Combined Child Health Service
Autistic Spectrum Disorders
Diagnostic & Patient Care Pathways
Diagnosis to School Leaver
November 2008
Combined Child Health Service
Table of Contents
Pathway 1 ............................................................................................................ 1
Pre – School Children - Diagnostic Pathway ......................................... 1
Guidance on use of Pre-School Diagnostic Patient Pathway .............. 2
Universal Child Health Screening .................................................... 2
Recognition of Child’s Difficulties .................................................... 2
Clinical Assessment ........................................................................ 3
Referral to Child Development Service............................................ 4
Diagnostic Assessment ................................................................... 6
Multi-Agency Case Conference ....................................................... 6
Pathway 2 ............................................................................................................ 7
Pre- School Children - Patient Care Pathway ........................................ 7
Guidance on use of Pre-School Patient Care Pathway ......................... 8
Diagnosis of Autistic Spectrum Disorder ......................................... 8
Information for Parents .................................................................... 8
Social Work ................................................................................... 10
Education ...................................................................................... 10
Health ............................................................................................ 11
Personal Child Health Records (PCHR) ........................................ 11
Voluntary Agencies........................................................................ 11
Joint Assessment of Needs / Integrated Assessment.................... 11
Individual Educational Plan / Co-ordinated Support Plan .............. 12
Key worker .................................................................................... 12
Regular Review ............................................................................. 12
Pathway 3 .......................................................................................................... 13
School Age Children - Diagnostic Pathway ......................................... 13
Guidance on use of School Age Diagnostic Patient Pathway ............ 14
Universal Child Health Screening .................................................. 14
Recognition of Child’s Difficulties .................................................. 14
Clinical Assessment ...................................................................... 15
Referral to Child Development Service.......................................... 17
Child and Family Mental Health Service ........................................ 19
Diagnostic Assessment ................................................................. 21
Multi-Agency Case Conference ..................................................... 21
Pathway 4 .......................................................................................................... 22
School Aged Children - Patient Care Pathway .................................... 22
Guidance on use of School Age Patient Care Pathway ...................... 23
November 2008
Combined Child Health Service
Diagnosis of Autistic Spectrum Disorder ....................................... 23
Information for Parents .................................................................. 23
Social Work ................................................................................... 26
Health ............................................................................................ 26
Education ...................................................................................... 26
Joint Assessment of Needs / Integrated Assessment.................... 27
Individual Educational Plan / Co-ordinated Support Plan .............. 27
Voluntary Agencies........................................................................ 28
Key worker .................................................................................... 28
Regular Review ............................................................................. 28
Annex 1 ................................................................................................... 29
THE CHAT assessment form. ....................................................... 29
Annex 2 ................................................................................................... 31
ICD-10 / DSM-IV Classification System......................................... 31
Documents used in the production of pathways ................................ 35
References:............................................................................................. 35
Working Group Members ...................................................................... 36
November 2008
Combined Child Health Service
Pathway 1
Pre – School Children - Diagnostic Pathway
Recognition of Childs Difficulties
Parents, Health Visitor, General Practitioner, Nursery Staff
(Professionals listen to parents concerns)
Clinical Assessment
Health Visitor/General Practitioner
No significant evidence of ASD
(but concerns remain)
Diagnosis of ASD being considered
Follow Up with Health Visitor
Refer to Child Development Services
Liaise with Nursery, Social Work (if involved
with family). Consider referral for speech &
Language therapy
Liaise with Health Visitor, Nursery, Social Work,
Allied Health Professionals e.g. Speech &
Language, Occupational Therapist
Discharge
Diagnostic Assessment
Multi-disciplinary, Multi-agency
Medical Assessment
Speech and Language Assessment
Educational Assessment
Involvement of Social Work Department
Consider Mental Health Assessment
and/or Autism Specific Assessment
If indicated Occupational Therapy and
Physiotherapy Assessment
Follow Up with
Child Development Services
Liaise with Health Visitor, Nursery, Social Work,
Allied Health Professionals, Educational
Psychologist
Multi-Agency Case
Conference
Diagnosis
of ASD
Follow
Patient Care
Pathway
November 2008
Discharge
Diagnosis of ASD
not confirmed
Follow Up with Child
Development Services
(as above)
and/or
Mental Health Service
1
Combined Child Health Service
Guidance on use of Pre-School Diagnostic Patient Pathway
Universal Child Health Screening
The early identification of a child requiring an assessment for health problems
and developmental disorders is the aim of the child health screening and
surveillance programmes.
Health for all Children (Hall 4) has led to a significant change in screening and
surveillance in Scotland.
Hall 4 states: Every child and parent should have access to a universal or core programme
of preventative pre-school care.
Formal screening should be confined to the evidence based programmes
agreed by the National Screening Committee.
Health professionals must respond promptly to parental concerns.
Formal universal screening for speech and language delay, global
developmental delay and autism is not recommended.
Scottish Executive 2005
Early identification, early therapeutic and educational intervention, and
seamless delivery of services may help a child to maximise their potential.
A key aim is to minimise the delay between the initial concerns of parents, a
diagnosis being made and provision of appropriate interventions and support.
Recognition of Child’s Difficulties
Concerns raised by parents should be taken seriously and responded to
appropriately in all cases. Parents may say that their child is different from
others of a similar age but are unable to give a clear explanation of the
differences. Behaviours that may lead to concerns being raised about a child
can include, failure to smile or lack of response to others smiling, slow to
develop speech, loss of speech and/or language skills, does not initiate play
with peers, aggression, repetitive and obsessive behaviours, inability to cope
with change and appear to be “in a world of their own”
Health professionals should be aware that the absence of normal
development, or delayed development is as important as the presence of
abnormal development in a child. Health Visitors, General Practitioner or
nursery staff may have concerns about a child that the parents have not
expressed, these concerns should be discussed with the parents in a
sensitive manner.
November 2008
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Combined Child Health Service
Clinical Assessment
“The primary aim of clinical assessment is to examine the profile of skills and
impairments of the child concerned in order to identify their specific needs.
Parents or other carers are partners with the professionals in this process”
Judith Gould, 2003 (NAPC 2003)
The universal core programme for child health surveillance has an important
role in the early detection of problems and includes enabling health
professionals to identify children who require further assessment for autistic
spectrum disorder (ASD)
The use of a screening tool such as, the Checklist for Autism in Toddlers
(CHAT) or the modified CHAT (M-CHAT) can be useful when considering
relevant clinical features identified during an assessment. ( see Annex 1)
Observation of the child for the triad of impairments should be incorporated in
a developmental assessment, these are: - Social interaction, Social
communication and Social imagination.
