AUTISM
SPECTRUM
COMMUNITY
ASSESSMENT
MANUAL
2
Contents
1.
Contents page
Page 2
2.
Flow chart of whole process
Page 4
3.
Referral to ASCA
Page 5
4.
ASCA Referral Form
Page 7
5.
Consent and Information Gathering
Process from Parent/Carer
Page 11
6.
Cover letter to parents
Page 12
7.
ASCA leaflet to parents
Page 13
8.
Consent Form
Page 15
9.
Information from Parents/Carers
Page 16
10.
Letter to GP
Page 26
11.
Assessment Report Request
Page 27
12.
Extra professionals request form
Page 28
13.
Guidelines for Professionals
Page 29
14.
School Based Assessment Form
Page 33
15.
Nursery based Assessment
Page 42
16.
Diagnosis Meeting Agenda
Page 53
17.
ICD-10 Criteria
Page 54
18.
Agenda for Feedback to Parents/Carers
Page 55
19.
ASCA Report Summary
Page 56
20.
ASCA Report Summary – FAST Referral
Page 57
21.
Appendix I - Executive Summary
[WASP Project]
22.
Page 58
Appendix II – Information Sharing
Document [SASPI Accord]
File Name: ASCA Manual
Owner: Mary Paris
Page 63
Version 3
© NHS Fife Children’s Services
Created on: April 2012
Review date: April 2014
3
ASCA Manual
File Name: ASCA Manual
Owner: Mary Paris
Version 3
© NHS Fife Children’s Services
Created on: April 2012
Review date: April 2014
4
ASCA Process Flowchart
Child has a Suspected ASD
Referrals have to be agreed by two professionals one from health and one from education and
parents. Referrals can come from Education*, Social Work*, Health*, Parents*. Referral form or
comprehensive letter including details on referral form has to be included with referral. Also include
any other relevant information.
Triage by community paediatricians. One of the following decisions will be made:
1. Requires further information – return to referrer
2. Requires clarification – general paediatric appointment given
3. Agreed referral – goes onto ASD/ASCA Pathway
4. If inappropriate referral – return to referrer or redirect to appropriate service
General paediatric appointment held,
two options available:
1. Remain within Community
Paediatric Service
2. Refer to appropriate service
3. Put onto ASD/ASCA Pathway
ASD / ASCA PATHWAY
Name added to ASD/ASCA database. Information leaflet and
consent paperwork sent to parents/carers.
Consent back from parents/carer. If consent paperwork not
returned within two weeks, ASO will contact parents/ carer by
phone and ascertain whether paperwork received or whether
referral is still required. If paperwork not received, then resend. If
consent not returned after a further 2 weeks, referral returned to
originator.
Set Diagnosis date with Education no later than 20 weeks from
acceptance onto the Pathway. ASO’s request Assessment
Reports to be returned three week prior to the Diagnosis
Meeting. ASO will provide pack to Community Paediatrician will
give to Chair at meeting. If no diagnosis made, pack to be
returned to ASO
Gather assessment reports and circulate three weeks prior to
Diagnosis Meeting.
Referrals can come from:




Education – also to be agreed with
Educational Psychology and Health
Social Work – also to be agreed
with health and education
Health – also to be agreed with
education
Parents – should seek advice from
school and health professional
File Name: ASCA Manual
Owner: Mary Paris
Diagnosis Meeting must, as a minimum, include community
paediatrician, education representative and two other
professionals.
Final Report agreed, signed by paediatrician, circulated to family
and involved professionals. If referred to FAST, along with the
ASCA reports, a front page, should be attached, explaining why
outcome could not be reached, also include a copy of the
completed Report Summary including the ICD-10.
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REVISED PROCESS FOR ASCA REFERRALS
Referrals are received by the Admin Support Officers in each of the CHP areas, are logged
on the system and taken to the next triage meeting. Referrals can come from a range of
professionals such as Health, Education and Social Work. Prior to a referral being made,
the appropriate Health and Education professionals must consult with each other to ensure
there is joint agreement about the referral to ASCA being made:
Education
also to be agreed with Educational Psychologist and Health
Social Work also to be agreed with Health and Education
Health
also to be agreed with Education
At the triage meeting, the referral is discussed and one of the following decisions made:
 Requires further information – return to referrer [follow same process when returned]
 Requires clarification – general paediatric appointment given
 Agreed ASCA referral – goes on the ASCA pathway
General Appointment:
Appointment made for the appropriate community paediatrician. Once the appointment has
taken place, the referral can then go onto the ASCA process if necessary.
ASCA Referral:
1. Send out consent paperwork. Wording in the covering letter would need to be
changed to say “…return by ……….. [two weeks]. If consent paperwork is not
returned, the ASO will contact parent by phone to see if they have received the consent,
if not received, send a second copy. If paperwork has been received and not returned,
clarify with parent/carer if the referral is still required, if yes, please return the consent
form within two weeks. If the consent is not returned within the two weeks, the original
referral will be returned to the referrer with an explanatory letter.
2. Agree diagnosis date with all professionals involved, however to facilitate a date no later
than 20 weeks from acceptance on pathway, the date will be set when the majority, if not
all of the professionals can attend.
3. Request reports from relevant professionals e.g. community paediatricians; education;
speech and language therapy and psychology + other professionals mentioned on the
referral.
4. Reports must be returned three weeks prior to the diagnosis meeting.
5. Diagnosis meeting must, as a minimum, include community paediatrician, school
representative and two other professionals. If additional professionals invited to the
meeting cannot attend, submitted reports will be used to help give evidence to form a
diagnosis.
6. Every effort should be made by all services to ensure that pre-arranged meetings
proceed as agreed. There will be occasions where a professional at short notice (most
likely because of illness) will be unable to attend an ASCA meeting. On such occasions,
the meeting should go ahead wherever possible. It may, for example, be possible for a
service to substitute for an absent colleague. A further consideration to ensure that the
meeting proceeds would be for the remaining professionals to agree a recommendation
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Owner: Mary Paris
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Created on: April 2012
Review date: April 2014
6
which will become the decision of the meeting subject to consultation with the absent
professional on their return to work/next availability.
Occasionally there are exceptional cases where the usual ASCA process will be
impossible to follow eg where a child has been off school long term. On these
occasions, relevant professionals should consult with each other to agree a practical and
reasonable way forward.
7. If diagnosis cannot be agreed or the conclusion is that further assessment is required,
the child will be referred to FAST. Where it is clear that no diagnosis of autism could be
made, the reasons for this should be explained to the parents. A referral to FAST should
NOT be made simply because the parents request this. Along with the ASCA reports,
a front page explaining why an outcome could not be reached should be attached
prior to sending to FAST to give as much background information as possible and
must include a copy of the ICD-10.
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Owner: Mary Paris
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Created on: April 2012
Review date: April 2014
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ASD ASSESSMENT PATHWAY REFERRAL FORM
All sections of this form must be completed. A Doctor’s Clinic letter with all details
requested is acceptable instead of the Referral Form. When a referral is being made by the
school, the referral must be agreed and supported by the school’s link educational
psychologist as well as a health professional.
Child’s Name: ______________________________________________________________
DOB/CHI: ___________________ GP Practice: __________________________________
GP Practice Address: ________________________________________________________
Parent’s Name: ____________________________________________________________
Address: __________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Tel Nos: __________________________________________________________________
[incl mob]
_________________________________________________________________________
School / Nursery: ___________________________________________________________
Head Teacher: _____________________________________________________________
Educational Psychologist: ____________________________________________________
Referral discussed fully and agreed with parents/carers
Yes
Discussed and agreed with educational psychologist?
Yes / No
If appropriate, has this referral been discussed with the child?:
Yes / No
Any previous diagnosis/assessments: ________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Medication: _______________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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Owner: Mary Paris
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Reason for requesting this referral: _____________________________________________
_________________________________________________________________________
_________________________________________________________________________
Please include observations / concerns about::
a.
Language and communication e.g. language development and social use of language:
b.
Social skills and relationships/social interaction e.g. eye contact, turn taking:
c.
Play/imagination/flexibility of thinking e.g. pretend play, routines and repetitive
behaviours:
d.
Any other significant information [e.g. significant family context issues, social factors
etc.
Information required with the referral [as appropriate]
Copies of any existing assessments e.g.
Please tick
Griffiths
School Observation Schedule
ISP
Speech and Language Reports
Occupational Therapy Reports
Any Clinical Letters
Confidentiality
All reports submitted will be shared with other professionals. Please ensure you are happy
with the content and edit accordingly. If this is not possible please contact the Admin
Support Officer detailed at the bottom of this referral form.
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Owner: Mary Paris
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Other Professionals Involved:
Professional
Address
Email & Tel No
School Doctor
Consultant Paediatrician
[Acute/Community]
Speech & Language
Clinical Psychologist
Ed Psychologist/PSHV
Occupational Therapist
Health Visitor
Social Worker
Hospital Consultants
General Practitioner
Head Teacher
Any Other
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Owner: Mary Paris
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Review date: April 2014
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Referred by [please print]:
_________________________________________________________________________
Designation:
_________________________________________________________________________
Signed:
_________________________________________________________________________
Location:
_________________________________________________________________________
Telephone Numbers:
_________________________________________________________________________
Date:
_________________________________________________________________________
Health/Education Professional Discussed and Agreed with:
Name:____________________________________________________________________
Signature: ________________________________________________________________
Designation:_______________________________________________________________
Telephone Numbers:________________________________________________________
Please send completed form to the appropriate Admin Support Officer [ASO]:
G&NEF CHP
Lindsey Kidd
Adamson Hospital
Bank Street
Cupar
KY15 4JG
Tel: 01334 651253
File Name: ASCA Manual
Owner: Mary Paris
K&L CHP
Hazel Laughlan
Seaview Ward
Whyteman’s Brae Hospital
Kirkcaldy
KY1 2ND
01592 645225
Version 3
© NHS Fife Children’s Services
D&WF CHP
Jill Hastie
Child Health Office
Lynebank Hospital
Dunfermline
KY11 4UW
01383 565495
Created on: April 2012
Review date: April 2014
11
Consent and Information Gathering Process from Parent/Carer to
ASCA
1.
When agreed that referral is appropriate and the child has been entered on the
database the information leaflet, consent form and parental questionnaire should be
sent to parents.
2.
Instances where parents are separated, consent will be required from both/either
parents or the parent with parental rights.
3.
Consent and parental questionnaire should be returned from parents/carers within
two weeks. If consent not received, the ASO’s will contact the parents/carers by
phone, to ascertain whether paperwork has been received or is still required. If
necessary resend paperwork. If consent not received after a further two weeks,
referral returned to originator.
4.
Once the parental consent and questionnaire are returned, a date for the Diagnosis
meeting will be agreed within 20 weeks, with the paediatrician and education
representatives, including the educational psychologist, as core members of the
group.
5.
The parental consent and questionnaire will then be sent to the professionals
involved.
6.
Subject to Information Sharing Policy [see Appendix II]
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Owner: Mary Paris
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Dunfermline & West Fife
Community Health Partnership
12
Child Health Office
Lynebank Hospital
Halbeath Road
Dunfermline
KY11 4UW
Child Health
Tel: 01383 565495
Email: jill.hastie@nhs.net
Date
April 2012
Your Ref
Our Ref
Enquiries to
Insert Patient Address Block
Dear
RE:
INSERT CHILD’S NAME, DOB/CHI, ADDRESS
Your child ___________________ has been referred for assessment for a possible autism
spectrum disorder. Enclosed are:



