Paediatrics – Development and Behaviour Pathway – Autism
The Paediatric Core Diagnostic team
The team includes professionals such as paediatricians, speech and language therapists, occupational therapists, psychologists and specialist nurses.
Paediatricians are doctors who manage medical conditions affecting infants, children and young people.
Speech and language therapists provide life-changing treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. They help people who, for physical or psychological reasons, have problems speaking and communicating.
Occupational therapists work with people of all ages and can look at all aspects of daily life in your home, school or workplace. They look at activities you find difficult and see if there's another way you can do them. For the ASD assessment the OT can look at how an individual’s sensory systems work and how that impacts home and school
Clinical psychologists work with people of all ages on a wide range of psychological difficulties in mental and physical health.
Specialist nurses support children, young people and their families, with a diagnosis of, or undergoing assessment of a neurodevelopmental condition. This can include attention deficit hyperactivity disorder (ADHD/ADD), Autism Spectrum Disorder (ASD), and associated difficulties at home or in school.
Referral and assessment
If you are concerned about your child then please speak to your child’s nursery, school setting or GP. They will be able to make a referral to the ASD pathway.
We accept referrals when there are concerns about a child to do with:
- Communication
- Social interaction
- Difficult or unpredictable behaviour
- Difficulty with daily tasks
We try to find out whether there is a developmental problem affecting the child’s learning and behaviour. This includes assessments for autism.
Our assessments include:
- Completing questionnaires
- Gathering information from school/pre-school/nursery
- Meetings with yourself and your child to review and assess their development
What you can expect
Unfortunately there are currently long waiting times for assessment. We are very sorry about this wait and are trying hard to improve it.
Between referral and assessment you can access our 'Understanding behaviours that challenge' Workshop. This is a live workshop using Microsoft Teams. Please email asd.forms@dchft.nhs.uk to express your interest. We will then contact you with the date of the workshop and an invite to access it.
We may send questionnaires to you, your child’s school, pre-school or nursery to complete and return. If you receive these, this information needs to be returned prior to your assessment appointment.
What happens during an assessment
The assessment process is usually made up of a few appointments.
It is recommended that autism assessments are multi-disciplinary where possible (i.e. at least two different professionals should be involved). For example, your child may see a Paediatrician and Speech and Language Therapist.
In your first appointment you will meet with a clinician who will gather information from you about your child’s development as well as their current strengths and difficulties.
They will also observe your child’s communication, social interaction and play/interests.
It can be helpful to bring your child’s red book along to this appointment.
Social story – attending an appointment (face to face)
Following this appointment your child will often be invited to attend further assessment. This may include:
- a face-to-face meeting with the clinician (if your initial appointment was via Attend Anywhere)
- a specialist speech and language assessment
- an ADOS (Autism Diagnostic Observation Schedule) – see below for more information
- a cognitive assessment
- a meeting with another member of the team e.g. Paediatrician/Clinical Psychologist/Educational Psychologist
- a school observation
We will also review the information provided from the questionnaires completed before the assessment and from other professionals (health visitor/teacher) who know your child.
Once we have gathered and considered all the information we will invite you to a feedback appointment.
Information about the ADOS-2 (Autism Diagnostic Observation Schedule-2)
Your child may be invited for an assessment of their social communication skills as part of the Core Diagnostic Process.
The assessment they will complete is called the ADOS-2 (Autism Diagnostic Observation Schedule-2) and it is an opportunity for us to observe your child/young person’s communication and social interaction skills whilst at play, in conversation, or when making imaginative use of materials. We will also be looking out for any restricted and repetitive behaviours.
As this assessment is used across the age-range, it does contain activities suitable for younger children as well as questions for older children. We try to explain this to our older teenagers to help them feel at ease.
For pre-school and non-verbal children, the assessment is designed to include a parent or carer and we ask that you bring a choice of two snacks on the day as well as a drink.
For school-age children and young adults the assessment is designed to take place without a parent present and no snack is required.
Some of our young people may worry about being seen on their own. We are happy to talk this through with them and if they are unable to manage it, we will of course support your child’s decision to have you present. However we do ask that you do not contribute or comment during the assessment, as we are specifically trying to observe the child’s responses.
The appointment can often be quite tiring for your young person. For this reason we do not offer additional time to discuss other issues or concerns with yourselves. In addition, the clinicians administering the ADOS need to score it immediately following the appointment.
Should there be anything you need to discuss, a separate telephone consultation can be arranged.
Please do not hesitate to contact us if you have any questions or require further information.
What happens after the assessment
Once an assessment is complete, parents and carers are given information about support available at home and at school.
A number of children who come in for an autism assessment will not receive a diagnosis of autism. If this is the case we will discuss your child's strengths and difficulties and make recommendations about further sources of support your child should receive.
Many of the children we see have other difficulties in addition to or instead of autism that may need further assessment. If this is the case we will refer your child onto the relevant services.
If your child is given a diagnosis of autism
You will be told during your feedback appointment if your child meets the criteria for a diagnosis of autism. The team will explain more about autism spectrum disorder (ASD) and how it might affect your child.
You will also be given information about the support you and your child can get in your local area. For example, you may be given contact details for support groups that can give you the opportunity to meet other families with experience of ASD, and advice about other services that are available.
The team will share information from the assessment with your child’s GP, and if you agree, with your child’s school or other professionals if appropriate, to help them offer you the support you need.
Following your feedback appointment you will receive a letter confirming the diagnosis and the next steps. This letter can be used as evidence of a confirmed diagnosis.
You will be given information about the Autism online workshop.
You will be sent a link to the autism advice and resource pack. This will include information about autism and what support services are available in the local area and nationally.
You may be offered ongoing follow-up by doctors if there are ongoing medical concerns such as extremely restricted eating, significant sleep difficulties, emotional or mental health difficulties or other developmental conditions such as ADHD (Attention Deficit Hyperactivity Disorder), developmental impairment or motor coordination difficulties that need further assessment or monitoring.
If there are no ongoing medical concerns your child will be discharged, but we will always accept a referral back if anything changes for your child in the future.
Useful links
CAMHS – what is the child and adolescent mental health service?
What is Autism? – an online workshop about autism
Ambitious about Autism – a toolkit to guide parents and carers through their child’s journey
Autism Unlimited – A Dorset-based charity who support children and young people with autism and their parents/carers
National Autistic Society Earlybird programme – a parenting support programme for parents/carers of autistic children
The Local Offer – find other local services and support groups
National Autistic Society – after diagnosis leaflet - information for parents/carers of children with autism