SIGN guidelines have listed features, which should alert health professionals
to the possibility of ASD:  Delay or absence of spoken language
 Looks through people; not aware of others
 Not responsive other peoples facial expression/feelings
 Lack of pretend play; little or no imagination
 Does not show typical interest in or play near peers purposefully
 Lack of turn-taking
 Unable to share pleasure
 Qualitative impairment in non-verbal communication
 Does not point at an object to direct person to look at it
 Lack of gaze monitoring
 Lack of initiation of activity or social play
 Unusual or repetitive hand and finger mannerisms
 Unusual reaction, or lack of reaction, to sensory play
If after carrying out a clinical assessment, health professionals do not suspect
ASD but concerns remain regular follow up by health visitor is recommended,
with liaison between nursery, Allied Health Professionals and social work as
required. The child can be referred to the Child Development Service at any
stage for further advice.
If diagnosis of ASD is being considered, the child should be referred to the
Child Development Service for further assessment.
November 2008
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Combined Child Health Service
Referral to Child Development Service
The Child Development Service is available at local clinics throughout
Grampian and can be accessed by referral to:Community Child Health Department
Royal Aberdeen Children’s Hospital
Westburn Road
Aberdeen
AB25 2ZG
Raeden Centre
Midstocket Road
Aberdeen
AB15 5PD
or
Dr A Liebenberg
Ward 2
Dr Gray’s Hospital
Pluscarden Road
Elgin
IV30 1SN
On referral, an initial assessment of the child will be arranged, including: Pre-natal, perinatal and developmental history up to age of child at
assessment. Any social and emotional factors should be included
along with evidence of any problems at home, pre-school or other
social occasions.
 Family history including evidence of any learning disability, speech
and language problems, developmental neurological problems,
psychiatric disorders, autistic spectrum disorder
 Description of family and extended family members (genogram would
be useful), include any family problems (parental separation/divorce,
death) as this may have an affect the child’s behaviour
 Description of the current problems experienced by child, parents,
health visitor, early years workers
 Physical and neurodevelopment examination
 Observation and assessment of behaviour, social and communication
skills. Observations may need to be made in areas out with the clinical
setting such as home and nursery. This allows for a more
comprehensive assessment. Information on how the child is
functioning at home/nursery should be obtained from as many varied
sources as possible.
An audiological examination may be required to exclude any underlying
hearing deficit.
If after the initial assessment a diagnostic assessment is not recommended,
ongoing reviews may be offered either through Child Development Services
or Health Visitor. Liaison with health visitor, social work, nursery, Allied Health
Professionals and educational psychology may be required to ensure the
child’s care and social needs are being met.
November 2008
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Combined Child Health Service
Referral for a multi-disciplinary, multi-agency diagnostic assessment may be
offered at a later date if indicated.
After carrying out a full clinical history and assessment, if ASD is suspected
the child will be referred for a multi-disciplinary, multi-agency diagnostic
assessment. Parents should be informed prior to referral of its nature and
purpose, to clarify the child’s difficulties and diagnosis and how best to help
with their progress.
November 2008
5
Combined Child Health Service
Diagnostic Assessment
SIGN guidelines recommend that the International Classification of Diseases,
version 10 (ICD-10) or the Diagnostic and Statistical Manual of Mental
Disorders 4th edition (DSM-IV) classification system should be used in
diagnosing ASD in children. (see Annex 2)
Undertaking a diagnostic assessment involves collecting and recording
information about the development, health, education and care needs of the
child and their family. Due to the assessments comprehensive nature it may
take place over a period of time.
Autism Specific Assessment generally involves a number of agencies,
including education and social work. This involves: taking a full clinical history, with detailed developmental history
 medical assessment; physical and neurological examination
 Speech and Language assessment: evaluation of speech and
language and communication skills.
 Occupational therapy and/or physiotherapy assessment may be
considered
 Specific mental health assessment may be considered
 Educational assessment (generally from 2 years old)
Educational Psychologists can provide key observational information
 Social care assessment if appropriate
Direct observation of the child in a variety of settings is recommended to help
assess the current functioning level of communication, emotional
development, social relationships and adaptive behaviour.
Use of an ASD specific diagnostic tool may be used.
Multi-Agency Case Conference
A multi-agency case conference involving the parents, child (if appropriate)
and all relevant professionals will take place to discuss and explain the
outcome of the diagnostic assessment, with the diagnosis of ASD being made
explicit at this time. If ASD is not suspected a further opinion may be sought if
indicated.
November 2008
6
Combined Child Health Service
Pathway 2
Pre- School Children - Patient Care Pathway
VoluntaryAgencies
(if required)
Consider Autism specific
assessments
Diagnosis of Autistic Spectrum Disorder
Health
Social Work
Identify any Social care
and Support Needs for
the family.
Respite care
Developmental review thorough
Child Development Services
Involvement of other health
professionals e.g. Allied health
professional services
Mental Health Services
Education
Identify any Additional
Support for Learning Needs.
Mainsteam Nursery
Developmental Nursery
Joint Assessment of Need
Integrated Assessment Framework Action Plan
Key Worker Appointed
(Not yet implemented)
+/- Individual Education Plan/
Coordinated Support Plan
Regular review and reassessment of needs by
various professionals involved
November 2008
7
Combined Child Health Service
Guidance on use of Pre-School Patient Care Pathway
Diagnosis of Autistic Spectrum Disorder
Autistic Spectrum Disorder is a complex, lifelong developmental condition that
affects individuals to different degrees, some with severe communication and
social interaction difficulties, whilst others may be skilled in their use of language
but still have a range of complex needs regarding social interaction and
understanding the motivation of others. (Scottish Society for Autism 2006)
Autistic Spectrum Disorder is more common in boys than in girls and is prevalent
in all nationalities and social classes. There is no clear single underlying cause
although research increasingly points to a genetic factor.
Information for Parents
Parents of children diagnosed with Autistic Spectrum Disorder will require clear
written and verbal information about the condition. The information should be
appropriate to the child’s age, ability and include short and long term plans.
Consideration should be given to informing parents that there is an increased risk
of ASD in siblings of affected children.
Information for parents and carers with a child or young person recently
diagnosed with an autistic spectrum disorder (2006)
The NHS Education for Scotland developed an information booklet, to provide
information to help the family immediately after diagnosis. The booklet is
available to download from: www.scottishautismnetwork.org.uk
Next Steps (2006)
Next Steps is an information resource produced by The National Autistic Society
Scotland, to provide information and support to those who have been diagnosed
with ASD their family and carers. The resource contains a directory of local
services available for children, young people and their families to enable them to
easily source and access relevant support. The resource manual is available to
download from: www.autism.org.uk.
Parents should be provided with information about training opportunities that are
available to them, such as The National Autistic Society Early Bird programme.
Early Bird Programme
The National Autistic Society Early Bird programme is a three month parent
training programme for children under 4 years of age with Autistic Spectrum
Disorder. Training involves group workshops and individual home visits, with
video recording feedback. The aim of the programme is to: support parents between diagnosis and education
 to empower parents and help them with their child’s social communication
and appropriate behaviour in the home setting.
 to help them establish good practice in handling their child and pre-empt
inappropriate behaviour.
