Children and Young People’s ASC (Thriving Kirklees) Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • Autism Spectrum Condition (ASC) in children and young people age 0-18yrs with a Kirklees GP

This guidance does not cover:

Assessment

Signs & Symptoms of ASC in pre-school children (across the triad of impairment)

1. Social Communication (Language and non-verbal skills)
  • may have delayed language development (for example, speaking less than 50 different words by the age of two), or not speaking at all
  • frequent repetition of set words and phrases
  • speech that sounds very monotonous or flat, or exaggerated with possible different accents eg American
  • verbal communication may be reduced to meet needs only, rather than for social communication
  • Reduced use of gestures to supplement communication
  • Doesn't point or hold out arms to be picked up
2. Social Interaction
  • not responding to their name being called, despite having normal hearing
  • rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
  • reacting unusually negatively when asked to do something by someone else
  • not being aware of other people's personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age
  • not enjoying situations that most children of their age like, such as birthday parties
  • preferring to play alone, rather than asking others to play with them
  • difficulties with using eye contact appropriately and directing facial expressions when communication
3. Social Flexibility/Behaviour
  • having repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something
  • preferring to have a familiar routine and getting very upset if there are changes to this routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASC may sniff toys, objects or people inappropriately

Signs and symptoms of ASC in school-age children (across the triad of impairment)

1. Social Communication (Language and nonverbal skills)
  • may have delayed receptive and expressive language skills
  • may not use available language skills for social communication- only to indicate needs
  • Reduced use of gestures to supplement communication
  • speech that sounds very monotonous or flat or exaggerated i.e. unusual intonation or different accent eg American
  • being unable to adapt the tone and content of their speech to different social situations – for example, speaking very formally at a party and then speaking to total strangers in a familiar way
  • speaking in pre-learned phrases, rather than putting together individual words to form new sentences
  • seeming to talk "at" people, rather than sharing a two-way conversation
  • taking people's speech literally and being unable to understand sarcasm, metaphors or figures of speech
2. Social Interaction
  • not being aware of other people's personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age, or having few close friends, despite attempts to form friendships
  • not understanding how people interact socially, such as greeting people or wishing them farewell
  • difficulties in understanding social rules eg for turn taking and waiting
  • difficulties with using eye contact appropriately and directing facial expressions when communicating
  • reacting unusually negatively when asked to do something by someone else
  • not enjoying situations and activities that most children of their age enjoy
3. Social Flexibility/Behaviour
  • repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing in a repetitive and unimaginative way, often preferring to play with objects rather than people
  • developing a highly specific interest in a particular subject or activity
  • preferring to have a familiar routine and getting very upset if there are changes to their normal routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASC may sniff toys, objects or people inappropriately
Differential Diagnoses
  • Some conditions may have symptoms similar to autism; therefore, professionals must be diligent when determining a diagnosis and its treatment. It is important to consider these other conditions, although the list is not exhaustive:
    • Developmental Delay/Intellectual Disability
    • Speech/Language Disorder
    • Selective Mutism
    • Psychosocial/Neglect/Attachment Disorders
    • Genetic Conditions
    • Hearing Impairment
    • Mental Health Conditions

if you have any queries and would like to discuss anything with a member of autism assessment team please ring 01484 343783 and ask to speak to the autism admin team

Investigations

Undertake the following to aid diagnosis, inform management or prior to referral:

  • If not carried out in last 6 months Hearing and vision test should be undertaken to inform and support the referral process

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • a Child or Young Persons' behaviour is presenting significant, immediate risk to themselves or others and adults do not feel they can keep them safe they should be taken to A&E or contact Thriving Kirklees Single Point of Access (SPoC) on 0300 3045555 for advice

Referral

Referral Criteria

  • Red flags - attend A&E or contact Thriving Kirklees SPoC on 0300 3045555 for advice
  • Please note GP's cannot refer directly to The Autism Assessment Team.
    • If symptoms are suggestive of an ASC diagnosis - Refer to SALT who can refer on after initial assessment
  • It may be appropriate to refer to other agencies, rather than SALT such as:
    • Anxiety and emotional well being difficulties - Refer to CAMHS via Thriving Kirklees SPoC
    • Concerns in relation to learning - advise parents that they can contact Educational Psychology
    • Wider developmental/medical concerns - Refer to Paediatrics in particular:
      • motor regression at any age
      • children older than 3 with language regression
  • if you have any queries and would like to discuss anything with a member of autism assessment team please ring 01484 343783 and ask to speak to the autism admin team

Referral Requirements

  • Referral to SALT should be supported by:
    • evidence of language or communication difficulties
    • recent hearing and vision test results

Referral Instructions

Supporting information

Shared Decision Making

  • Young People have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/Supporting Information

Assurance & Governance

  • This guidance was developed on: 01.2018
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 03.2018
  • Publication Date: 03.2018
  • Review Date: 03.2020
  • Ref No: MH6 - 01.2018
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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