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Autism in under 19s: recognition, referral and diagnosis

Key priorities for implementation

Local pathway for recognition, referral and diagnostic assessment of possible autism

  • A local autism multi-agency strategy group should be set up, with managerial, commissioner and clinical representation from child health and mental health services, education, social care, parent and carer service users, and the voluntary sector
  • The local autism strategy group should appoint a lead professional to be responsible for the local autism pathway for recognition, referral and diagnosis of children and young people. The aims of the group should include:
    • improving early recognition of autism by raising awareness of the signs and symptoms of autism through multi-agency training
    • making sure the relevant professionals (healthcare, social care, education and voluntary sector) are aware of the local autism pathway and how to access diagnostic services
    • supporting the smooth transition to adult services for young people going through the diagnostic pathway
    • ensuring data collection and audit of the pathway takes place
  • In each area a multidisciplinary group (the autism team) should be set up. The core membership should include a:
    • paediatrician and/or child and adolescent psychiatrist
    • speech and language therapist
    • clinical and/or educational psychologist
  • The autism team should either include or have regular access to the following professionals if they are not already in the team:
    • paediatrician or paediatric neurologist
    • child and adolescent psychiatrist
    • educational psychologist
    • clinical psychologist
    • occupational therapist
  • Consider including in the autism team (or arranging access for the team to) other relevant professionals who may be able to contribute to the autism diagnostic assessment. For example, a specialist health visitor or nurse, specialist teacher or social worker
  • Provide a single point of referral for access to the autism team

Autism diagnostic assessment for children and young people

  • A case coordinator in the autism team should be identified for every child or young person who is to have an autism diagnostic assessment
  • Include in every autism diagnostic assessment:
      • detailed questions about parent's or carer's concerns and, if appropriate, the child's or young person's concerns
      • details of the child's or young person's experiences of home life, education and social care
      • a developmental history, focusing on developmental and behavioural features consistent with ICD-10 or DSM-IV criteria (consider using an autism-specific tool to gather this information)
      • assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours, focusing on features consistent with ICD-10 or DSM-IV criteria (consider using an autism-specific tool to gather this information)
      • a medical history, including prenatal, perinatal and family history, and past and current health conditions
      • a physical examination
      • consideration of the differential diagnosis
      • systematic assessment for conditions that may coexist with autism
      • development of a profile of the child's or young person's strengths, skills, impairments and needs that can be used to create a needs-based management plan, taking into account family and educational context
      • communication of assessment findings to the parent or carer and, if appropriate, the child or young person
  • Consider the following differential diagnoses for autism and whether specific assessments are needed to help interpret the autism history and observations:
    • neurodevelopmental disorders:
      • specific language delay or disorder
      • intellectual disability or global developmental delay
      • developmental coordination disorder (DCD)
    • mental and behavioural disorders:
      • attention deficit hyperactivity disorder (ADHD)
      • mood disorder
      • anxiety disorder
      • attachment disorders
      • oppositional defiant disorder (ODD)
      • conduct disorder
      • obsessive compulsive disorder (OCD)
      • psychosis
    • conditions in which there is developmental regression:
      • Rett syndrome
      • epileptic encephalopathy
    • other conditions:
      • severe hearing impairment
      • severe visual impairment
      • maltreatment
      • selective mutism

Communicating the results from the autism diagnostic assessment

  • With parental or carer consent and, if appropriate, the consent of the child or young person, make the profile available to professionals in education (for example, through a school visit by a member of the autism team) and, if appropriate, social care. This is so it can contribute to the child or young person's individual education plan and needs-based management plan

© NICE 2011. Autism in under 19s: recognition, referral and diagnosis. Available from: www.nice.org.uk/guidance/CG128. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. 

First included: September 2011.