The programme helps parents understand their child’s autism and have the
opportunity to share issues with other families.
November 2008
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Combined Child Health Service
Providing further information on local support groups and other national and
local resources available will help empower parents in the care of their child.
Further sources of information include:Grampian Autistic Society
33-35 Carnie Drive
Aberdeen
AB25 3AN
Tel: 01224 277900
Email: admin.gas@classmail.co.uk
Website: Under construction
National Autistic Society Scotland
Central Chambers
109 Hope Street
Glasgow
G2 6LL
Website: www.autism.org.uk
The Scottish Society for Autism
Hilton House
Alloa Business Park
Whins Road
Alloa
FK10 3SA
Website:www.autism-in-scotland.org.uk
The National AutisticSociety
393 City Road
London
EC1V 1NG
Website: www.nas.org.uk
Contact a Family
Craigmillar Social Enterprise & Arts centre
11/9 Harewood Road
Edinburgh
EH16 4 NT
Tel: 0131 659 2930
Website: www.cafamily.org.uk
VSA Carers Centre
24-28 Belmont Street
Aberdeen
AB10 1JH
Tel: 01224 646677
Website: www.vsa.org.uk
Aberdeenshire Autism Support Group
(to become Aberdeenshire branch of NAS)
Susan Kay
2 Broadstraik Crescent
Westhill
Aberdeenshire
Tel: 01224 743475
Email: susankay@tinyworld.co.uk
November 2008
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Combined Child Health Service
Social Work
An assessment of need may be carried out to determine what support and
services are required by the child and their family. This may include respite
care, play schemes for child or siblings and details of available financial
assistance.
Education
The Health Service may identify a child as appearing to have additional
support needs arising from a disability within the meaning of the Disability
Discrimination Act 1995, and bring this child to the attention of the education
authority.
The educational authority will decide whether to assess the child to find out if
they have additional support needs and will determine what support is
required.
The educational authority in partnership with the parents will decide if the child
attends a mainstream nursery school or a developmental nursery or
combination. The Educational Psychologists work collaboratively with parents,
nurseries, medical colleagues and other agencies in diagnosis and planned
intervention.
All 3 and 4 year olds in Scotland are entitled to a funded part time pre-school
education placement.
The Education (Additional Support for Learning) (Scotland) Act 2004 (ASL
Act) introduced a new framework for providing support to children and young
people who require additional help with their learning.
The education authority may then, at its discretion, establish whether the child
has additional support needs arising from a disability under its arrangements
for identifying and providing for children with additional support needs.
The Additional Support for Learning Act requires an educational authority to
provide additional support to certain disabled pre-school children in their area
who are under 3 years old. Once it is established by the educational authority
the child has additional support needs, the authority would then have a duty to
provide suitable provision to meet those needs.
The ASL Act aims to ensure that all children and young people are provided
with the necessary support to help them work towards achieving their full
potential. The ASL Act also promotes collaborative working among all
agencies involved with supporting children.
November 2008
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Combined Child Health Service
Health
A developmental review through Child Development Services involving other
health professionals may be required to assess and manage developmental,
medical and co-morbid problems.
Personal Child Health Records (PCHR)
Personal Child Health Records were introduced to facilitate partnership with
parents and to empower them in overseeing their child’s development and
health care. It is important that health professionals use this record to allow
parents to have available written information about their child’s health and
development. Information on diagnosis and how to access appropriate
information and support can also be recorded in the Personal Child Health
Records.
Voluntary Agencies
An Autism specific assessment of support needs by a voluntary agency e.g.
Grampian Autistic Society may be useful depending on the complexity of the
child’s difficulties or circumstances.
Joint Assessment of Needs / Integrated Assessment
Joint assessment of needs is a co-ordinated Multi-Agency approach to
gathering information and aims to avoid parents having to repeat information
more than once, giving a holistic view of the child within their family and
community enabling assessment of medical, social and educational needs.
Action plans are developed using the systematic assessment and analysis of
the information obtained about the child. The child and their family may
participate in the development of the action plan. An action plan records the
needs and the professional responses and responsibilities to the child,
outlining the basis for providing support, services and resources to meet the
needs of the child.
An action plan should state:





what action should be taken
by whom to improve the child’s circumstances
the reasons for the plan
timescales
intended outcome and future review date
The plan should be as simple as necessary and relevant to the child's needs.
It should be updated or amended as needs change.
November 2008
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Combined Child Health Service
Individual Educational Plan / Co-ordinated Support Plan
An Individual Educational Plan (IEP) describes in detail the nature of the
child’s additional support needs, the ways in which these are to be met, the
learning outcomes to be achieved, and specifies what additional support is
required, including that required from agencies outwith education. The IEP
should be reviewed and updated regularly, involving the parents and child
(where possible).
A Co-ordinated support plan is prepared for children who:
 need support due to complex or multiple factors that have a significant
adverse affect on their education
 require significant involvement from one or more additional agencies
such as health and social work
 will need support for more than a year
The aim of a co-ordinated support plan is to ensure that the various
professionals and agencies involved in providing support are working together
and that the support is co-ordinated.
A Co-ordinated support plan:
 is an action plan for children who require significant additional support
with their education
 supports partnership working to help children achieve educational
targets
 is monitored and reviewed regularly
 involves the child, their family, education and additional agencies
(Enquire, 2007)
Key worker
A key worker is a named person who works in partnership with the family and
can provide a link between professionals and agencies involved in the child’s
care. Key workers can co-ordinate access to, and delivery of services
required from various agencies.
Regular Review
The child will have regular reviews carried out by the various professionals
and agencies involved in their care. Their needs will be reassessed and plans
updated as required.
November 2008
12
Combined Child Health Service
Pathway 3
School Age Children - Diagnostic Pathway
Recognition of Childs Difficulties
Parent, Teacher, Friends, School Nurse, Health Visitor,
School Doctor, General Practitioner
Clinical Assessment
General Practitioner/ School Doctor/School
Nurse/Health Visitor
Referral to Child and Family Mental
Health Service (CAFMHS)/Young
Peoples Department (YPD)
Liaise with School, Educational Psychology,
Learning Disabilities Team, Social Work,
Community Child Health Department (School
Health Service), Specialist Health Visitors,
Allied Health Professional Services
Discharged
Ongoing Mental
Health Service
Involvement
(Not ASD)
Referral to Child Development Service
Liaise with School, Educational Psychology,
Learning Disabilities Team, Social Work, Specialist
Health Visitors, CAFMHS, Young Peoples
Department (YPD), Allied Health Professional
Services
Discharged
Multi-Agency Case Conference
Diagnostic Assessment
Multi-disciplinary, Multi-agency
Medical Assessment
Speech and Language Assessment
Educational Assessment
Involvement of Social Work
Consider Mental Health Assessment and/or Autism
Specific Assessment
If indicated Physiotherapy and Occupational Therapy
Assessment
November 2008
Diagnosis of ASD
Diagnosis of ASD
not confirmed
Follow up offered
as recommended through Multi-Agency
Case Conference
Child Development Services,
Mental Health Services (CAFMHS/YPD)
13
Combined Child Health Service
Guidance on use of School Age Diagnostic Patient Pathway
Universal Child Health Screening
The early identification of a child requiring an assessment for health problems
and developmental disorders is the aim of the child health screening and
surveillance programmes.