A leaflet for you explaining the ASCA process
A consent form for participation in the process, gathering and sharing of relevant
information
An information gathering questionnaire
If you wish your child to be assessed, please sign the enclosed consent form, fill in the
questionnaire and return both in the enclosed addressed envelope. We will then contact you
to arrange attendance to receive feedback on the outcome of the diagnosis meeting. You
will be given an appointment by a community paediatrician and various other professionals
to start your child’s assessment, there will then be a date arranged in about 20 weeks time
for the professionals involved to discuss any possible diagnosis and talk to you about the
outcomes of the assessment and the way forward.
Please complete and return both documents within three weeks. If we do not hear from you
within that time, we will assume that you do not wish your child to be assessed and their
details will be removed from the system.
Yours sincerely
JILL HASTIE
Admin Support Officer
Enc
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Owner: Mary Paris
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Created on: April 2012
Review date: April 2014
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INFORMATION LEAFLET – ASCA PATHWAY
Your child ________________ has been referred by _______________________________
for an assessment of a possible autism spectrum disorder [ASD]. This process is as follows:
Tier 1: Consent for Information Gathering and Sharing
Following receipt of your consent we will write to professionals already involved with your
child to ask for assessment reports and other relevant information.
Tier 2: Community Assessment
There will be a community assessment for your child.

The people involved will be:
o Your child’s school teachers and the educational psychologist from their school
o A community paediatrician
o A speech and language therapist
o A clinical associate psychologist

If you have any questions around this process, you will have an opportunity to discuss
them at the first assessment meeting. You may of course also wish to discuss the
process with educational professionals such as your school head teacher or link
educational psychologist to your child’s school.

Assessment will take place in your home, school and/or clinic. This may take up to four
months and will include:
o A detailed history from yourselves
o An observation of your child at home and school
o An educational psychologist’s assessment
o A speech and language assessment
o A psychological assessment
You will receive all assessment reports following the Diagnosis meeting; however some
individual services may provide you a copy of their report in advance of the meeting.

Following completion of the assessments, there will be a meeting arranged at the school
where a multi-agency decision will be made as to whether there is enough information
available to:
o Diagnose an ASD confidently. If this is the case, a diagnosis will be given at this
point
o Be sure your child does not have an ASD
o Decide that more information and more specialist assessments are required
[referral on to Tier 3]
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Owner: Mary Paris
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
As part of this discussion it may be decided that your child needs further assessments
for alternative diagnoses.

You will be invited to attend a feedback session at the end of the diagnosis meeting with
some of the professionals involved. If you disagree with the outcome of the diagnosis
meeting you have the right to request a further specialist assessment.
Tier 3: Specialist Assessment
If a definitive decision cannot be reached at Tier 2, all the information that has already been
gathered will be passed on to, and will form an essential part of the assessment by, the
specialist Fife Autism Spectrum Team [FAST]. This team consists of a group of
professionals from various disciplines who have had extensive additional training and
experience in assessment and management of ASD.

This team will arrange for your child to come in, with yourselves, for a half day
assessment. This may be several months later.

