The following advice is adapted from NICE Guideline CG128, Autism in under 19s: recognition, referral and diagnosis. [http://www.nice.org.uk/guidance/cg128/chapter/1-recommendations]
If the referral describes regression in language in a child over 3 or regression in motor skills at any age, forward the referral to a paediatrician or paediatric neurologist for an initial opinion. They can then refer back to the autism team if necessary.
If the referral describes regression in language in a child under 3, carry out an autism assessment.
If neither of above apply, then take into account the following when deciding whether to assess for ASD.
- the severity and duration of the signs and/or symptoms
- the extent to which the signs and/or symptoms are present across different settings (for example, home and school)
- the impact of the signs and/or symptoms on the child or young person and on their family or carer
- the level of parental or carer concern, and if appropriate the concerns of the child or young person
- factors associated with an increased prevalence of autism
- the likelihood of an alternative diagnosis.
If there is insufficient information to make a decision, seek further information from the referrer or other healthcare professionals.
If the referral is accepted, and if the parents/carers consent, also seek additional information from school/college as well as any other involved health or social care professionals. This should include results from any vision or hearing assessments.
Upon acceptance of the referral, appoint a case coordinator and aim to begin diagnostic assessment within 3 months of referral. If the child or their family have identified support needs, do not wait for diagnosis in order to put in place support.
Consider carrying out home or school observations of the child, or alternatively obtaining video recordings of home or school.
The role of the case coordinator should be to:
- act as a single point of contact for the parents or carers and, if appropriate, the child or young person being assessed, through whom they can communicate with the rest of the autism team
- keep parents or carers and, if appropriate, the child or young person, up-to-date about the likely time and sequence of assessments
- arrange the provision of information and support for parents, carers, children and young people as directed by the autism team
- gather information relevant to the autism diagnostic assessment