Health for all Children (Hall 4) has led to a significant change in screening and
surveillance in Scotland.
All children receive a health check when starting primary school, with little
formal child health surveillance after that. In school age children detection of
problems should be part of mainstream school life.
Hall 4 states: Formal screening should be confined to the evidence based programmes
agreed by the National Screening Committee.
Health professionals must respond promptly to parental concerns.
Formal universal screening for speech and language delay, global
developmental delay and autism is not recommended.
Children starting school should receive the agreed screening programmes.
Health care of school-age children should include support for children with
problems and special needs.
Scottish Executive 2005
Early identification, early therapeutic and educational intervention, and
seamless delivery of services may help a child to maximise their potential.
A key aim is to minimise the delay between the initial concerns of parents, a
diagnosis being made and provision of appropriate interventions and support.
Recognition of Child’s Difficulties
Concerns raised by parents should be taken seriously and responded to
appropriately in all cases. Parents may say that their child is different from
others of a similar age but are unable to give a clear explanation of the
differences. Behaviours that may lead to concerns being raised about a child
can include, loss of speech and/or language skills, inappropriate reaction to
teacher’s instructions, school refusal, poor concentration, does not initiate
play with peers, aggression, repetitive and obsessive behaviours, inability to
cope with change and appear to be “in a world of their own”. Times of change
or transition between schools or other services are periods when difficulties
can be recognised, this can include first years of primary school, move to
secondary school or in adolescence.
Health professionals should be aware that the absence of normal
development, or delayed development is as important as the presence of
abnormal development in a child. General Practitioner, school doctor, school
nurse or school teacher may have concerns about a child that the parents
have not expressed, these concerns should be discussed with the parents.
November 2008
14
Combined Child Health Service
Clinical Assessment
“The primary aim of clinical assessment is to examine the profile of skills and
impairments of the child concerned in order to identify their specific needs.
Parents or other carers are partners with the professionals in this process”
Judith Gould, 2003 (NAPC 2003)
The universal core programme for child health surveillance involves
partnership working between children, parents and health professionals and
may assist in the early recognition of Autistic Spectrum Disorder (ASD)
Observation of the child for the triad of impairments should be incorporated in
a developmental assessment, these are: - Social interaction, Social
communication and Social imagination.
SIGN guidelines have listed features, which should alert health professionals
to the possibility of ASD in school aged children:Communication impairment
 abnormalities in language development including muteness
 odd or inappropriate prosody
 persistent echolalia
 referral of self as “you” or “he” beyond three years
 unusual vocabulary for child’s age/social group
 limited use of language for communication and/or tendency to talk
freely only about specific topics
Social impairment
 inability to join in play of other children or inappropriate attempts at joint
play (may manifest as aggressive or disruptive behaviour)
 lack of awareness of classroom “norms” (criticising teachers, overt
unwillingness to cooperate in classroom activities, inability to
appreciate or follow current trends)
 easily overwhelmed by social or other stimulation
 failure to relate normally to adults (too intense/no relationship)
 showing extreme reactions to invasion of personal space and
resistance to being hurried
Impairments of interest, activities and/or behaviours
 lack of flexible cooperative imaginative play/creativity
 difficulty in organising self in relation to unstructured space ( hugging
the perimeter of playgrounds and halls)
 inability to cope with change or unstructured situations, even ones that
other children enjoy (school trips, teacher away etc)
Other factors
 unusual profile of skills/deficits
 any other evidence of odd behaviours including unusual responses to
sensory stimuli
November 2008
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Combined Child Health Service
SIGN guidelines have also listed features, which should alert health
professionals to the possibility of ASD in adolescents:General Picture
 long standing difficulty in social behaviours, communication and coping
with change, which are obvious at times of transition (change of school,
leaving school)
 significant discrepancy between academic ability and “social”
intelligence, most difficulties in unstructured social situations (in school,
work breaks)
 socially “naïve”, lack common sense, not as independent as peers
Language, non-verbal skills and social communication
 problems with communication, even if wide vocabulary and normal use
of grammar. May be unduly quiet, may talk at others rather than hold a
to and fro conversation, or may provide excessive information on topics
of own interest
 unable to adapt style of communication to social situations, may sound
like “a little professor” (overly formal), or be inappropriately familiar
 may have speech peculiarities including “flat”, unmodulated speech,
repetitiveness, use of stereotyped phrases
 may take things literally and fail to understand sarcasm or metaphor
 unusual use of timing of non-verbal interaction (eye contact, gesture
and facial expression)
Social problems
 difficulty making and maintaining peer friendships, though may find it
easier with adults or younger children
 can appear unaware or uninterested in peer group “norms”, may
alienate by behaviours which transgress “unwritten rules”
 may lack awareness of personal space, or be intolerant of intrusions
on own space
Rigidity in thinking and behaviour
 preference of highly specific, narrow interests or hobbies, or may enjoy
collecting, numbering or listing
 strong preferences for familiar routines, may have repetitive behaviours
or intrusive rituals
 problems using imagination (in writing, future planning)
 may have unusual reactions to sensory stimuli (sounds, tastes, smell,
touch, hot or cold)
If a diagnosis of ASD is being considered, the child may be referred to the
Child Development Service or Mental Health Services - Child and Family
Mental Health Service (CAFMHS) up to the age of 13 years, (young people
with learning disabilities are seen up to school leaving age) or The Young
Persons Department (YPD) from 13-18 years for further assessment.
Alternatively when concerns are identified in school, an Educational
Psychology consultation may clarify issues and support onward referral.
November 2008
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Combined Child Health Service
Referral to Child Development Service
The Child Development Service is available at local clinics throughout
Grampian and can be accessed by referral to:Community Child Health Department
Royal Aberdeen Children’s Hospital
Westburn Road
Aberdeen
AB25 2ZG
or
Dr A Liebenberg
Ward 2
Dr Gray’s Hospital
Pluscarden Road
Elgin
IV30 1SN
On referral, an initial assessment of the child will be arranged, including: Pre-natal, perinatal and developmental history up to age of child at
assessment. Any social and emotional factors should be included
along with evidence of any problems at home, school or other social
occasions.