This assessment will consist of:
o An extension of information gathering from yourselves
o A detailed assessment of your child’s learning ability and style [cognitive
assessment]
o A specific autism assessment tool [ADOS] where the child is observed during
structured activities which assess your child’s abilities in communication,
interaction and creativity

At the end of this assessment the team will talk to you and discuss the outcome.
At the end of Tiers 2 and 3, we will plan any necessary further interventions and support in
discussion with you. You will receive a written report. If a diagnosis of ASD is not given,
further investigations or support will be organised as required.
If you have any questions or require any further information please contact the Admin
Support Officer in your area, as detailed below.
Please send completed forms to the appropriate Admin Support Officer [ASO]:
G&NEF CHP
Lindsey Kidd
Adamson Hospital
Bank Street
Cupar
KY15 5JG
Tel: 01334 651253
File Name: ASCA Manual
Owner: Mary Paris
K&L CHP
Hazel Laughlan
Seaview Ward
Whyteman’s Brae Hospital
Kirkcaldy
KY1 2ND
Tel: 01592-645225
Version 3
© NHS Fife Children’s Services
D&WF CHP
Jill Hastie
Children’s Services Office
Ward 12, Lynebank Hospital
Dunfermline
KY11 4UW
Tel: 01383-565495
Created on: April 2012
Review date: April 2014
15
ASCA Pathway Consent Form
[Please note to maintain the objectivity of the Diagnosis Meeting,
Parents will be invited to Part 2 only]
Child’s Name: _______________________________
DOB/CHI__________________
Address: _________________________________________________________________
I understand my child has been referred for assessment of an autism spectrum disorder.

Yes
No

I give my permission for information to be gathered from professionals/services who already
know my child.

Yes
No

I give permission for the gathered information to be shared with other involved professionals.

Yes
No

I give consent for the assessment team, as detailed in the enclosed letter, to be contacted
and for assessment meetings to be set up as necessary.

Yes
No

I give consent for the assessment team to be contacted and a Diagnosis Meeting to be
arranged once all assessments are complete.

Yes
No

I would prefer the feedback from the Diagnosis Meeting to be given by the following
professionals [please tick up to two professionals]:
 Your child’s school teachers and/or the educational psychologist from their school

 A community paediatrician

 A speech and language therapist

 A clinical associate psychologist

If, for any reason, your chosen professionals are not available; others members of the
Diagnosis team will provide feedback.
NAME:
SIGNATURE:
DATE:
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INFORMATION FROM PARENTS/CARERS
Child’s Name:
Date of Birth:
Father’s Name:
Address:
Mother’s Name:
Name of School:
Home telephone number:
Date completed:
We know that this questionnaire is extremely long – so we are grateful to you for taking the
time to complete it. Please do not worry if you cannot answer every question. There will be
opportunity to discuss these at the appointment.
It will be most helpful if you give details or tell us about an actual incident rather than
Yes or No.
BIRTH HISTORY
1.
Did you have any difficulties during pregnancy?
2.
Were you on any medication during pregnancy?
3.
Was your child born at the time expected? Yes / No
If not, was he/she earlier / later?
How many weeks early / late?
What was his/her birth weight?
4.
Did you have a normal delivery? Yes / No
If not, could you please describe what happened?
5.
Did your baby have any problems immediately after birth? Yes / No
If yes, please describe:
6.
Did he/she have to be in special care? Yes / No
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7.
How were things in general, for both mum and baby, in the early weeks after the birth?
MEDICAL HISTORY
1.
Has your child had any serious illness? Yes / No
If yes, please describe:
FAMILY HISTORY
1.
Do you feel anybody in the extended family has any problems similar to your child?
Yes / No
If yes, please describe:
2.
Has anyone in the extended family ever been diagnosed as having an autism spectrum
disorder? Yes / No
3.
Does anyone in the family have any emotional or mental health difficulties? Yes / No
4.
Does anyone in the family have any learning or language difficulties? Yes / No
MOTOR DEVELOPMENT
1.
Did you have any concerns about your child’s physical development, e.g. floppiness?
Yes / No
2.
At what age did he/she:
Sit unsupported:
Crawl:
Walk:
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3.
Do you have any concerns about your child’s physical development/co-ordination now?
Yes / No
If so, please describe:
0 – 1 YEAR
1.
How would you describe your child as a baby?
2.
How would you he/she let you know when he/she needed to be fed?
3.
What comforted him/her when she was upset?
4.
When you went to see him/her in their cot in the morning, was he/she pleased to see
you?
Yes / No
How would you know?
Around 6 – 8 months did he/she put their arms up to be lifted? Yes / No
Would he/she get upset if you walked out again? Yes / No
5.
At around 6 – 7 months, did he/she enjoy you playing with him/her? Yes / No
6.
If given toys to play with, what would he/she actually do? E.g. play with them
appropriately, ignore them or throw them.
7.
If you had to keep him/her happy on your lap for a while, say in a waiting room, could
you do it just by chatting to him/her? Yes / No
8.
If you smiled and made faces at him/her, would he/she do the same back? Yes / No
9.
Did he/she enjoy traditional lap games? E.g. This little piggy, Peek-a-boo etc. Yes /
No
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10.
Was it difficult to get his/her attention? Yes / No
11.
Did you ever wonder if he/she might be deaf? Yes / No
AROUND 1 – 2 YEARS
1.
Did he/she point at things he/she wanted? E.g. food or a toy. Yes / No
2.
Did he/she point out interesting things and look to see whether you were interested?
E.g. cars in the street, animals. Yes / No
3.
When you took him/her out in their buggy, would he/she look at things you pointed at?
Yes / No
4.
Did he/she bring things to you for help? Yes / No
Did he/she bring things to show for interest? Yes / No
5.
Did he/she get upset if separated from you? Yes / No
6.
Did he/she ever go through a stage of tip-toeing when he/she walked? Yes / No
7.
What was his/her play like in his/her second year – can you give examples?
Would he/she feed and talk to a teddy – or do other “pretending” play – give examples:
8.
How did he/she react to something spinning, like the washing machine or a toy top?
2 – 3 YEARS
1.
If he/she had tantrums, what caused them?
How easy was he/she to distract or comfort?
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2.
Did you have problems taking him/her out, say to shops or on the street? Yes / No
3.
If he/she wanted something that he/she could not reach, what did he/she do?
COMMUNICATION
1.
Did he/she babble? Yes / No
2.
What were his/her first words?
At what age?
3.
When did he/she go on to link words into simple sentences?
At what age was he/she using simple sentences to:
4.

Get what he/she wanted?

Show you something interesting?

Start a conversation?

Ask for information and listen to your answers?
Does he/she now talk about a range of topics? Yes / No
If not, what does he/she prefer to talk about?
5.
Does he/she notice if you are bored or not listening to him/her talking? Yes / No
6.
Does he/she start conversations off, listen to your answers and then answer so that the
conversation goes back and forth? Yes / No
7.
Is there anything unusual about his/her tone of voice, his/her accent, the way he/she
speaks or his/her use of loud and soft? Yes / No
8.
Has he/she ever exactly repeated the things you say? Yes / No
Is yes, at what sort of age?
How long did it last?
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9.
Has he/she ever produced “chunks” of language that you recognise from somewhere
else?
Yes / No
10.
Has he/she ever repeated phrases over and over again? Yes / No
Give examples:
11.
Has he/she made up words of their own? Yes / No
Give examples:
12.
Does he/she ever tend to talk non-stop at you? Yes / No
13.
Does he/she ever tend to take language literally. E.g. pull your socks up? Yes / No
Can you give an example?
14.
Do you feel your child uses eye contact effectively? E.g. to catch your attention in a
crowded room. Yes / No
15.
Can you tell how your child is feeling from his/her facial expression? Yes / No
16.
Does he/she understand body language, gestures and facial expressions? Yes / No
If he/she has a problem – what difficulties does he/she have?
Does he/she know how you feel by your facial expressions? Yes / No
17.
If asked to do so, could he/she “put on” a disgusted face? Yes / No
SOCIAL BEHAVIOUR
1.
How does he/she get on with children of his/her own age?
2.
How does he/she get on with adults?
3.
Are there any problems:

Making friends

Meeting people he/she knows
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Yes / No
Yes / No
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4.

