Diagnosis of Autism spectrum disorder and ADHD in children and young people
Gold Standard Assessment
We pride ourselves on adhering to NICE (National Institute for Health & Care Excellence) guidelines for Autism spectrum disorder (2017) and ADHD (2019). We are always able to start diagnostic assessments within 3 months of the referral. We also always take parents’ or carers’ concerns and, if appropriate, the child’s or young person’s concerns, about behaviour or development seriously, even if these are not shared by others.
Our autism clinic aims to:
- Offer a thorough and timely diagnosis of Autism
- Improve early recognition of Autism
- Identify girls with Autism, who are typically under-diagnosed
- Support children throughout their education
- Support smooth transition to adult services
Our multidisciplinary team includes:
- Speech & Language Therapist
- Occupational Therapist
all of whom are present for the autism assessment and diagnosis.
We also work closely with and may refer on to:
- Child & Adolescent Psychiatrists
- Educational Psychologists
- Clinical Psychologists
- Health Visitors
- Specialist Teachers
- Social Workers
Our team have the skills and competencies to carry out a thorough autism diagnostic assessment and communicate with children and young people with suspected or known autism, and with their parents and carers to sensitively share the diagnosis with them. We take the time to listen to parents or carers and, if appropriate, the child or young person, discuss concerns and agree any actions to follow including referral.
We will NOT rule out autism because of:
- good eye contact, smiling and showing affection to family members
- reported pretend play or normal language milestones
- difficulties appearing to resolve after a needs-based intervention (such as a supportive structured learning environment)
- a previous assessment that concluded that there was no autism, if new information becomes available.
Our autism diagnostic assessment includes:
- Administration of ADI-R (Autism Diagnostic Interview, Revised), a comprehensive autism-specific tool; parent/carer interview with Paediatrician
- Reviewing reports from the pre-school or school
- School visit observations (optional)
- Administration of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) with Speech & Language Therapist, Paediatrician and Occupational Therapist
- Administration of SPM (Sensory Processing Measure), SPM-P (Sensory Processing Measure – Preschool), Infant/Toddler Sensory Profile, Sensory Profile 2 or Adolescent/Adult Sensory Profile Questionnaire
- Administration of Developmental Profile 4 (DP-4) to identify developmental strengths and weaknesses across five key areas; including physical, adaptive behaviour, social-emotional, cognitive and communication (if appropriate)
- A general physical examination
- Consideration of the differential diagnosis and systematic assessment for conditions that may coexist with autism
- Discussion of findings, in person and on the day, with parents or carers and, if appropriate, the child or young person. We explain the basis of conclusions, even if the diagnosis of autism was not reached.
- Provision of a detailed written report of the autism diagnostic assessment, profiling the child’s or young person’s strengths, skills, impairments and needs, while focusing on features consistent with ICD-10 or DSM-5 criteria, and detailing recommended interventions, services and support.
In order to have our diagnosis recognised by the NHS, we encourage parents/carers to share information, including the written report of the diagnostic assessment, with their GP. We also encourage parents/carers to share information with key professionals involved in the child’s or young person’s care, including those in education and social care.
We then offer a follow-up appointment with an appropriate member of the autism team within 6 weeks of the end of the autism assessment for further discussion (for example about the conclusions of the assessment and the implications for the child or young person).
Further assessments may be needed to construct a profile for each child or young person, for example:
- intellectual ability and learning style
- academic skills
- speech, language and communication
- fine and gross motor skills
- adaptive behaviour (including self-help skills)
- mental and emotional health (including self-esteem)
- physical health and nutrition
- sensory processing difficulties
- behaviour likely to affect day-to-day functioning and social participation
- socialisation skills.
If we are unable to support you within our team, we will recommend local services who can do so.
The team also have the skills needed to carry out an autism diagnostic assessment, for children and young people with special circumstances including:
- coexisting conditions such as severe visual and hearing impairments, motor disorders including cerebral palsy, severe learning (intellectual) disabilities, complex language disorders or
- complex mental health disorders; and
- looked-after children and young people.
We recognise that signs or symptoms may have previously been masked by the child or young person’s coping mechanisms and/or a supportive environment. We also believe that it is necessary to take into account cultural variation, but do not assume that language delay is accounted for if English is not the family’s first language or by early hearing difficulties.
Factors associated with an increased prevalence of Autism inclue (NICE, 2017):
- 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.
- A learning (intellectual) disability.
- Attention deficit hyperactivity disorder.
- Neonatal encephalopathy or epileptic encephalopathy, including infantile spasms.
- Chromosomal disorders such as Down’s syndrome.
- Genetic disorders such as fragile X.
- Muscular dystrophy.
- Tuberous sclerosis.
If you have any concerns about development or behaviour but are not sure whether the signs and/or symptoms suggest autism, please do not hesitate to contact us for advice to help you decide if a referral to our multidisciplinary team is necessary. You can also find more information on signs and symptoms of possible autism at Appendix: Signs and symptoms of possible autism | Autism spectrum disorder in under 19s: recognition, referral and diagnosis | Guidance | NICE or National Autistic Society (autism.org.uk).
Our multidisciplinary team also have expertise in the diagnosis and management of ADD/ADHD, and other associated conditions.
If a child or young person’s behavioural and/or attention difficulties are suggestive of ADHD and are having an adverse impact on their development or family life, then our team will assess to determine the severity of the symptoms, how these affect the child or young person and the parents or carers, and the extent to which they affect them in different settings.
Our paediatrician, is able to make a diagnosis of ADHD on the basis of:
- a full clinical assessment of the person; including discussion about behaviour and symptoms in the different domains and settings of the person’s everyday life and
- a full developmental and psychiatric history and
- observer reports and assessment of the person’s mental state and
- administration of the Conners-3 rating scales.
For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:
- meet the diagnostic criteria in DSM 5 or ICD 10 and
- cause at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings and
- be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.
People in the following groups have increased prevalence of ADHD compared with the general population:
- people born preterm
- looked-after children and young people
- children and young people diagnosed with oppositional defiant disorder or conduct disorder
- children and young people with mood disorders (for example, anxiety and depression)
- people with a close family member diagnosed with ADHD
- people with epilepsy
- people with neurodevelopmental disorders (for example, autism spectrum disorder, tic disorders, learning disability [intellectual disability] and specific learning difficulties)
- adults with a mental health condition
- people with a history of substance misuse
- people known to the Youth Justice System or Adult Criminal Justice System
- people with acquired brain injury. [NICE, 2018]
We ensure that people with ADHD have a comprehensive, holistic shared treatment plan that addresses psychological, behavioural and occupational or educational needs.
We may offer medication for children aged 5 years and over and young people only if:
- their ADHD symptoms are still causing a persistent significant impairment in at least one domain after environmental modifications have been implemented and reviewed
- they and their parents and carers have discussed information about ADHD
- a baseline assessment has been carried out.
If medication is prescribed, reviews will need to be booked after 4, 8 and 12 weeks with our paediatrician.
We may also recommend Sensory Integration therapy.
We work closely with local charities, such as ADHD+ Support, who aim to provide information, support and services to those with ADHD and its many associated and co-existing conditions.
For more information, contact us on: 01245 423827