 Family history including evidence of any learning disability, speech
and language problems, developmental neurological problems,
psychiatric disorders, autistic spectrum disorder
 Description of family and extended family members (genogram would
be useful), include any family problems (parental separation/divorce,
death) as this may have an affect the child’s behaviour
 Description of the current problems experienced by child, parents,
teacher
 Physical and neurodevelopment examination
 Observation and assessment of behaviour, social and communication
skills. Observations may need to be made in areas out with the clinical
setting such as home and school. This allows for a more
comprehensive assessment. Information on how the child is
functioning at home/school should be obtained from as many varied
sources as possible.
An audiological examination may be required to exclude any underlying
hearing deficit.
If after the initial assessment a diagnostic assessment is not recommended,
ongoing reviews may be offered through Child Development Services, or the
child may be discharged from Child Development Services. Liaison with
specialist health visitors, social work, school, Allied Health Professionals,
CAFMHS, YPD and educational psychology may be required to ensure the
child’s care and social needs are being met.
If comorbid mental health problems are identified during the initial
assessment, the child may be referral to CAFMHS, YPD or Learning
Disabilities Team for further assessment, diagnosis and management of the
problems.
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Combined Child Health Service
Referral for a multi-disciplinary, multi-agency diagnostic assessment may be
offered at a later date if indicated.
After carrying out a full clinical history and assessment, if ASD is suspected
the child will be referred for a multi-disciplinary, multi-agency diagnostic
assessment. Parents should be informed prior to referral of its nature and
purpose, to clarify the child’s difficulties and diagnosis and how best to help
with their progress.
November 2008
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Combined Child Health Service
Child and Family Mental Health Service
Children up to the age of 13 years may be referred directly to Child and
Family Mental Health Service (CAFMHS), young people with learning
disabilities may be seen up to school leaving age or young people from 13-18
years to the Young Persons Department (YPD) from Community Child Health
Services or General Practitioner.
The Child and Family Mental Health Service are available throughout
Grampian and can be accessed by referral to:Child and Family Mental Health Service
Lower Ground Floor
Royal Aberdeen Children’s Hospital
Westburn Road
Aberdeen
AB25 2ZG
Young Persons Department
Lower Garden Villa
Royal Cornhill Hospital
Cornhill Road
Aberdeen
AB25 2ZH
Child and Family Mental Health Service
The Rowan Centre
Maryhill
High Street
Elgin
IV30 1AT
On referral, an initial assessment of the child will be arranged, including: Pre-natal, perinatal and developmental history up to age of child at
assessment. Any social and emotional factors should be included
along with evidence of any problems at home, school or other social
occasions.
 Family history including evidence of any learning disability, speech
and language problems, developmental neurological problems,
psychiatric disorders, autistic spectrum disorder
 Description of family and extended family members (genogram would
be useful), include any family problems (parental separation/divorce,
death) as this may have an affect the child’s behaviour
 Description of the current problems experienced by child, parents,
teacher
 Physical and neurodevelopment examination
 Observation and assessment of behaviour, social and communication
skills. Observations may need to be made in areas out with the clinical
setting such as home and school. This allows for a more
comprehensive assessment. Information on how the child is
functioning at home/school should be obtained from as many varied
sources as possible.
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Combined Child Health Service
If after the initial assessment a diagnostic assessment is not recommended,
the child may be discharged from Child and Family Mental Health Services.
Liaison with Community Child Health Department, specialist health visitors,
social work, school, Allied Health Professionals, educational psychology may
be required to ensure the child’s care and social needs are being met.
If comorbid problems such as anxiety disorder, behavioural problems,
Obsessive Compulsive disorder (OCD), depression, Attention Deficit
hyperactivity Disorder (ADHD) are identified during the initial assessment, the
child may have ongoing involvement with CAFMHS, YPD or Learning
Disabilities Team for further assessment, diagnosis and management of the
problems.
Referral for a multi-disciplinary, multi-agency diagnostic assessment may be
offered at a later date if indicated.
After carrying out a full clinical history and assessment, if ASD is suspected
the child will be referred for a multi-disciplinary, multi-agency diagnostic
assessment. Parents should be informed prior to referral of its nature and
purpose, to clarify the child’s difficulties and diagnosis and how best to help
with their progress.
November 2008
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Combined Child Health Service
Diagnostic Assessment
SIGN guidelines recommend that the International Classification of Diseases,
version 10 (ICD-10) or the Diagnostic and Statistical Manual of Mental
Disorders 4th edition (DSM-IV) classification system should be used in
diagnosing ASD in children. (See annex 2)
Undertaking a diagnostic assessment involves collecting and recording
information about the development, health, education and care needs of the
child and their family. Due to the assessments comprehensive nature it may
take place over a period of time.
Autism Specific Assessment generally involves a number of agencies,
including education and social work. This involves: taking a full clinical history, with detailed developmental history
 medical assessment; physical and neurological examination
 Speech and Language assessment: evaluation of speech and
language and communication skills.
 assessment of functioning within the school
 cognitive assessment may be considered to assess child’s intellectual
development
 Occupational therapy and/or physiotherapy assessment may be
considered
 specific mental health assessment may be considered
 Educational assessment
Educational Psychologists (through their consultation model) can
provide information that is key to helpful intervention.
 Social care assessment if appropriate
Direct observation of the child in a variety of settings is recommended to help
assess the current functioning level of communication, emotional
development, social relationships and adaptive behaviour.
An ASD specific diagnostic tool may be used.
Multi-Agency Case Conference
A multi-agency case conference involving the parents, child (if appropriate)
and all relevant professionals will take place to discuss and explain the
outcome of the diagnostic assessment, with the diagnosis of ASD being made
explicit at this time. If ASD is not confirmed a further opinion may be sought if
indicated.
November 2008
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Combined Child Health Service
Pathway 4
School Aged Children - Patient Care Pathway
VoluntaryAgencies
(if required)
Consider Autism specific
assessments
Diagnosis of Autistic Spectrum Disorder
Health
Social Work
Identify any Social care
and Support Needs for the
family.
Respite care
Developmental review thorough
Child Development Services
Involvement of other health
professionals e.g. Allied health
professional services
Mental Health Services
Education
Identify any Additional
Support for Learning Needs.
Mainstream School
Specialist Unit
Special School
Joint Assessment of Need
Integrated Assessment Framework Action Plan
Key Worker Appointed
(Not yet implemented)
+/- Individual Education Plan/
Coordinated Support Plan
Regular review and reassessment of needs by
various professionals involved
November 2008
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Combined Child Health Service
Guidance on use of School Age Patient Care Pathway
Diagnosis of Autistic Spectrum Disorder
Autistic Spectrum Disorder is a complex, lifelong developmental condition that
affects individuals to different degrees, some with severe communication and
social interaction difficulties, whilst others may be skilled in their use of
language but still have a range of complex needs regarding social interaction
and understanding the motivation of others. (Scottish Society for Autism,
2006)
Autistic Spectrum Disorder is more common in boys than in girls and is
prevalent in all nationalities and social classes. There is no clear single
underlying cause although research increasingly points to a genetic factor.
