Choosing an Observer for an Adult Clinical Assessment

How to choose an observer whose perspective fits the purpose of the assessment.

Key takeaways 

• The best observer depends on the purpose of the assessment. Someone who knew the client during childhood may provide different information from someone who knows them well today. 

• No single observer has the full picture. Different observers may see the client in different settings or at different points in their life, so more than one observer may be helpful. 

• Differences between self and observer ratings can be meaningful. They can provide useful information about how the client’s experiences and functioning vary across perspectives and situations. 

What makes someone the right observer for an adult clinical assessment? It may be tempting to assume that the person closest to the client is automatically the best choice. But familiarity alone does not mean that someone has seen the behaviors or situations most relevant to the assessment. A useful observer generally knows the client well, has had opportunities to observe the kinds of behaviors the assessment asks about during the relevant time period, and can provide thoughtful and honest information. 

The best choice depends on the purpose of the assessment. Someone who knew the client as a child may provide important developmental context, while someone in the client’s life now may be better able to describe their current day-to-day functioning. The clinician and client can work together to decide which perspective would be most useful. 

Why include an observer?

A comprehensive clinical assessment often draws on information from more than one person because no single perspective captures the full picture of a client’s experiences and functioning. Self-report measures can capture experiences that others may not see or know about, including the effort required to complete everyday tasks, how distressing certain situations feel, concerns they may not have shared with others, and the strategies the client uses to manage or hide difficulties.  

At the same time, clients may not always recognize when a longstanding pattern is unusual or contributing to difficulty. When a pattern has been part of the client’s experience for much of their life, it may simply feel normal to them. An observer can add another perspective by noticing patterns across situations and describing how certain behaviors or difficulties affect the client’s work, responsibilities, or relationships. 

Self- and observer reports often provide overlapping but not identical information, which is why many clinical assessments collect information from more than one source.¹ Observer ratings are meant to complement the client’s own account, not replace it. Measures such as the Autism Spectrum Rating Scales™ Adult (ASRS® Adult) and Conners Adult ADHD Rating Scales™ 2nd Edition (CAARS™ 2) include both self-report and observer forms. These forms are only one component of a broader clinical assessment, which may also include interviews, clinical observations, and other sources of information. Rating scales can provide useful information about symptoms and functioning, but they do not determine a diagnosis on their own. 

Identifying the most useful perspective 

The observer’s relationship to the client is only one consideration. It is also important to consider what the person has directly observed and whether that perspective is relevant to the purpose of the assessment. The clinician can help the client consider which settings, behaviors, or periods of life matter most for the assessment. The client can then identify someone who has firsthand knowledge in that area.  

Childhood and developmental history 

When developmental history is relevant, the clinician may suggest choosing an observer who knew the client during childhood. This could be a parent, caregiver, older sibling, another relative, or another adult who knew the client well at that time. Information about early development can be particularly relevant in assessments for neurodevelopmental conditions, such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder, where clinicians consider whether certain characteristics were present early in life. Some characteristics associated with autism may also become less noticeable to others with age, making information about the client’s early development particularly valuable.²  

However, someone who knew the client during childhood may have limited knowledge of current functioning. When possible, adult ADHD guidance recommends gathering information from someone who knew the client as a child and someone who knows the client well today.³ Guidance for adult autism assessments similarly supports gathering information about early development, current functioning, or both from people who knew or know the client well.⁴  

An observer who has known the client across several life stages may also be able to describe how the client’s behavior and functioning have changed over time. If no suitable childhood observer is available, clinicians may draw on other sources of developmental information, including interviews with the client, school records, or previous assessments. 

Current settings and functioning 

For information about the client’s current life, consider which settings matter most for the assessment. A partner, roommate, sibling, or close friend may be able to describe the client’s routines, organization, communication, and relationships. A coworker, supervisor, or educator may know more about how the client handles tasks, deadlines, and demands at work or school. Someone may know the client very well in one setting but have little knowledge of another. 

The most useful observer is often the person who regularly sees the behaviors most relevant to the concerns being assessed. The clinician may suggest a type of observer, such as a family member, friend, partner, or coworker, and the client can then decide which specific person to ask.  

Because each observer sees only part of the client’s life, using more than one observer across different settings can provide a more complete picture. For example, ratings from both a partner and a coworker may help the clinician understand whether similar difficulties occur at home and at work or are more noticeable in one setting. If the assessment covers both early development and current functioning, it may be helpful to include one observer who knew the client during childhood and another who knows them well today. 

Privacy, comfort, and response quality 

The client should be comfortable involving the person they choose. This level of familiarity is especially important when considering a coworker, supervisor, or someone else whose involvement may require the client to share private information. Before contacting an observer, the clinician and client can discuss privacy, consent, and what the observer will be asked to do.  

A useful observer should be able to describe what they have noticed, including both strengths and difficulties, without trying to shape the outcome. If someone has little contact with the client, sees the client only in a very limited setting, or may struggle to give a balanced or honest view, another observer may be able to provide more useful information.  

