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A rate of around 1 in 100 is a best estimate of the prevalence of autism spectrum disorders in children (National Autistic Society website). The majority of children on the spectrum will have shown signs of the condition in the first three years of life, but their needs may not have been identified within this period. There is no single test for autism and the average age for a diagnosis is about five and a half, when the social demands of school life may make a child's difficulties obvious for the first time.
The National Autism Plan for Children on screening and assessment recommends that parental concern about any developmental problem should trigger referral for a general developmental assessment. The Plan recommends a three-stage assessment framework to improve early identification. Professionals should be aware of the referral pathways to follow in their local area when it is suspected that a child may be on the autism spectrum.
Early identification of a child on the autism spectrum is crucial, as additional educational support may be needed. Identification and assessment of speech, language and communication needs associated with the autism spectrum are particularly important for young children.
The ability of professionals to recognise and identify children on the autism spectrum has improved tremendously in the last few years, to the extent that there has been a significant increase in the numbers of children diagnosed. Instruments and techniques to identify needs and diagnose autism continue to be developed and modified, for example, the Checklist for Autism in Toddlers (CHAT) is used for training Health Visitors to be aware of the triad of impairments.
The National Autism Plan recommends training of all relevant professionals to recognise ‘alerting’ signals of possible autism spectrum conditions both at pre-school and school. It says that there should be regular opportunities in the early years to discuss a child’s development with parents as part of ‘surveillance’ to detect and respond rapidly to any developmental concerns.
Despite the existence of published diagnostic criteria, diagnostic practice varies throughout the UK in terms of the methods and terminology used and the professionals involved. Once a child is referred, assessments may be made by different professionals, including paediatricians, psychiatrists, psychologists, and speech and language therapists. Different practices can be confusing and frustrating for parents and professionals alike. In some areas, professionals from different agencies have set up working parties to agree their practices.
Parents sometimes experience problems getting a diagnosis for their child. In particular, able children on the autism spectrum are not always recognised early and work is still required to improve ways of achieving this. The National Autism Plan recommends that the age of detection and diagnosis of all developmental problems including autism should be audited in each local area.
A diagnosis can point the way to the type of difficulties a child may have but support will need to be based on identification of their specific needs and strengths. In the sphere of education, this will be through the special educational needs framework.
Special educational needs
Health authorities and NHS Trusts must inform parents and local authorities where they believe a child under compulsory school age may have special educational needs (SEN). Local authorities are legally responsible for identifying those children in their area who will need special educational provision. They must publish information about how they go about this.
The SEN Code of Practice emphasises the importance of early identification, assessment and provision for any child who may have special educational needs. It says that the earlier action is taken, the more responsive the child is likely to be and that schools should be aware that children may start school with unidentified special educational needs. It recognises that parents are likely to be the best source of information on their child in many cases and that schools need to be open and responsive to expressions of concern by parents.
The Code suggests schools measure children’s progress by:
- teacher observation and assessment,
- progress against the objective of the national literacy and numeracy strategies,
- performance in end of key stage tests and National Curriculum assessments and
- standardised screening or assessment tools.
Clearly able children on the autism spectrum may perform very well on many of these measures and teachers will need to look at other developmental areas such as how a child plays and interacts with others to identify their special educational needs.
The number of education professionals with a knowledge and understanding of autism has increased in recent years. Not all teachers and support staff have adequate training, however. A survey by the NUT of members found that 39% of teachers were not confident in identifying children on the autism spectrum and an even greater proportion were unconfident about teaching them.
Often schools’ special educational needs co-ordinators (SENCOs) will take the lead in identifying children on the autism spectrum, referring them for statutory assessment, and providing training and support for other school staff.
Behaviours which can assist in identification include:
- delay or absence of spoken language
- prolonged echolalia
- difficulty in playing with other children
- failure to share interests of others
- resistance to change
- repeated actions or questions
- insistence on routine
- following own agenda.