Information for Parents
Parents of children diagnosed with an Autistic Spectrum Disorder (ASD) will
require clear written and verbal information about the condition. The
information should be appropriate to the child’s age, ability and include short
and long term plans. Consideration should be taken on informing parents that
there is an increased risk of ASD in siblings of affected children.
Information for parents and carers with a child or young person recently
diagnosed with an autistic spectrum disorder (2006)
The NHS Education for Scotland developed an information booklet, to provide
information to help the family immediately after diagnosis. The booklet is
available to download from: www.scottishautismnetwork.org.uk
Next Steps (2006)
Next Steps is an information resource produced by The National Autistic
Society Scotland, to provide information and support to those who have been
diagnosed with ASD their family and carers. The resource contains a directory
of local services available for children, young people and their families to
enable them to easily source and access relevant support. The resource
manual is available to download from: www.autism.org.uk.
Parents should be provided with information about training opportunities that
are available to them, such as The National Autistic Society Early Bird Plus
programme and help! Programme.
Early Bird Plus Programme
The National Autistic Society Early Bird Plus programme is a three month
training programme for parents and professionals of children aged 4-8 years
with an Autistic Spectrum Disorder. The Early Bird Plus programme
addresses the child’s needs at home and at school. Training involves eight
group workshops and two individual home visits.
The aim of the programme is to: to empower parents and help them with their child’s social
communication and appropriate behaviour.
November 2008
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Combined Child Health Service



to help them establish good practice in handling their child and preempt inappropriate behaviour.
to encourage a consistent approach between home and school by
training parents and professionals together
improve communication between parent and child
help! Programme
The National Autistic Society help! programme offers information and support
for parents and carers of school age children 5-11years old, young people 1116 years old and adults, who have been diagnosed with ASD in the last 12-18
months. There are different types of programmes available, these include the
20 hour, 1day or 2day programmes, consisting of presentations, group
discussions, DVD material and a help! parent manual.
The aim of the programme is to: to develop knowledge and understanding of ASD
 provide positive management strategies
 provide information on local support services
These programmes help parents understand their child’s autism and have the
opportunity to share issues with other families.
Providing further information on local support groups and other national and
local resources available will help empower parents in the care of their child.
Further sources of information include:Grampian Autistic Society
33-35 Carnie Drive
Aberdeen
AB25 3AN
Tel: 01224 277900
Email: admin.gas@classmail.co.uk
National Autistic Society Scotland
Central Chambers
109 Hope Street
Glasgow
G2 6LL
Website: www.autism.org.uk
The Scottish Society for Autism
Hilton House
Alloa Business Park
Whins Road
Alloa
FK10 3SA
Website: www.autism-in-scotland.org.uk
National Autistic Society
393 City Road
London
EC1V 1NG
Website: www.nas.org.uk
Aberdeenshire Autism Support Group
(to become Aberdeenshire branch of NAS)
Susan Kay
2 Broadstraik Crescent
Westhill
Aberdeenshire
Tel: 01224 743475
Email: susankay@tinyworld.co.uk
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Combined Child Health Service
Contact a Family Scotland
Craigmillar Social Enterprise & Arts Centre
11/9 Harewood Road
Edinburgh
EH16 4NT
Tel: 0131 659 2930
Website: www.cafamily.org.uk
November 2008
VSA Carers Centre
24-28 Belmont Street
Aberdeen
AB10 1JH
Tel: 01224 646677
Website: www.vsa.org.uk
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Combined Child Health Service
Social Work
An assessment of need may be carried out to determine what support and
services are required by the child and their family. This may include family
support services, mainstream or specialist childcare, respite care, leisure and
recreational facilities and details of available financial assistance.
Health
Children and young people with ASD may also have medical or emotional
problems and require access to the same health care as other children.
A developmental review through Child Development Services involving other
health professionals may be required to assess and manage
developmental,medical and mental health problems.
Education
The Health Service may identify a child as appearing to have additional
support needs arising from a disability and bring this child to the attention of
the education authority.
The educational authority will decide whether to assess the child to find out if
they have additional support needs and will determine what support is
required.
The educational authority in partnership with the parents will decide if the child
attends a mainstream school, a specialist unit attached to a mainstream
school or a special school.
The Educational Psychologists work collaboratively with parents, schools,
medical colleagues and other agencies in diagnosis and planned intervention.
The Education (Additional Support for Learning) (Scotland) Act 2004 (ASL
Act) introduced a new framework, based on the idea of additional support
needs, to provide for children and young people who require additional help
with their learning.
The education authority may then, at its discretion, establish whether the child
has additional support needs arising from a disability under its arrangements
for identifying and providing for children with additional support needs. Once it
is established by the educational authority the child has additional support
needs, the authority would then have a duty to provide suitable provision to
meet those needs.
The ASL Act aims to ensure that all children and young people are provided
with the necessary support to help them work towards achieving their full
potential.
The ASL Act also promotes collaborative working among all agencies
involved with supporting children.
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Combined Child Health Service
Joint Assessment of Needs / Integrated Assessment
Joint assessment of needs is a co-ordinated Multi-Agency approach to
gathering information and aims to avoid parents having to repeat information
more than once, giving a holistic view of the child within their family and
community enabling assessment of medical, social and educational needs.
Action plans are developed using the systematic assessment and analysis of
the information obtained about the child. The child and their family may
participate in the development of the action plan.
An action plan records the needs and the professional responses and
responsibilities to the child, outlining the basis for providing support, services
and resources to meet the needs of the child.
An action plan should state:
 what action should be taken
 by whom to improve the child’s circumstances
 the reasons for the plan
 timescales
 intended outcome and future review date
The plan should be as simple as necessary and relevant to the child's needs.
It should be updated or amended as needs change.
Individual Educational Plan / Co-ordinated Support Plan
An Individual Educational Plan (IEP) describes in detail the nature of the
child’s additional support needs, the ways in which these are to be met, the
learning outcomes to be achieved, and specifies what additional support is
required, including that required from agencies outwith education.
The IEP should be reviewed and updated regularly, involving the parents and
child (where possible).
A Co-ordinated support plan is prepared for children who:
 need support due to complex or multiple factors that have a significant
adverse affect on their education
 require significant involvement from one or more additional agencies
such as health and social work
 will need support for more than a year
The aim of a co-ordinated support plan (CSP) is to ensure that the various
professionals and agencies involved in providing support are working together
and that the support is co-ordinated
A Co-ordinated support plan:
 is an action plan for children who require significant additional support
with their education
 supports partnership working to help children achieve educational
targets
 is monitored and reviewed regularly
 involves the child, their family, education and additional agencies
(Enquire, 2007)
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Combined Child Health Service
Voluntary Agencies
An Autism specific assessment of support needs by a voluntary agency e.g.