Meeting new people
Yes / No

Coping in a strange situation
Yes / No
How does he/she react if he/she is hurt?
If you are hurt e.g. does he/she comfort you? Yes / No
5.
Are there any problems in different social situations? E.g. supermarket, big gatherings
etc? Yes / No
6.
Can he/she “put themselves in other people’s shoes” and understand how other people
feel? Yes / No
7.
Does he/she ever come out with embarrassing remarks in an inappropriately loud
voice?
Yes / No
PLAY BEHAVIOUR
1.
Typically between 1 and 2 years what would his/her favourite play be?
2.
Does he/she line up toys or objects? Yes / No
If so, at what age?
Does he/she get upset if people then move the toys or objects? Yes / No
3.
Does he/she enjoy rough and tumble play? Yes / No
4.
Give an example of his/her pretend play at around age 3.
5.
How does he/she relate to other children? E.g. ignore, watch, approach, make contact,
other?
6.
Does he/she:

Take turns
Yes / No

Share
Yes / No

Wait for his/her go
Yes / No
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
Ask others to join in
Yes / No

Win or lose gracefully
Yes / No

Understand rules in games like football
Yes / No
7.
What activities does he/she enjoy most now?
8.
What does he/she watch on television or video?
Does he/she have favourite programmes or videos that he/she watches over and over
again? Yes / No
What are these?
Does he/she rewind parts of the video repetitively? Yes / No
OTHER BEHAVIOURS
1.
Has he/she ever done any of the following: [give approximate age]










Flapped his/her hands vigorously
Spun round and round
Smelt things frequently before using or eating
Licked things that one usually does not lick
Smeared things like soap, creams excessively
Liked to touch and stroke things, particularly of specific
textures that he/she seems to enjoy. E.g. fur, silk, etc
Used your hands to do things
Shown an extreme dislike of getting his/her hair brushed
Complained about clothes being uncomfortable or
scratchy
Avoided getting his/her hands dirty
Have you ever noticed any of the following:
 Facial or body twitches
 Blinking eyes a lot
 Making funny noises in his/her throat
 Sniffing or coughing a lot when he/she has not got a cold
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Age
___
___
___
___
___
Yes / No
Yes / No
Yes / No
Yes / No
___
___
___
___
Yes / No
___
Yes / No
Yes / No
Yes / No
Yes / No
___
___
___
___
2.
Does he/she ever cover his/her ears to sound? Yes / No
3.
Has he/she ever shown any fascination with lights, patterns, shiny things, water,
spinning things? Yes / No
If yes, please describe:
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4.
Has he/she ever seemed unaware of hot, cold or pain? Yes / No
5.
Has he/she ever needed an object with him/her all the time and carried it around? Yes
/ No
If yes, please describe:
6.
Has he/she ever been fascinated by, or obsessional about anything? Yes / No
If yes, please describe:
7.
Have you ever felt that he/she was particularly knowledgeable about anything or
collected unusual things? Yes / No
If yes, please give details:
8.
What happens if you change his/her routine or the way things are done in your family?
Please give details:
9.
Does he/she have any rituals i.e. are there certain things that he/she has to do a
certain way, perhaps in relation to:




Mealtimes
Bedtime
Toys
Where things are placed
Yes / No
Yes / No
Yes / No
Yes / No
If yes, please give details:
10.
Have there ever been any problems if you moved things e.g. furniture, his/her
possessions etc? Yes / No
If yes, please describe:
11.
Does he/she eat a wide range of foods? Yes / No
Will he/she try new foods? Yes / No
12.
Are there any other problems with behaviour that you are concerned about? Yes / No
If yes, please give details:
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POSTURE AND MOVEMENT [please tick each box you feel is appropriate]
1.
Which of the following words describe how your child moves e.g. walking, running,
climbing?
Stiff
Awkward
Clumsy
Often falls
Bumps into things
Accident Prone
Trips over feet
Move slowly
Stays away from
others
Agile
2.
3.
When sitting in a chair to play or at mealtimes does your child?
Sit upright
Slump
Lean to one side
Fidget
Sit normally
Sit briefly
Which of the following does your child find difficult?
Jump
Skip
Hop [right leg: left leg]
Catch ball [two hands]
Throw ball
Walk along wall/kerb
Hit with bat
Ride a bicycle/tricycle
Climb
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Dunfermline & West Fife
Community Health Partnership
Child Health
Date
April 2012
Your Ref
Our Ref
Enquiries to
26
Children’s Services Office
Lynebank Hospital
Halbeath Road
Dunfermline
KY11 4UW
Tel: 01383 565495
Email: jill.hastie@nhs.net
Insert Address Block
Dear Dr
RE:
INSERT CHILD’S NAME, ADDRESS AND DOB/CHI
____________________________ has been referred to ASCA [Autism Spectrum
Community Assessment] for assessment for a possible Autism Spectrum Disorder.
I have enclosed a copy of the letter that has been sent to the parents for your information.
Yours sincerely
JILL HASTIE
Admin Support Officer
Enc
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Dunfermline & West Fife
Community Health Partnership
Child Health
27
Children’s Services Office
Lynebank Hospital
Halbeath Road
Dunfermline
KY11 4UW
Tel: 01383 565495
Email: jill.hastie@nhs.net
Date
April 2012
Your Ref
Our Ref
Enquiries to
Insert Address Block
Dear
RE:
INSERT CHILD’S NAME, ADDRESS AND DOB/CHI
As you may know ____________________________ has been referred for an Autism
Spectrum Community Assessment and as a result you are requested to provide an
assessment report. If the child is not already known to your service, please make
arrangements to carry out an assessment and forward your report to me as soon as
available.
These reports will be discussed at the multi-agency Diagnosis meeting. The date of the
meeting is ____________________ at _____________ in __________________________.
The reports will be required three weeks prior to this meeting date for onward circulation to
the professionals involved.
Yours sincerely
JILL HASTIE
Admin Support Officer
Please note that any information shared is subject to the Information Sharing Protocol
agreed between NHS Fife and Fife Council Education Services [see Appendix II]. If required
a signed copy of this protocol can be obtained from Business Manager – Children’s
Services.
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Child Health
28
Children’s Services Office
Lynebank Hospital
Halbeath Road
Dunfermline
KY11 4UW
Tel: 01383 565495
Email: jill.hastie@nhs.net
Date
April 2012
Your Ref
Our Ref
Enquiries to
Insert Address Block
Dear
RE:
INSERT CHILD’S NAME, ADDRESS AND DOB/CHI
____________________________ has been referred for an ASD Assessment to ASCA
[Autism Spectrum Community Assessment]
To help us with this assessment we would be most grateful if you would copy us any
relevant reports and clinic letters. We have permission from the parents to ask you for this
information.
These reports will be discussed at the Diagnosis meeting. The date of the meeting is
____________________ at _____________ in __________________________. The
reports will be required three weeks prior to this meeting date for onward circulation to the
professionals involved.
Yours sincerely
JILL HASTIE
Admin Support Officer
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GUIDELINES FOR PROFESSIONALS INVOLVED IN ASCA
Introduction
ASCA stands for Autism Spectrum Community Assessment; it is also known as ASD Tier 2
Assessment. It is a model that aims to share information and jointly plan assessment,
diagnosis and support for children with suspected Autism Spectrum Disorder. This guidance
is for all professionals involved in the assessment process i.e.