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TeacherNet offers information about a wide range of special education needs and provides materials for teachers, parents and others working with children with in England.
The Children’s Workforce Development Council website includes information on the core skills, qualifications for practitioners and the Common Assessment Framework (CAF). SENCOs, health visitors, school nurses, workers in children’s centres and voluntary sector workers are among those beginning to use the CAF to assess additional needs in children, particularly where those needs cannot be met by a single agency. Many children on the autism spectrum are likely to need referral for a specialist assessment, but the CAF can be a useful first step in identifying needs and provision.
Early Support Programme: the Government programme to achieve better co-ordinated, family-focused services for young disabled children and their families.
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National Autism Plan for Children (NAPC) (2003) Produced by the National Initiative for Autism: Screening and Assessment (NIASA).The Plan covers the identification, assessment, diagnosis and access to early interventions for pre-school and primary school aged children with autism spectrum disorders. The guidelines are for parents and all who work with children and were developed by a multi-disciplinary group of core professionals from Health, Education, Social Services, and representatives of parents and the voluntary sector. It recommends three stages of assessment:
1.a general multi-disciplinary developmental assessment, with clear identification of concerns, a developmental history, a full examination and appropriate further tests
2. a multi-agency assessment capable of assessing the differential diagnosis of possible ASD and where appropriate leading to a comprehensive care plan
3. a tertiary ASD assessment where there is, for example a need for a second opinion, diagnostic doubt, complexity, and specific advice about treatments or key transition stages.
The British Psychological Society Position Paper (2006) Autistic Spectrum Disorders: Guidance for Chartered Psychologists working with Children and Young People provides lists of the competencies and skills required to identify children on the autism spectrum.
National Autistic Society
Information on identification and diagnosis of autism
The SEN Code of Practice describes identification and assessment of special educational needs.
Every Child Matters: cross-government working with local partners to achieve better outcomes for children and young people.
Advice on including children with different SEN, including those on the autism spectrum, in mainstream classrooms: Inclusive Schooling — Children with Special Educational Needs.
OAASIS The Office for Advice, Assistance, Support and Information on Special Needs (OAASIS) provides information on all SEN issues, particularly on autism spectrum disorders and Asperger's syndrome. The site has downloadable information sheets on a wide range of SEN issues, as well as advice on how to find a special needs school.
SNIP This is the website of Special Needs Information Press (SNIP), a monthly newsletter produced by two practising SEN teachers. The site offers practical guidance to help teachers in mainstream schools identify and address the diverse needs of SEN pupils.
Seach, D. (1998) Autistic Spectrum Disorder: Positive Approaches for teaching children with ASD. Publications department NASEN: 0800 0182998 Ref: ASD.
Supporting early identification and intervention for children with SEN: guidance aimed at supporting LAs and Early Years Development and Childcare Partnerships (EYDCPs) in developing local Area Special Educational Needs Coordinator (SENCO) strategies.
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Doncaster LEA's Service for Children with Autism Spectrum Disorders Education professionals work jointly with health professionals at the local Child Development Clinic, providing a multi-agency diagnosis for young children who may have an ASD. Good practice example on Teachernet
Islington Multi-Agency Integrated Pathway for Children and Young People with Autism Spectrum Disorder
This project looked at how quickly children could be assessed and diagnosed and the ease at which services could be accessed once concerns were highlighted. In relation to early identification, it resulted in improved awareness in referrers with more children than before at the able end of the autism spectrum being identified under-five. It found that referrers needed to improve skills on how to broach the possibility of a diagnosis with parents of children thought to be on the autism spectrum.
The assessment pathway was open to all. The project found that having several gateways in a system confuses access, delaying diagnosis and identification of needs that can only be detrimental to the child and family. Professionals were concerned that the option of self referral would lead to a flood of referrals. In fact of the three families that self referred, all had complex needs identified, irrespective of diagnosis. One of the children was found to be on the autism spectrum.
The project recommended that early identification should relate to early identification of need irrespective of age to prevent a crisis occurring.
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