Autistic society may be useful depending on the complexity of the child’s
difficulties or circumstances.
Key worker
A key worker is a named person who works in partnership with the family and
can provide a link between professionals and agencies involved in the child’s
care. Key workers can co-ordinate access to, and delivery of services
required from various agencies.
Regular Review
The child will have regular reviews carried out by the various professionals
and agencies involved in their care. Their needs will be reassessed and plans
updated as required.
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Combined Child Health Service
Annex 1
THE CHAT assessment form.
(The National Autistic Society, www.nas.org.uk accessed July 2007)
THE CHAT
To be used by GPs or Health Visitors during the 18 month developmental
check-up.
Child’s name:................................. Date of birth:............... Age:................
Child’s address:................................................. Phone number: ................
SECTION A: ASK PARENT:
1. Does your child enjoy being swung, bounced on your
YES
NO
YES
NO
3. Does your child like climbing on things, such as up stairs? YES
NO
4. Does your child enjoy playing peek-a-boo/hide-and-seek? YES
NO
5. Does your child ever PRETEND, for example, to make a
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
knee, etc?
2. Does your child take an interest in other children?
cup of tea using a toy cup and teapot, or pretend other
things?
6. Does your child ever use his/her index finger to point, to
ASK for something?
7. Does your child ever use his/her index finger to point, to
indicate INTEREST in something?
8. Can your child play properly with small toys (e.g. cars or
bricks) without just mouthing, fiddling or dropping them?
9. Does your child ever bring objects over to you (parent) to
SHOW you something?
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Combined Child Health Service
SECTION B: GP OR HV OBSERVATION:
i. During the appointment, has the child made eye contact
YES
NO
YES
NO*
YES
NO**
YES
NO***
YES
NO
with you?
ii. Get child’s attention, then point across the room at an
interesting object and say “Oh look! There’s a (name of toy)!”
Watch child’s face. Does the child look across to see what
you are pointing at?
iii. Get the child’s attention, then give child a miniature toy
cup and teapot and say “Can you make a cup of tea?” Does
the child pretend to pour out tea, drink it, etc?
iv. Say to the child “Where’s the light?”, or “Show me the
light”. Does the child POINT with his/her index finger at the
light?
v. Can the child build a tower of bricks? (If so how many?)
(Number of bricks:.............)
* (To record YES on this item, ensure the child has not simply looked at your
hand, but has actually looked at the object you are pointing at.)
** (If you can elicit an example of pretending in some other game, score a
YES on this item.)
*** (Repeat this with “Where’s the teddy?” or some other unreachable object,
if child does not understand the word “light”. To record YES on this item, the
child must have looked up at your face around the time of pointing.)
 MRC/SBC 1995
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Combined Child Health Service
Annex 2
ICD-10 / DSM-IV Classification System
International Classification of Diseases, version 10 (ICD-10) and the
Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSMIV) definition of Autism. (SIGN Guidelines 2007)
ICD-10 Classification System
DSM-IV Classification System
F84.0 Childhood Autism
299.00 Autism
A. Presence of abnormal or
A total of six or more from 1, 2 and 3,
impaired development before
with at least two from 1 and one each
the age of three years, in at
from 2 and3.
least one of the following
1. Qualitative impairment in social
areas:
interaction, as manifested by at
least two of the following:
 receptive or expressive
language as used in social
 marked impairment in the use
communication
of multiple nonverbal
behaviours such as eye-to- the development of selective
eye gaze, facial expression,
social attachment or of
body posture and gestures to
reciprocal social interactions
regulate social interactions
 functional or symbolic play
 failure to develop peer
B. Qualitative abnormalities in
relationships appropriate to
reciprocal social interaction,
development level
manifest in at least one of the
following areas:
 a lack of spontaneous seeking
to share enjoyment, interest or
 failure to adequately use eyeachievements with other
to-eye gaze, facial expression,
people (by a lack of showing,
body posture and gesture to
bringing or pointing out
regulate social interaction
objects of interest)
 failure to develop (in a manner
 lack of social or emotional
appropriate mental age, and
reciprocity
despite ample opportunities)
2. Qualitative impairment in
peer relationships that involve
communication as manifested
a mutual sharing of interests,
by at least one of the following:
activities and emotions
 delay in or total lack of the
 a lack of socio-emotional
development of the spoken
reciprocity as shown by an
language (not accompanied by
impaired or deviant response
an attempt to compensate
to other peoples emotions; or
through alternative modes of
a lack of modulation of
communication such as
behaviour according to social
gesture or mime)
context, or a weak integration
of emotional and
 in individuals with adequate
communicative behaviours
speech, marked impairment in
C. Qualitative abnormalities in
the ability to initiate or sustain
communication, manifests in at
a conversation with others
least two of the following
 stereotyped and repetitive use
areas:
of language or idiosyncratic
 a delay in, or total lack of
language
development of spoken
 lack of varied, spontaneous
November 2008
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Combined Child Health Service
ICD-10 Classification System
language that is not
accompanied by an attempt to
compensate through the use
of gesture or mime as
alternative modes of
communication (often
preceded by a lack of
communicative babbling);
 relative failure to initiate or
sustain conversation
interchange (at whatever level
of language skills are present)
in which there is reciprocal to
and from responsiveness to
the communications of the
other person;
 stereotyping and repetitive
use of language or
idiosyncratic use of wards or
phrases;
 abnormalities in pitch, stress,
rate, rhythm and intonation of
speech;
D. Restricted, repetitive, and
stereotyped patterns of
behaviour, interests and
activities manifests in at least
two of the following areas:
 an encompassing
preoccupation with one or
more stereotyped and
restricted patterns of interest
that are abnormal in content
and focus; or one or more
interests that are abnormal in
their intensity and
circumscribed nature although
not abnormal in their content
or focus,
 apparently compulsive
adherence to specific, nonfunctional, routines or rituals;
 stereotyped and repetitive
motor mannerisms that
involve either hand or finger
flapping or twisting, or
complex whole body
movements;
 preoccupation with partNovember 2008
DSM-IV Classification System
make-believe play or social
imitative play appropriate to
developmental level
3. Restricted repetitive and
stereotyped patterns of
behaviour, interest and
activities, as manifested by at
least one of the following:
 encompassing preoccupation
with one or more stereotyped
and restricted patterns of
interest that is abnormal either
in intensity or focus
 apparently inflexible
adherence to specific, nonfunctional routines or rituals
 stereotyped and repetitive
motor mannerisms (hand or
finger flapping or twisting, or
complex whole body
movements)
 persistent preoccupation with
parts of objects
4. Delay or abnormal functioning
in at least one of the following
areas, with onset prior to the
age of three years:
 Social interaction
 Language as used in social
communication
 Symbolic or imaginative play
5. The disturbance is not better
accounted for by Rett’s
Disorder or childhood
Disintegrative Disorder.