Class teachers / special needs teachers
Educational psychologists
Paediatricians
Speech and language therapists
Occupational therapists
Clinical associate psychologists [see Information Sharing – Appendix II]
Guidance for Assessments
Following agreement by Community Paediatricians to place the referred child on the ASCA
pathway, the Admin Support Officer [ASO] will arrange the date of the Diagnosis Meeting.
This date will be set in agreement between the paediatrician and relevant education
professional.
Once the date has been agreed this will be circulated to all professionals involved with a
request for new or existing reports to be sent to the appropriate ASO three weeks in
advance of the meeting. The reports will then be forwarded to the professionals only for
preparatory reading. As the purpose of the meeting is to make a joint decision, authors of
reports must ensure that the reports do not include a decision on diagnosis.
The ASO will also ensure that an ASD information pack is sent to the Paediatrician to give to
the Chair. The Chair will provide the pack to parents/carer during the feedback process if a
positive ASD diagnosis is made. If a diagnosis is not made, the pack should be returned to
the ASO.
Professionals should use whatever assessment tools they would usually deem appropriate
for consideration/exclusion of ASD. Colleagues should discuss within their professional
groups which tools are most appropriate. As there will now be only one meeting for all the
professionals to share their assessments/reports, it is imperative that professionals consult
with each other in advance and in good time. Professionals should ensure:
 Ensure effective information sharing with each other
 Liaise with each other to agree sharing of tasks
 Ensure tasks are carried out within reasonable timescales
 Avoid duplication of tasks and use context with which they are most familiar as main
focus for assessment
Guidance for Diagnosis Meeting
Refer to Diagnosis Meeting Agenda
Assessment reports should be sent to appropriate ASO three weeks before the date of the
meeting for distribution to all professionals prior to the meeting. This is to give professionals
enough time to read the reports. These reports will not be sent by ASO’s to the parents at
this time. However some services may wish to share their reports with parents in advance of
the diagnostic meeting.
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Diagnosis meeting must, as a minimum, include community paediatrician, education
representative and two other professionals.
Agenda should include:
1. Introductions
2. Explanation of the purpose of the meeting:
 Decision to be made following reports and discussions and going through ICD-10
 Professionals must not give opinions until after reports, discussion and ICD-10 have
been fully discussed
 Note that ICD-10 is just one of a range of assessment tools used in the process and
diagnosis should not hinge on ICD-10 alone
 There is a need to reassure all that there is no pressure to make a diagnosis,
indeed that the threshold for referral to Tier 3 should be low
 Also that the diagnosis is for ASD only – the team should not be make other
diagnoses as part of this specific process
 Reminder that children with possible additional problems or complex differential
diagnoses may not be diagnosed at Tier 2 as they need more detailed assessments.
If this is the case they should be referred to Tier 3. However, some cases, despite
being complex, are clearly diagnosable for ASD at Tier 2 due to the clarity of their
autism. If this is the case, it is reasonable to make a diagnosis at Tier 2 rather than
refer on to FAST.
Complex Cases
When considering the effect of complexities on the diagnosis of an ASD in a child at Tier
2, the main consideration is whether the complexity is going to complicate making a
diagnosis.
For example:
 ADHD that is fully diagnosed and managed might not need referral onto Tier 3
 ADHD that comes up as a diagnostic possibility in the middle of an assessment of
ASD almost certainly needs addressed first by the appropriate professionals
 When professionals are unsure if the presentation is ASD or ADHD it will need to go
to Tier 3.
 Learning disability that is fully assessed and understood might not need to go to Tier
3, while a possible learning disability complicating the diagnosis will.
If a child with significant complexity is seen at Tier 2 and all are in agreement that the
child does not have a diagnosis of ASD, it will NOT be necessary for the case to be
referred on to Tier 3. However, follow up by the appropriate service should be arranged.
If a child is in the middle of a process of major change e.g. going from nursery to primary
school, consideration my be given to delaying the ASCA assessment until they have
settled into their new environment, provided that the parents are in agreement with this.
3. Team to speak to brief summary [paragraph] – what they have done and what they have
found – remind team not to give a definitive opinion.
4. ICD-10 criteria [A – E] should be led ideally by a professional familiar with the criteria.
Go through A to E, discussing criteria and assessments carried out. Diagnosis can only
be made if there is evidence from the joint assessments and ICD-10 that the criteria are
fulfilled, however diagnosis is not based on this alone.
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Record on ICD-10 form which criteria are met – this form should then be added to child’s
notes. This can be useful for Tier 3 referral.
5. Individuals decide:
a. ASD
b. Not ASD
c. Referral to Tier 3
6. Group decision – any dissension, however minor, should lead to a referral to Tier 3.
7. Next Steps:



Team should make a decision regarding who meets with the family to discuss the
outcome of the meeting, bearing in mind the family’s wishes from previous
discussion. Every effort should be made to avoid keeping parents/carers waiting for
the outcome of the meetings decision.
Any future assessments/interventions should be discussed with the family at the
feedback meeting.
The team should identify the review mechanism [whether in health or education]
considering planning and intervention.
Guidance for Feedback to Parents
1. Parents/carers attending a feedback meeting should not be kept waiting beyond their
appointment time.
2. Inform the parents of the team decision. Parents may have a range of emotions. Be
sympathetic, transparent and concise. Acknowledge and validate parent’s response and
emotions.
3. Explain how the decision was reached and why. Allow time to discuss questions and
concerns.
4. If a decision is made to refer onto FAST, it should be explained to the parents/carers that
the referral to this Tier 3 service can be withdrawn if they so wish.
5. If a diagnosis of ASD is made, an information pack should be given to the parents.
6. Copies of the final report and all professional reports will be sent to the parents. In all
cases a copy of the report summary will be sent to the GP and the referrer.
7. Identify an appropriate professional that the family can contact with any questions or
feedback they may have about the process following the diagnosis meeting.
Ensuring that the Views of the Child or Young Person is heard
It is a political and legislative requirement to seek the views of children and young people
about decisions that affect them (the Children (Scotland) Act 1995; Article 12 of the United
Nations Convention on the Rights of the Child (UNCRC) 1989; the Standards in Scotland’s
Schools etc. Act 2000; The Education (Additional Support for Learning) (Scotland) Act
2004).
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In all assessment and planning processes, good practice starts with listening carefully to
children and their families about what is important to them. In addition to the political and
legislative right, children and young people have valuable insight into their own needs and
circumstances which is important to seek and record. In the ASCA process, children and
young people have the right to:




the appropriate information
the opportunity to give agreement and express their views
knowledge of what is happening
support to understand why
A flexible and reflective approach is required to adapt to the needs of each individual.
Situations should be facilitated to enable young people to understand what is happening and
give their views. This means supporting them to think in advance about their thoughts and
feelings and what they may want to share with others.
Meetings & Cases: Exceptional Circumstances
Every effort should be made by all services to ensure that pre-arranged meetings proceed
as agreed. There will be occasions where a professional at short notice (most likely
because of illness) will be unable to attend an ASCA meeting. On such occasions, the
meeting should go ahead wherever possible. It may for example be possible for a service to
substitute for an absent colleague. A further consideration to ensure that the meeting
proceeds would be for the remaining professionals to agree a recommendation which will
become the decision of the meeting subject to consultation with the absent professional on
their return to work/next availability.
Occasionally there are exceptional cases where the usual ASCA process will be impossible
to follow eg where a child has been off school long term. On these occasions, relevant
professionals should consult with each other to agree a practical and reasonable way
forward.
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Autistic Spectrum Difficulties [School Based Assessment]
To be completed by school senior management representative in conjunction with the
link EP and school and support staff who know the child well and returned to the
Admin Support Officer at least 3 weeks prior to the Diagnosis Meeting.
Observation Record for School Age Children from Primary 2 upwards
The assessment information covers the areas of additional support needs which are
associated with autistic spectrum difficulties:
1.
2.
3.
4.
Language and communication
Social skills and relationships
Thinking and behaving flexibly and creatively
Co-ordination and hypersensitivities
It will help inform an individual profile as part of a multi-agency assessment. Many children
will have some difficulty in one or more of these areas at different times in their lives. Please
answer the questions in the context of what is developmentally appropriate for the age or
Tier of the child or young person.
Name of school:
Name of pupil:
DOB:
Class:
Completed by:
Date form completed:
Age/Tier completed:
Pupil/parental views on assessment:
Assessment Profile [including pupil’s strengths, likes, dislikes, curricular attainments and
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difficulties]:
Strategies tried so far [please indicate what works well and what does not]:
Less successful strategies?
What works well?
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1.
Language and communication
Do you have any concerns re the pupil’s
skills in this area?
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Level and/or subtlety of eye contact
Use of gesture
Understanding of gesture
Appropriate facial expression
Social use of smiling
Integration of speech/ eye contact/ gesture
Use of intonation – tone of voice, accent, the
way he/she speaks
Understanding of intonation
Do you have any concerns re the pupil’s
skills in this area?
Instance of repetition or echolalia
Frequency of inventing words
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Repetitive memorising of strings of words or
songs
Understanding of metaphor e.g. “you need to
pull your socks up” or literal understanding
e.g. “run on the spot”
Functional use of language
Social use of language
Reciprocal conversation skills eg social give
and take or persevering on a topic
Use of inference in written language
Understanding of inference in written
language
2.
Social Skills and Relationships
A. In Class
Do you have any concerns re the pupil’s
skills in this area?
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Turn taking skills
Co-operation in groups
Initiating contact with children
Social behaviour, friendships
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Participating in team games, understanding
of rules
Showing embarrassment
Initiating contact with adults
Showing empathy eg shows concerns if
someone is hurt
Recognising emotions
Interaction with adults
Understanding of hierarchies eg Head
teacher role
Interaction with other children
2. Social Skills and Relationships
B
In Playground
Do you have any concerns re the pupil’s
skills in this area?
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Turn taking skills
Co-operation in groups
Interaction with other children
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Initiating contact with children
Social behaviour, friendships
Participation in team games, understanding
of rules
Showing embarrassment
Initiating contact with adults
Showing empathy eg shows concerns if
someone is hurt
What role does the child or young person assume in friendships? [E.g. a leader of a much
younger child or follower of an older child?].
3.
Thinking and Behaving Flexibly and Creatively
Do you have any concerns re the pupil’s
skills in this area?
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Ease of coping with change e.g. a new
environment
Ease of coping with unexpected events
Ability to modify behaviour according to
situation
Dependency on routine and structure
Routine, repetitive or restricted patterns of
behaviour
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Creative use of objects in play [beyond their
everyday purpose]
Copying play from TV programmes
Sorting and arranging behaviour
Do you have any concerns re the pupil’s
skills in this area?
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Yes No
Please give examples and/or
comments where there are
areas of difficulty
Understanding other people’s perspectives
e.g. being able to put himself/herself in other
people’s shoes
Range of imaginative play
Ability to write imaginatively
Interest in fiction
Pre-occupation with facts
Does the pupil have any areas of special
knowledge or interest
4.
Co-ordination and Atypical Sensitivities
Do you have any concerns re the pupil’s
skills/ sensitivities in this area?
Manipulation of small objects
Fine motor skills
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Pencil grip
Organisational skills
Balance and co-ordination skills
Sensitivity to touch e.g. unaware of hot/cold
or pain
Likes to touch, stroke specific textures
Dislike of getting hands dirty
Sensitivity to smell
Sensitivity to noise e.g. puts hands over ears
Sensitivity to taste and/or texture
Any other observations that are atypical for that age [please tick]
Unusual gait
Walking on tiptoes
Jerky movements
Flapping hands
Rocking





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Frequent blinking
Odd or inappropriate noises
Spinning
Head banging
Facial or body twitches
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Any other observations/comments [please include any relevant information on how the
pupil has presented in earlier years].
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Autistic Spectrum Difficulties [School Based Assessment]
To be completed by school senior management representative in conjunction with the
link EP and school and support staff who know the child well and returned to the
Admin Support Officer at least 3 weeks prior to the Diagnosis Meeting.
Observation Record for Children in Nursery and Primary 1 or for those who have
significant learning problems i.e. ASN Depts
The interview covers the areas of additional support needs which are associated with autistic
spectrum difficulties:
1.
2.
3.
4.
Language and communication
Social skills and relationships
Thinking and behaving flexibly and creatively
Co-ordination and hypersensitivities
It will help inform an individual profile as part of a multi-agency assessment. Many children
will have some difficulty in one or more of these areas at different times in their lives. Please
answer the questions in the context of what is developmentally appropriate for the age or
Tier of the child.
Name of
nursery/school:
Name of child:
DOB:
Class:
Completed by:
Date form completed:
Age/Tier Concerns:
Parental views on assessment:
Pupil views on assessment [if appropriate]:
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Assessment Profile [including child’s strengths, likes, dislikes, curricular attainments and
difficulties]:
Strategies tried so far [please indicate what works well and what does not]:
Less successful strategies?
What works well?
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1.
Language and Communication
Comment on the child’s
use of and/or
understanding of the
following:
Yes No
Please describe
Does the child use
appropriate eye contact?
Does the child use hand
gestures e.g. waving, arms
up to be lifted?
Does the child point to
request an item?
Does the child point to draw
an individual’s attention to
something of interest?
Does the child use
appropriate body
language?
Does the child use your
hand as a tool and
take/move your hand
towards what they would
like?
Does the child follow an
adults use of gesture e.g.
would the child look
towards what the adult is
pointing at?
Would the child come here
then the adult uses a
gesture?
Does the child use a variety
of facial expressions and
direct these facial
expressions towards
another?
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Comment on the child’s
use of and/or
understanding of the
following:
Yes No
Please describe
Does the child understand
the facial expressions of
others?
Does the child respond to
environmental sounds e.g.
telephone ringing?
Does the child have some
situational understanding
e.g. is able to tell that it is
lunchtime by listening to the
sounds in the kitchen or
knows it is bath time by
seeing his pyjamas and
hearing the bath running?
Does the child respond to
your tone of voice?
Does the child understand
words e.g. name being
called, key words, simple
instructions?
Does the child understand
pictures, photographs,
symbols, text or numbers?
Does the child use a range
of sounds to babble?
Does the child have any
unusual sounds?
Does the child use words
to:




Ask
Comment
To greet
Get attention
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Does the child echo or
repeat words or short
chunks of videos, songs *
If the child is using
language, comment on the
child’s use of tone of voice,
rate of speech and
loudness
* Repetition is a part of normal language development. Please comment whether the
repetition is to an unusual extent or whether it is a true echo i.e. with the same intonation
and usually not integrated with eye contact.
2. Social Skills and Relationships
Comment on the child’s
use of and/or
understanding of the
following:
Yes No
Please describe
Is the child aware of and
interested in others?
Does the child copy facial
expressions, gestures,
actions and sounds?
Can the child take turns
with sounds/babble?
Does the child smile in
response to you?
Does the child seek comfort
when upset?
Does the child initiate
contact with another child?
Does the child initiate
contact with another adult?
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Comment on the child’s
use of and/or
understanding of the
following:
How does the child react
when someone else is
hurt?
Yes No
Please describe
How would the child react if
mummy is angry?
How does the child react to
strangers?
Would the child bring and
show you an object of
interest?
Would the child give you an
object to get help with it?
Would the child give you an
object which they have
found/ or to show you?
How does the child ask for
help?
How does the child attract
your attention to his/her
activity?
Does the child share toys?
Can the child follow any
adult’s eye gaze towards
something of interest?
Can the child use their eyes
to direct an adult’s attention
toward something which
may be of shared interest?
Can the child participate
and anticipate within social
games e.g. peek-a-boo,
round and round the
garden?
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Does the child enjoy these
games?
Would the child seek
reassurance in an
unfamiliar situation?
How would the child do
this?
Play
What does the child like to play with?
What are the child’s favourite toys?
Comment on the child’s
use of and/or
understanding of the
following:
Yes No
Please describe
Does the child play
appropriately with cause
and effect toys?
Does the child have a
special liking for bits of toys
e.g. the wheels on vehicles,
shiny parts or flashing
lights?
Would the child play
appropriately with toy items
e.g. take a toy telephone to
his ear or move cars along
the floor or mat?
Does the child repeat play
patterns to an unusual
extent?
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Does the child like to line
up, sort or arrange toys?
Does the child have any
unusual attachments to
toys, objects or routines?
Does the child engage in
pretend play e.g. would he
feed the dolly, put dolly to
bed, take the cars to the
garage?
Can the child pretend to be
mummy or daddy when
playing?
Would they dress up?
Would they be able to
understand and use an
item beyond its intended
purpose e.g. use a box to
represent a car or a house?
Would the child copy
sequences of play from the
television?
3. Thinking and Behaving Flexibly and Creatively
How does the child respond to changes in routine?
How does the child cope with new events or situations?
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Does the child show any routine, repetitive or restricted patterns of behaviour? Please give
examples:
4. Co-ordination and Atypical Sensitivities
Do you have any
concerns regarding the
child’s skills/ behaviours
in this area?
Yes No
Any comments/observations
Manipulation of small
objects
Fine motor skills
Balance and co-ordination
skills
Sensitivity to touch e.g.
unaware of hot/cold or pain
Likes to touch, stroke
specific textures
Dislike of getting hands
dirty
Sensitivity to smell
Sensitivity to noise e.g.
puts hands over ears
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Has the child ever done any of the following?
Yes No
Flapped his/her hands vigorously
Spun round and round
Smelt things frequently before using or eating
Licked things that one usually does not lick
Smeared things like soap, creams excessively
Liked to touch and stroke things, particularly of specific textures that he/she
seems to enjoy e.g. fur, silk etc
Used your hand to do things
Shown an extreme dislike of getting hair brushed
Complained about clothes being uncomfortable or scratchy
Avoided getting his/her hands dirty
Have you ever noticed any of the following?
Yes No
Facial or body twitches
Blinking eyes a lot
Making funny noises in his/her throat
Sniffing or coughing a lot when he/she does not have a cold
2.
Does he/she ever cover his/her ears to sound?
3.
Has he/she ever shown any fascination with lights, patterns, shiny things,
water, spinning things etc. If yes, please describe:
4.
Has he/she ever seemed unaware of hot, cold or pain?
5.
Has he/she ever needed an object with him/her all the time and carried it
around? If yes, please describe the object:
6.
Has he/she ever been fascinated by, or obsessional about anything?
7.
Does he/she eat a wide range of snacks? Will he/she try new snacks?
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Any other observations/comments
Please describe any other unusual behaviours you are concerned about?
Please include any relevant information about changes in behaviour/presentation
since the child started nursery?
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Diagnosis Meeting Agenda
Chaired by Senior Staff Member from School
Assessment reports will have been circulated in advance of this meeting NB: no minutes
need to be taken. The completed copies of ICD10 [see page 54] and the ASCA Report
Summary [see page 56] and where appropriate, the ASCA FAST Referral [see page 57]
must be sent as soon as possible by the Chairperson to the Admin Support Officers.
1. Brief introductions
2. Purpose of meeting
3. Individuals summarised assessment reports [not giving opinion on diagnosis]
NB: only key points will be discussed
4. Use ICD-10 criteria
5. Individual opinions sought
6. Decision to be made



