Autistic Spectrum Disorders in children and young people

Children & Family Health Devon co-ordinates the diagnostic pathway for Autistic Spectrum Disorders in Devon (excluding Plymouth) for children and young people aged 5 – 17.

For children aged under 5 please follow the under 5's pathway.

Anyone can refer onto the pathway including Schools and Parents who are often better placed to make a referral rather than a GP.

Prior to referral most children should have had an extensive early help assessment; this would normally be carried out within the school context and could include Educational Psychology input or other school support, or input from other health professionals e.g. Paediatrician, Speech and Language Therapy or Child Adolescent Mental Health Services (CAMHS).

A request for service will not be accepted if there is no clear evidence that the child or young person has signs or symptoms that are expected for Autistic Spectrum Condition (ASC) or when a Paediatrician or Psychiatrist does not support the request.

Once on the pathway the following steps will take place:

  • Collation of all information known about a child including any assessments
  • A medical assessment by a paediatrician
  • A developmental history from the parents and an evidence based assessment of the child
  • Further assessments if required e.g. cognitive or language

Following diagnosis a report will be shared with the family and a feedback meeting will take place, potentially at a team around the child meeting at their school.

Our aim is to complete this process in 12 months from referral to final feedback.

If you are unsure about anything you can access information and advice via the single point of access.

Assessment

Specific areas we will be looking for evidence of in the referral will include the following:

Essential signs
  • Evidence of persistent difficulties with social communication & social interaction
  • Evidence of restricted & repetitive patterns of behaviour
Additional risk factors / signs
  • A sibling with autism
  • Birth defects associated with central nervous system malformation and/or dysfunction, including cerebral palsy
  • Gestational age less than 35 weeks
  • Parental schizophrenia-like psychosis or affective disorder
  • Maternal use of sodium valproate in pregnancy
  • Intellectual disability
  • Neonatal encephalopathy or epileptic encephalopathy, including infantile spasms
  • Chromosomal disorders such as Down's syndrome
  • Genetic disorders such as fragile X
  • Muscular dystrophy
  • Neurofibromatosis
  • Tuberous sclerosis
Please also let us know
  • Severity and duration of the signs and symptoms
  • Whether the signs and symptoms are present across different settings
  • The impact of the signs and or symptoms on the child, young person and their family

Red Flags

We will prioritise children and young people who are approaching a school transition and children in care.

Investigations

In order to be accepted onto the pathway we will need to see evidence of what early help assessments have already taken place e.g. Educational Psychology reports, Speech and Language Therapy Assessments, School based intervention etc.

Children should have been seen before they are referred. If you are unable to see the child or young person please indicate why. Ideally you should at least speak to another professional who is regularly involved in the child's life. Families and children where appropriate should give consent to the referral and have some understanding of the service to which they are being referred to.

Management

Even after making a referral, you retain clinical responsibility for monitoring the referred young person until you have had confirmation from our services that we have seen them. Please put any necessary safeguards in place for example regular review appointments, or ensuring that relevant responsible adults are aware of the young person's needs. Please also remain in contact with us as to any significant changes in the young person's presentation that might alter our view of the urgency of their need.

Referral

Anyone can refer onto the Autistic Spectrum Disorders pathway including parents, young people themselves, school staff and other agencies. The person or agency who has the most information may be the most appropriate to make the referral.

Use the website to guide you to what information needs to come in with a referral.

For Autistic Spectrum Disorders this will include home and school screeners, reports from any professionals who have been involved to date and ideally a Devon Assessment Framework. Parents or School are often best placed to provide this information themselves. Home and school screeners can be accessed from our website here and here.

If you feel you are best placed to make the referral please use the request for services form. This form is available on some GP systems; we are rolling access out to all practices across Devon.

Request for services form

This helps you think about why you are referring and what outcomes are desired for the child you are referring and their family. It also ensures that you pass on the correct information about the child.

A consent form should also be included with the referral form if possible.

Forms that do not have sufficient information in them to allow us to undertake effective clinical screening will be returned to the referrer, the parent or another suitably placed person to provide this. This can delay processing a referral.

If you are unsure about anything you can phone into the Single Point of Access for support on making a referral.

Supporting Information

Pathway Group

This guideline has been signed off by Devon CCG.

Publication date: December 2019

 

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