Please note: This chapter describes the processes currently in operation. The Autism Pathway is under review and the new processes will be published here once agreed.
This chapter sets out the systems we have in Wigan around the diagnosis of autism. It is important to note that when working with a child/young person who may have autism related difficulties or a diagnosis of autism, it is necessary to identify the primary need to establish which area of this file to work through. A diagnosis is not sufficient evidence to apply for an EHC Plan and it is therefore important to implement and evidence the relevant graduated response.
Please remember that education staff are not in a position to diagnose autism.
Autism is a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them.
It is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways. Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities (external link) and need a lifetime of specialist support. People with autism may also experience over or under-sensitivity (external link) to sounds, touch, tastes, smells, light or colours.
More information can be found on The National Autistic Society website (external link).
10.3 Different signs of autism
Children and young people must have persistent deficits in the triad of impairments, social communication, social interaction and flexibility of thought, across multiple contexts and at different levels.
Social Communication Difficulties
- Lack of development of spoken language or a severe delay, with evidence from a specialist speech and language therapist
- Marked impairment in the ability to initiate or sustain a conversation with others
- Stereotyped or repetitive use of language.
Social Interaction Difficulties
- Lack of, or marked impairment, in the use of non-verbal behaviours during interactions, for example, eye contact, facial expression and gesture/body postures to regulate interactions
- Failure or limited development of peer relationships, appropriate to developmental level
- Does not spontaneously share enjoyment, interests and achievements with others
- Shows a lack of social and emotional reciprocity, ie. ‘give and take’.
Difficulties with Social Imagination and Flexible Thinking
- Shows a pre-occupation with one or more stereotyped interests, and has restricted patterns of interests, that are unusually intense or focused
- Shows an inflexible adherence to specific non-functional routines or rituals
- Shows stereotyped or repetitive motor mannerisms, for example, hand flapping, twisting or turning in circles, complex whole body movements
- Persistent pre-occupation with an object or part of an object.
- Over or under-sensitivity to light, sound, smell, taste, pain or noise
- Difficulty or disorder in early development, e.g. toilet training
- Difficulty with fine and/or gross motor skill development
- Advanced skill or ability in a specific aspect or area of the curriculum
- High level of cognitive ability but deficits in social skills.
10.4 The Autism Pathway: 5 – 19yrs
This diagram demonstrates the processes currently in place to diagnose autism between the ages of 5 and 19 years.
Range of Interventions
The continued use of the ‘assess, plan, do, and review’ approach will apply to interventions, though the nature and duration of the intervention may vary. The use of targeted interventions, over a period of time would be expected to provide more detailed information about the nature of the child/young person’s difficulties, and their response to these approaches.
Procedure for Assessment
The assessment approaches and tools will enable the professional to further identify the nature of the difficulties presented by the child/young person, and to eliminate those needs, which are not associated with Autism i.e. referral to the Educational Psychologist, Speech and Language therapist, TESS, Outreach Team.
Monitoring and Evaluation
The interventions will need to be monitored, as appropriate to the nature of the approach. The impact of the intervention will need to be evaluated to determine:
- The impact on the difficulty
- Need for continued intervention or
- Referral to the Pathway.
To make a referral to the pathway specific evidence of behaviour patterns associated with the triad of impairments associated with Autism would be required.
10.5 Referral to Autism Pathway Panel
Procedure for Referral to the Autism Pathway Panel
Prior to a child or young person being referred to a service for assessment, the parent/carer and where appropriate, the young person, will have been consulted about the referral, and be in agreement with this. Consent must be obtained at this point.
Two or more professionals would need to have been involved with the child/young person before a referral to the Autism Pathway Manager for inclusion on the agenda of the inter-agency decision making Autism Pathway Panel to take place. The professional would provide written evidence to indicate that the child or young person meets the specific needs relating to Autism.
- Completion and submission of the Panel referral form by the referring professional
- Evidence of assess, plan, do and review intervention from another service professional, for example School SENCO, Targeted Education Support Service, Speech & Language Therapist
- Provision of evidence of intervention from an additional targeted/specialist service professional, for example Consultant Community Paediatrician, Consultant Psychiatrist, CAMHS, Educational Psychologist, Outreach Service, Speech & Language Therapist.
The relevant referral forms and advice for schools and professionals can be found on the Autism Spectrum Condition Pathway webpage.
10.6 The Autism Pathway Panel
The primary function of the Panel is to consider the evidence about a child or young person. The Panel will discuss the assessment and intervention information presented at the meeting, and identifies the key features of the behaviours exhibited. The key behaviours will be compared with the criteria in the assessment tool (DSM 5), and if sufficient points are met, verify a diagnosis.
If insufficient criteria are met at this point, this feedback will be given to the referrer and the parents. It will be emphasized that the child/young person can be re-referred to the Panel following further input and intervention by involved professionals if concerns persist.
The panel members will:
- Examine the evidence put forward to support the diagnosis/identification of autism, and determine if further assessment is required to make a decision
- Specify the areas for additional assessment
- Identify the services or professionals required to complete the specified assessments
- Ensure that referrals/requests are made to specific professionals, with an identified time period for completion of assessments and return of evidence
- Consider and make decisions about the additional evidence
- Agree, or not, a diagnosis of autism
- Consider who should liaise with the family following the panel meeting, and when this will be undertaken
- Consider any additional assistance or provision required to support a child/young person and their family.
The Panel will decide how to talk with the parents, family members and the child/young person about the diagnosis of ASC. The approach will be determined by the readiness of the family and child/young person to accept the diagnosis, as evident from the information provided in the referral documentation and evidence at the Panel meeting. The Panel will decide which professionals are in the best position to share the outcome of the decision-making with the family and the child/young person, and gain parental perspectives on this. Until the named professional has shared the outcome with the family then it is required that all other professionals i.e. school staff, Educational Psychologist, etc. do not discuss the outcome with the family.
Membership of the Panel
- Autism Pathway Manager (Chair)
- Consultant Paediatrician
- Specialist Speech and Language Therapist
- Representative from CAMHS
- Principal or Senior Educational Psychologist
- Representative Manager from Primary Child Mental Health Team
- Representative from Early Years Quality and Inclusion Team
- Representative from Schools – secondary & primary
- Member of Admin team (minute-taker).
10.7 Specific Assessment Tools, Interventions and Support
Specific Assessment Tools
There are a range of assessment tools that could be used as part of the evidence. For further information take a look at the Autism Spectrum Condition Pathway webpage.
Once a diagnosis has been made the details of a range of appropriate interventions can be found on the Autism Spectrum Condition Pathway webpage.
Support available in Wigan
The following services may be available both pre and post-assessment, some may be involved in the actual assessment. Short Breaks is only available following confirmation of a diagnosis.
- Targeted Education Support Service (TESS)
- Speech & Language Therapist
- Occupational Therapist – Sensory Integration
- Education Psychology Service
- Outreach Team
- Paediatric Learning Disability Nursing Service• Autism Pathway Manager
- The National Autistic Society (external link)
10.8 Training for Professionals and Parents
Wigan Council also delivers a number of courses for parents/carers, some of which are designed for Parents/carers AND practitioners.
To view the Training Handbook and register for any courses, check out the Autism Spectrum Condition Pathway webpage.