ASD
Not ASD
Referral to Tier 3
7. Next steps




Who reports to family
Outcome of feedback meeting to members of the Diagnosis meeting
[email suffice]
Further interventions or assessments
Follow up / Review
8. AOCB
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ICD – 10 research criteria for autism
Criteria
Evidence from reports
A Presence of abnormal or impaired development before the age
of three in at least ONE of the following:
Receptive / expressive language use in social
communication.
The development of selective social attachments /
reciprocal social interaction
Functional or symbolic play
B Qualitative abnormalities in social interaction in at least ONE of
the following areas
Failure to use eye gaze / facial expression / body
posture and gesture to regulate social interaction
Failure to develop peer relationships that involve a
mutual sharing of interests, activities and emotions
A lack of socio-emotional reciprocity shown in inappropriate response to others / modulating behaviour
to context / weak integration of social / emotional and
communicative behaviours
C Qualitative abnormalities in communication, in at least TWO of
the following areas
A delay, or total lack of spoken language
accompanied with no attempt to compensate through
use of gesture or mime
Relative failure to initiate or sustain conversational
interchange where there is a reciprocal to and from
responsiveness to the communication
Stereotyped and repetitive use of language /
idiosyncratic words or phrases
Abnormalities in pitch, stress, rate, rhythm, intonation
of speech
D Restricted, repetitive and stereotyped patterns of behaviour,
interests and activities – in at least TWO of the following areas
Encompassing preoccupation with one or more
stereotyped and restricted patterns that are abnormal
in content or focus; or one or more interests that are
abnormal in their intensity and nature but not in their
content or focus
Compulsive adherence to specific, non-functional
routines or rituals
Stereotyped and repetitive motor mannerisms eg
hand flapping or twisting or whole body movements
Preoccupation with part objects or non-functional
elements of play materials (eg odour, feel, noise,
vibration)
Distress over changes in small, non-functional details
of the environment
E clinical picture not attributable to other disorders
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Agenda for Feedback to Parents/Carers
Should be minimum of two professionals
1. Feedback of decision
2. Brief explanation of how decision reached
3. Parent’s questions and concerns
4. Next steps, including review
5. If diagnosis given, give pack
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Final ASCA Report Summary for Parents/Carers
[To be returned to Admin Support Officers for Distribution]
Child’s name: ………………………………………………………………
Address: ……………………………………………………………………
Date of Birth/CHI: ……………………………..
………………………….has been assessed for a suspected autism spectrum disorder.
The following professionals took part in the assessment and their reports are
attached:
1
…………………………………………………………..
2
…………………………………………………………..
3
…………………………………………………………...
4
……………………………………………………………
5
……………………………………………………………
6
……………………………………………………………
The following decision was reached:
Next steps:
ASCA Chair Signature: ………………………… Date of Report: ………………...
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Final ASCA Report Summary
FAST REFERRAL
[To be returned to Admin Support Officers with supporting paperwork for onward
referral as soon as possible.]
Child’s name: ………………………………………………………………
Address: ……………………………………………………………………
Date of Birth/CHI: …………………………………………………………
The following professional groups took part in the assessment and their reports are
attached:
1
…………………………………………………………..
2
…………………………………………………………..
3
…………………………………………………………...
4
……………………………………………………………
5
……………………………………………………………
6
……………………………………………………………
Please give reasons for onward referral to FAST enclosing a copy of completed ICD10.
Any special requirements/information that the FASTeam should be aware of?
Name [please print]: ………………………………………………………………………..
Signature: ……..……………………………………….... Date: ………………..............
Designation: ……………………………………………..
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Appendix I
Evaluating the Feasibility and Acceptability of a New
Model of Autism Spectrum Disorder (ASD)
Assessment
and
Diagnosis
by
a
Multi-Agency Community Based Team
The WASP Project (West-Fife Autism Spectrum Pilot)
Evaluation Report
Executive Summary
January 2009
Contributors:
Wendy Simpson, Public Health, Playfield Institute, NHS Fife
Carolyn Brown, Educational Psychology, Fife Council
Zoe Claisse, Paediatrics, NHS Fife
Emma George, Playfield Institute, NHS Fife
Ruth Metcalfe, Clinical Psychology, NHS Fife
Julia Neufeind, Playfield Institute, NHS Fife
Nara Nisbet, Speech & Language Therapy, NHS Fife
Lorna Watson, Consultant in Public Health, NHS Fife
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Executive Summary
Introduction
National guidelines stress the importance of early diagnosis of Autism Spectrum Disorder
(ASD) and intervention by multi-agency services to help children maximize their potential. At
present in Fife there are three specialist ASD assessment teams that receive the majority of
referrals. Waiting lists are approximately 18 months for this service and ASD diagnosis rates
are 49%. This pilot was set up to investigate the feasibility and acceptability of assessing
children in their school and community by local workers. The aim of this approach was to
promote earlier identification of ASD; to reduce the number of children being referred
unnecessarily to the specialist ASD assessment service and to provide seamless links to
support in the child’s school and community.
The study asked whether the local teams were able to make decisions about ASD diagnosis
and whether their decisions were in line with specialists’ views; how long the process took;
what factors influence the decision-making process; whether the process was feasible and
whether the model was acceptable to the parents and workers involved.
Method
Workers were required to attend a planning meeting, then to carry out assessments of the
child and finally attend a decision meeting where, as a group, they came to a decision about
whether the child definitely had ASD, did not have ASD or needed to be referred for further
assessment. Specialist observers were present to validate the decision. Interviews and
focus groups were carried out by a researcher to assess the views of parents and workers.
Results
17 children took part in the study from 11 primary schools in West Fife. Six were identified
with ASD, three as not ASD and eight were referred for further assessment. 16/17 decisions
were validated by the specialist observers. Excluding the case not validated, younger
children under 8 were more likely to be given a diagnostic decision than those 8 or over
(p<O.05). Those without co-morbidity were more likely to be given a diagnosis of ASD than
to be referred for further assessment (p<0.05). The average length of time taken for the
process was 18 weeks. In general, the model was found acceptable to parents and workers.
They particularly appreciated the natural environment for the assessments and the wide
range of information gathered from different sources. However, they found the process
difficult, in particular setting up the meetings. Workers also felt they needed more
information about how to carry out meetings, to make assessments and compile reports.
Conclusions
In conclusion, this pilot suggests that it is feasible to set up multi-agency community teams,
based in schools, which are able to diagnose straightforward ASD cases and non ASD
cases and which are also able to make decisions about when to refer to the specialist
service, FAST. Although it was a relatively small pilot group, the results indicated that
referrals to FAST for school aged children may be able to be cut by 50% if this model is
rolled out, with 75% of younger children and 25% of older children being given a definitive
decision. This would have a significant impact on waiting lists, which are currently
unacceptably long. The majority of workers and parents involved were able to appreciate
the benefits of this model of working in terms of earlier diagnosis, a more natural
assessment environment and improved links to support. However, in practice there were
many frustrations relating to dissemination of information about the model and the process.
Future development of this model requires careful consideration of the views of participants
expressed in the full report, the improvements they suggested and the staff training
requirements outlined. In particular there is a clear need for dedicated administration
support and a high quality, detailed information manual for parents and staff.
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Moreover, a plan for ongoing monitoring of the service would need to be created including
audit of outcomes and validation of the decision-making process.
Recommendations
In the light of the conclusions of this pilot, the authors have agreed on the following main
recommendations for service planning:
1. A roll-out sub-group should be set up to oversee the roll-out aims, materials and process.
2. A current study of clinicians’ time for taking part in this pilot will inform the roll-out plan.
We would envisage the requirement for some re-configuration of health services and
possibly the need for additional resources within some of the health service teams.
There should be no need for additional resources for the education service.
3. A plan for ongoing monitoring of the service; audit of outcomes and validation of the
decision-making process will need to be created. We would envisage some ongoing
involvement of FAST in this process.
4. A manual should be compiled including:
a. Clear guidelines for all staff about the step-by-step process for the two school meetings, the
assessment process and the compiling of reports.
b. Clear guidelines for staff about the actual decision process, including how to use the ICD-10.
In particular, there is a need to reassure staff that there is no pressure to make a diagnosis,
indeed that their threshold for referral to FAST should be low. Also that the diagnosis is for
ASD only – the team should not be making other diagnoses as part of this specific process.
c. A clear explanation for parents of the entire assessment / decision process and the care
pathway, ( i.e. that this is Tier 2 of the process and that only more obvious cases can be
diagnosed or ruled out at this Tier, but that it is an important part of the process of contextual
information-gathering for FAST). This could also include guidelines for parents on how to
explain the process and the condition (if diagnosed) to their child.
d. All necessary printable paperwork e.g. standardised letters to parents and GPs, meeting
agendas, screening tools, history-taking forms, etc.
5. Standard agendas should be created for both school meetings to ensure consistency of
approach. The agenda for the 1st meeting should consist of: sharing current information;
addressing parental concerns; planning joint assessments; and asking parents how they
want to be involved in the decision-making process. The agenda for the 2nd meeting
should include: presentation of assessment reports; use of ICD-10; decision-making;
discussion of ongoing treatment/care plan, whatever the outcome; and informing the
parents of the result if they have chosen not to attend the meeting.
6. Parents should not be present at the second meeting. However they should be clearly
informed of the process of making a decision. To be informed following the meeting,
they should be seen by the head teacher (or other school representative) and a clinician
(preferably one who already knows the family). Training should be provided for these
professionals to ensure effective and appropriate communication with parents about the
outcome of the assessment/diagnosis process.
7. A protocol for the presentation of the final report should be developed. Initial
assessment reports should be sent to all professionals involved and the parents in
advance of the 2nd school meeting.
8. The multi-agency teams will take joint responsibility for the diagnoses and will be
required to adhere to the agreed protocol. Assuming the protocol is adhered to, final
clinical responsibility will lie with the area consultant paediatrician whose role it will be to
verify, support and ultimately take responsibility for the team processes, assessments
and decisions.
9. We would recommend that a permanent senior administrator post should be created.
We would envisage that this post would be jointly funded by health and the council and
would report to the joint ASD steering group. This post would act as general project
manager for the roll-out, with the following main tasks:
a. managing a central referral system including FAST referrals
b. maintaining a database of all children in this system across Fife
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c. taking responsibility for setting up all school meetings
d. planning an on-going training programme for staff
e. organising the distribution of all necessary documentation – letters, manuals,
assessment reports, final reports to parents and staff
f. acting as a central contact point for all staff and parents involved
g. planning the ongoing monitoring/audit process
References
Le Couteur A. National Initiative for Autism: Screening and Assessment (NIASA). National Autism Plan for Children (NAPC):
Plan for Identification, assessment, diagnosis and access to early interventions for pre-school and primary school aged children
with autism spectrum disorder (ASD). London: National Autistic Society; 2003.
Medical Research Council (MRC). MRC Review of Autism Research: Epidemiology and Causes. London: MRC; 2001.
Public Health Institute of Scotland (PHIS) Autistic Spectrum Disorders: Needs Assessment Report. Glasgow: PHIS;2001.
Roberts, A. FAST (Fife Autism Spectrum Team) Report and Recommendations.
Management, NHS Fife, August, 2008
Unpublished Report for Child Health
Simpson W. & Hyland J. Families’ Views on Services for Autism. Unpublished Report for Department of Public Health, NHS
Fife, 2003
Scottish Intercollegiate Guidelines Network (SIGN). Assessment, diagnosis and clinical interventions for children and young
people with autism spectrum disorders. A national clinical guideline. SIGN;2007.
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