Information for Referrers
The following advice is adapted from NICE Guideline CG128, Autism in under 19s: recognition, referral and diagnosis. [www.nice.org.uk/guidance/cg128/chapter/1-Guidance#recognising-children-and-young-people-with-possible-autism]
What signs should prompt a referral from primary care for an ASD assessment?
Professionals should use clinical judgement in when deciding whether to refer a child or young person for further assessment for autism (or for an alternative assessment pathway), or seek advice from more experienced colleagues or the autism team.
The decision to refer to the autism team should be considered on the basis of
- Signs or symptoms (see downloads below)
Special attention should be paid to the level of parental concern about the child or young person.
Decisions should take into account the presence of any known risk factors for autism.
Where the signs and symptoms are not sufficient to prompt an immediate referral, a healthcare professional should consider a period of watchful waiting as signs and symptoms may change with maturity. However, if the parent or carer or the professional remains significantly concerned, then the referral decision should be reconsidered.
Regression of language or social skills without loss of motor skills in a child under 3 years should prompt a direct referral for an autism assessment as there is a high likelihood of autism with this presentation. If regression of language is observed in a child over 3 years, they should be referred to a paediatrician or paediatric neurologist for an initial opinion, even if there are signs and symptoms of autism (a change in social skills in isolation in the older child may indicate a more varied aetiology). These clinicians can refer on to the autism team if necessary.
If the parents or carers, or if appropriate the child or young person, prefer not to be referred to the autism team, consider a period of watchful waiting. If concerns remain reconsider referral.
Should referrers use tools to identify an increased likelihood of autism?
Tools to identify an increased likelihood of autism can help to identify signs and symptoms of autism in a structured way which may be useful. However, the scores from such tools should not be relied upon to make or rule out referral. They are not a substitute for clinical judgement.
If a tool has been used in any way, information, including the scores resulting from the responses, should accompany any referral as additional information to the team receiving the referral.
There are a number of screening tools available, which are easy and quick to use and suitable for non-specialist professionals. Some are free to use, others incur a fee.
M-CHAT (Download below)
Screening tool for toddlers aged 16-30 months.
Asperger Syndrome Screening Questionnaire (Download below)
Suitable for screening children aged 6 to 17 who may be at the high-functioning end of the autistic spectrum. One each to be completed by a parent and a teacher. Score 0 for No, 1 for Somewhat, 2 for Yes. Free to use. Not suitable for use in children with moderate or severe learning disabilities.
Social Communication Questionnaire (£)
Suitable for children over the age of 4, with a mental age over 2.