299.80 Pervasive Development
Disorder nor otherwise specified
(including Atypical Autism)
This category should be used when
there is a severe and pervasive
impairment in the development of
reciprocal social interactions
associated with impairment in either
verbal or nonverbal communication
skills or with the presence of
stereotyped behaviour, interests and
activities, but the criteria are not met
for a specific Pervasive Development
Disorder, Schizophrenia, Schizotypal
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Combined Child Health Service
ICD-10 Classification System
objects or non-functional
elements of play materials
(such as their odour ,the feel
of their surface, or the noise or
vibration that they generate);
 distress over changes in
small, non-functional, details
of the environment;
E. The clinical picture is not
attributable to the other
varieties of pervasive
development disorder.
F84.1 Atypical autism
A. Presence of abnormal or
impaired development at or
after age three years(criteria
as for autism expected age of
manifestation)
B. Qualitative abnormalities in
reciprocal social interactions or
in communication, or
restricted, repetitive and
stereotyped patterns of
behaviour, interests and
activities (criteria as for autism
except that it is not necessary
to meet the criteria in terms of
numbers of areas of
abnormality).
C. The disorder does not meet
the diagnostic criteria for
autism (F84.0)
Autism may be atypical in either age
of onset (F84.11) or phenomenology
(F84.12), these two types being
differentiated with a fifth character for
research purposes.
Syndromes that are atypical in both
respects should be coded F84.12
F84.10 Atypicality in age of onset
A. Does not meet criterion A for
autism. That is, abnormal or
impaired development is
evident only at or after age
three years.
B. Meets criteria B, C, D and E for
autism (F84.0)
F84.11 Atypicality in
symptomatology
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DSM-IV Classification System
Personality Disorder, or Avoidant
Personality Disorder. For example,
this category includes *atypical
autism*- presentations that do not
meet the criteria for autistic Disorder
because of late age of onset, atypical
symptomatology, or sub threshold
symptomatology, or all of these.
229.80 Aspergers Disorder
1. Qualitative impairment in social
interaction, as manifested by at
least two of the following:
 marked impairment in the use
of multiple nonverbal
behaviours such as eye-to-eye
gaze, facial expression, body
postures, and gestures to
regulate social interaction
 failure to develop peer
relationships appropriate to
developmental level
 a lack of spontaneous seeking
to share enjoyment, interest, or
achievements with other
people(e.g. by a lack of
showing, brining, or pointing
out objects of interest to other
people)
 lack of social or emotional
reciprocity
2. Restricted repetitive and
stereotyped patterns of
behaviour, interests, and
activities, as manifested by a
least one of the following:
 encompassing preoccupation
with one or more stereotyped
and restricted patterns of
interest that is abnormal either
in intensity or focus
 apparently inflexible
adherence to specific, nonfunctional routines or rituals
 stereotyped and repetitive
motor mannerisms (e.g. hand
or finger flapping or twisting, or
complex whole-body
movements)
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Combined Child Health Service
ICD-10 Classification System
A. Meets criterion A for autism.
(i.e. presence of abnormal or
impaired development is
evident only at or after age
three years).
B. Qualitative abnormalities in
reciprocal social interactions or
in communication, or
restricted, repetitive and
stereotyped patterns of
behaviour, interests and
activities (criteria as for autism
except that it is not necessary
to meet the criteria in terms of
numbers of areas of
abnormality).
C. Meets criterion E for autism.
D. Does not meets the full criteria
B, C and D for autism (F84.0)
F84.12 Atypicality in both age of
onset and symptomatology
A. Does not meet criterion A for
autism. That is, abnormal or
impaired development is
evident only at or after age
three years.
B. Qualitative abnormalities in
reciprocal social interactions or
in communication, or
restricted, repetitive and
stereotyped patterns of
behaviour, interests and
activities (criteria as for autism
except that it is not necessary
to meet the criteria in terms of
numbers of areas of
abnormality).
C. Meets criterion E for autism.
Does not meets the full criteria
B, C and D for autism (F84.0)
November 2008
DSM-IV Classification System
 persistent preoccupation with
parts of objects
3. The disturbance causes
clinically significant impairment
in social, occupation, or other
important areas of functioning.
4. There is no clinically significant
general delay in language (e.g.
single words used by age 2
years, communicative phrases
used by age 3 years)
5. There is no clinically significant
delay in cognitive development
or in the development of ageappropriate self-help skills,
adaptive behaviour (other than
in social interaction), and
curiosity about the
environment in childhood.
6. Criteria are not met for another
specific Pervasive
development disorder or
Schizophrenia.
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Combined Child Health Service
Documents used in the production of pathways

Assessment, diagnosis and clinical interventions for children and young
people with autism spectrum disorder. SIGN Guideline 2007

Autistic Spectrum Disorders, Needs Assessment Report. Public Health
Institute of Scotland (PHIS) 2001

Autistic Spectrum Disorders Needs Assessment Report (2001),
Scottish Executive Report on Implementation and Next Steps. Scottish
Executive 2006

National Autism Plan for Children (NAPC) National Initiative for Autism:
Screening and Assessment (NIASA) 2003
References:

Enquire, Planning children’s and young people’s learning,
www.enquire.co.uk (accessed 2007)

Scottish Society for Autism (2006), What is Autism?
www.autism-in-scotland.org.uk (accessed 2007)

Scottish Executive, Education (Additional Support for Learning)
(Scotland) Act 2004

Scottish Executive (2006), Getting it Right for Every Child

National Autistic Society, Early Bird Plus Programme, www.nas.org.uk
(accessed 2007)

National Autistic Society, help programme, www.nas.org.uk (accessed
2007)

National Autistic Society Scotland (2006), Scottish autism information
resource Next Steps, working with parents, working with professionals,
working together

NHS Scotland (2006), Information for parents and carers with a child or
young person recently diagnosed with an Autism Spectrum Disorder
November 2008
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Combined Child Health Service
Working Group Members
Jackie Crum (chair)
Consultant Paediatrician
Elaine Bremner
Team Manager, Aberdeenshire Social Work
Christine Bruce
Staff Grade Paediatrician
Lynn Buntin
Clinical Psychologist
Donella Clark
Senior Practioner,Aberdeenshire Social Work
Ena Cromar
Project Co-Ordinator, Children with Disabilities
Suleman Daud
Consultant Paediatrician
John Forrester
Training & Assessment Consultant
(Grampian Autistic Society)
Janette Fotheringham
Educational Psychologist Aberdeenshire
Anne Gilchrist
Consultant Psychiatrist
Andre Liebenberg
Consultant Paediatrician
Izy McDonald
Health Visitor Aberdeenshire
Gail McKeitch
Parent Representative
Elma Stephen
Consultant Paediatrician
Gail Thomson
Service Manager
Royal Aberdeen Children’s Hospital
Donald Todd
Clinical Nurse Manager
November 2008
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