When self and observer ratings disagree 

Differences between self and observer ratings can be clinically meaningful. Disagreement does not necessarily mean that one person is right and the other is wrong.  Instead, the client and observer may interpret the same situation differently, observe the client in different situations, notice different aspects of the same behavior, or have access to different information.  

For example, a client may experience substantial internal effort, sensory discomfort, uncertainty, or exhaustion while appearing outwardly composed. An observer may notice missed deadlines, difficulty staying organized, or communication differences without knowing what the client is experiencing internally. Differences may also reflect how often the observer sees the client, the situations they share, changes over time, or strategies the client uses to compensate or camouflage.  

Differences can go in either direction. In one study, caregivers of autistic adults described more difficulty with everyday living skills than the adults reported for themselves.⁵ Other studies found that adults reported more autism-related traits than their observers did, with this difference particularly notable among women.^6,7  

Clinicians can explore these differences through follow-up questions and consider what each perspective reveals about the client’s experiences and functioning. Because differences between self and observer ratings are common¹, clinicians may also want to discuss this possibility with clients in advance. Rather than treating differing ratings as a problem that must be resolved, clinicians can use them to develop a more complete and context-sensitive understanding of the client.  

A quick decision guide 

When helping a client choose an observer, consider these questions: 

• Familiarity: Does this person know the client well enough to recognize recurring patterns in their behavior? 

• Frequency: Does this person interact with the client often enough to provide informed ratings? 

• Context: Has the observer seen the client in settings relevant to the assessment? 

• Specificity: Can this person describe things they have actually observed and provide honest, concrete examples? 

• Timing: If developmental history is important, did the observer know the client during childhood? 

• Coverage: Would an additional observer contribute meaningful information from another life period or setting? 

• Comfort and Privacy: Is the client comfortable involving this person, and have privacy or disclosure concerns been addressed?  

No one person needs to fit every criterion. The clinician can focus on the perspective that matters most, suggest more than one type of observer, or use another source of information. 

Bringing the perspectives together 

There is no single best observer for every adult clinical assessment. The most useful choice is someone who has had opportunities to observe the client during the time period and in the situations most relevant to the assessment, whether that involves childhood development, current functioning, or both. Using more than one observer can help cover different settings and life periods.  

Observer ratings may support the client’s account, add context, or highlight meaningful differences between perspectives. The information they provide should be considered alongside the client’s own account and the other parts of a comprehensive clinical assessment. Together, these different perspectives can contribute to a more complete understanding of the client. 

 

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References 

¹ Achenbach, T. M., Krukowski, R. A., Dumenci, L., & Ivanova, M. Y. (2005). Assessment of adult psychopathology: Meta-analyses and implications of cross-informant correlations. Psychological Bulletin, 131(3), 361–382. https://doi.org/10.1037/0033-2909.131.3.361  

² Bal, V. H., Kim, S.-H., Fok, M., & Lord, C. (2019). Autism spectrum disorder symptoms from ages 2 to 19 years: Implications for diagnosing adolescents and young adults. Autism Research, 12(1), 89–99. https://doi.org/10.1002/aur.2004  

³ Adamou, M., Arif, M., Asherson, P., Cubbin, S., Leaver, L., Sedgwick-Müller, J., Müller-Sedgwick, U., van Rensburg, K., & Kustow, J. (2024). The adult ADHD assessment quality assurance standard. Frontiers in Psychiatry, 15, Article 1380410. https://doi.org/10.3389/fpsyt.2024.1380410  

⁴ Wigham, S., Ingham, B., Le Couteur, A., Wilson, C., Ensum, I., & Parr, J. R. (2022). A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults. Autism, 26(8), 1959–1972. https://doi.org/10.1177/13623613211073020  

⁵ Sandercock, R. K., Lamarche, E. M., Klinger, M. R., & Klinger, L. G. (2020). Assessing the convergence of self-report and informant measures for adults with autism spectrum disorder. Autism, 24(8), 2256–2268. https://doi.org/10.1177/1362361320942981  

⁶ Pagán, A. F., Izuno-Garcia, A. K., Hughes, K. R., Chapman, K. S., & Loveland, K. A. (2024). Self- and informant report in a first-time diagnosis of autism spectrum disorder in adulthood: The role of females. Advances in Neurodevelopmental Disorders, 8(4), 536–546. https://doi.org/10.1007/s41252-023-00371-0  

⁷ Taylor, S. C., Gehringer, B. N., Dow, H. C., Langer, A., Rawot, E., Smernoff, Z., Steeman, S., Almasy, L., Rader, D. J., Bučan, M., & Brodkin, E. S. (2024). Contrasting views of autism spectrum traits in adults, especially in self-reports vs. informant-reports for women high in autism spectrum traits. Journal of Autism and Developmental Disorders, 54(3), 1088–1100. https://doi.org/10.1007/s10803-022-05822-6