAS-2 test is part of your diagnostic process, the assessment process does not invent a new person. It names patterns that already existed. It’s about finally having language for experiences they’ve carried their entire lives.
Because when people don’t have accurate language for their nervous system, sensory needs, emotional processing, or communication style, they often build identities around shame instead.
“Too sensitive.”
“Too intense.”
“Too rigid.”
“Too awkward.”
“Too much.”
“Too dramatic.”
“Too difficult.”
An affirming assessment process can begin separating identity from shame.
Is the MIGDAS-2 Better Than the ADOS-2?
The ADOS-2 is a highly standardized autism assessment tool often considered part of the “gold standard” in autism evaluations. The MIGDAS-2 is more qualitative, sensory-based, and narrative-focused. Some clinicians use one, some use the other, and many use them together as part of a comprehensive evaluation.
The “best” assessment depends on:
the clinician’s training
the client’s age
communication style
masking patterns
developmental history
the complexity of the presentation
For many adults (particularly highly masking adults) the MIGDAS-2 can offer space for experiences that might not appear clearly in highly structured testing alone.
Final Thoughts
If you’re considering an autism assessment, there’s a good chance you’ve already spent years trying to understand yourself. Depending on where you live, I may be able to help you. See my clinical offering page to learn more about what I provide.
