The assessment and diagnosis of Autism Spectrum Disorder (ASD) in children and young people: Information for Secondary Schools

What is ASD?

Autism is a lifelong developmental condition that affects how a person communicates with and relates to, other people and the world around them. It is thought to affect at least one per cent of the population. It is a spectrum condition, which means that, while all people with autism share certain areas of difficulty, their condition will affect them in different ways.

Using Autism-Friendly Strategies:

People with autism may:

be over- or under-sensitive to light, sound, and pain

have a very literal understanding of language

find open-ended questions difficult to answer

need more time to process information

find it very stressful when appointments run late.

Adjustments need to be tailored to the individual but consider the following:

ensure your staff are autism trained and aware

explain clearly what will happen at the beginning of the interaction, meeting or lesson to reduce anxiety

ask clear, specific questions – be aware of how you phrase questions

give the young person time to process what you’ve said before asking more questions

check the individual understands what you’ve said – even if they appear to have understood
use visual aids to support your lessons if possible, e.g. pictures/diagrams

adjust to any sensory needs – e.g. reduce electric lighting, minimise clutter

provide a written summary

What types of difficulties might a secondary aged child have?

Signs and symptoms of possible autism in secondary school children (older than 11 years or equivalent mental age) (NICE Guidelines)

Social interaction and reciprocal communication behaviours

Spoken language may be unusual in several ways:

very limited use

monotonous tone

repetitive speech, frequent use of stereotyped (learnt) phrases, content dominated by excessive information on topics of own interest

talking ‘at’ others rather than sharing a two-way conversation

responses to others can seem rude or inappropriate.

Interacting with others

reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
long-standing difficulties in reciprocal social communication and interaction: few close friends or reciprocal relationships

reduced or absent understanding of friendship; often an unsuccessful desire to have friends (although may find it easier with adults or younger children)

social isolation and apparent preference for aloneness

reduced or absent greeting and farewell behaviours

lack of awareness and understanding of socially expected behaviour

problems losing at games, turn-taking and understanding ‘changing the rules’

may appear unaware or uninterested in what other young people his or her age are interested in

unable to adapt style of communication to social situations, for example, may be overly formal or inappropriately familiar

subtle difficulties in understanding other’s intentions; may take things literally and misunderstand sarcasm or metaphor

makes comments without awareness of social niceties or hierarchies

unusually negative response to the requests of others (demand avoidant behaviour).

Eye contact, pointing and other gestures

poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people’s eyes when speaking) and spoken language used in social communication.

Ideas and imagination

history of a lack of flexible social imaginative play and creativity, although scenes seen on visual media (for example, television) may be re-enacted.

Unusual or restricted interests and/or rigid and repetitive behaviours

repetitive ‘stereotypical’ movements such as hand flapping, body rocking while standing, spinning, finger flicking

preference for highly specific interests or hobbies

a strong adherence to rules or fairness that leads to argument

highly repetitive behaviours or rituals that negatively affect the young person’s daily activities

excessive emotional distress at what seems trivial to others, for example, change in routine

dislike of change, which often leads to anxiety or other forms of distress including aggression

over or under reaction to sensory stimuli, for example, textures, sounds, smells

excessive reaction to taste, smell, texture or appearance of food and/or extreme food fads.

Other factors that may support a concern about autism

unusual profile of skills and deficits (for example, social or motor coordination skills poorly developed, while particular areas of knowledge, reading or vocabulary skills are advanced for chronological or mental age).
social and emotional development more immature than other areas of development, excessive trusting (naivety), lack of common sense, less independent than peers.

Further information about autism in different age groups for Primary Care Practitioners is available on the following website: asd.nes.scot.nhs.uk

Further information and advice for teachers are available on:

www.autism.org.uk/professionals/teachers.aspx

How should I raise concerns?

Families may approach you with a specific concern that their child may have ASD. Alternately, concerns may be raised by another professional following developmental review or observations.

It can be difficult for professionals to raise concerns with families. Rather than talking in terms of diagnostic labels, it may be more appropriate to give descriptions of behaviours or developmental concerns. If they do not share your concerns, you may need to make this a gradual process.

How do I refer for an assessment for ASD?

The Cornwall multidisciplinary pathway for the assessment and diagnosis of Autism Spectrum Disorder (ASD) in children and young people was developed using national guidelines.

It aims to provide timely assessment and where appropriate, diagnosis close to home if possible.

The process is initiated by a referral to the most appropriate members of the multidisciplinary team.

For children over 5 years and 6 months, if CAMHS already have involvement, please contact the CAMHS team in the first instance to discuss your concerns.

If CAMHS are not involved, a referral to the ASD Assessment Team (ASDAT) can be made through the Early Help Hub (contact details are provided at the end of this leaflet). This should be accompanied by more detailed information from the family and school (these forms are found with the referral form on the Early Help Hub)

If the young person is over 16 and does not have a Learning Disability, please refer to Outlook Southwest – contact details are provided at the end of this leaflet.

What information do I need to gather?

Please complete all sections on the referral form and the additional form for schools that accompanies the referral form. Describe what you see
Please request additional information from the parents on the accompanying form; this will enable us to establish if this is the most appropriate assessment pathway. Until we have all of this information, we will not screen the referral.