Purpose of review Early autism diagnosis is especially difficult when developmental history or caregiver input is unavailable (e.g., displaced, institutionalized, or orphaned children). We synthesize observation-first, clinician-led approaches and regulated, technology-enabled aids that minimize reliance on collateral history. Recent findings Standardized direct observation (e.g., ADOS-2 modules that do not require a caregiver) can support diagnosis when history is limited, but feasibility hinges on training, cultural adaptation, and service capacity. Many legacy instruments predate DSM-5/DSM-5-TR, creating construct gaps. Recently cleared aids, an eye-tracking system for toddlers, and a software tool combining short videos, caregiver input, and clinician ratings, function as decision support rather than stand-alone diagnostics. Mobile and remote screening paradigms show promise but require independent, cross-cultural validation. Summary Diagnostic equity necessitates pathways that are effective when medical histories are incomplete. We outline a minimum dataset and a pragmatic workflow that replace caregiver reports with structured observations, school/residential collateral, and carefully integrated objective measures, under clinician synthesis. Priorities include updating legacy instruments, publishing brief observational batteries with known accuracy bounds, and validating tools across languages and contexts.
AlMuraikhi et al. (Tue,) studied this question.