New Autism Assessment
Why Assess for Autism?
Wellbeing, ‘the state of being happy, healthy or prosperous is recognised as lower for those with ASD compared to neurotypical counterparts particularly in relation to physical, psychological, social supports and peers (Biggs 2016, Merriman-Webster 2018). Poorer wellbeing is particularly evident at times of transition, including the transition to adulthood, when significant attention needs to be focused on ensuring adequate services, supports and relationships to facilitate a successful outcome (Biggs 2016). Wellbeing and similarly quality of life is difficult to accurately quantify but factors which are known to impact on outcome in those with ASD include ‘physical wellbeing, material wellbeing, interpersonal relationships, social inclusion, personal development, self-determination, emotional wellbeing and rights’ (Plimley 2007, p.207).
It is essential that supports and services which can optimise wellbeing and quality of life are provided early in a child’s life and for those who receive a late diagnosis as soon as possible after diagnosis. Needs change as a person ages, the needs of a child differ to those of a teenage, an adult and an older adult. Needs also change at times of transition such as moving from Montessori to national school to secondary school to University or work, when a relationship ends or a person is bereaved or when an individual struggles as peers or siblings move to another life stage such as relationships, marriage or having children while they themselves may not.
The majority of autistic adults are single & living with their parents, up to 91% are unemployed, up to 95% have been bullied and up to 40% have been sexually or financially exploited (O’Rourke 2016). Knapp, Romeo and Beecham (2009) showed the estimated lifetime cost for an adult with ASD to range from £800,000 to £1,230,000. To address these barriers to positive outcomes, supports and services should be person-centred, unified across medical and social care models, available when needed and available on an ongoing basis from infancy to old age (Plimley 2007).
Evidence-Based Assessment According to International Best-Practice Guidelines
Autism spectrum disorder can be behaviourally defined by diagnostic criteria specifying pervasive qualitative differences in social and communication skills and behaviour. However, as yet, there are no definitive medical tests, biochemical, neuroimaging or otherwise to detect autism spectrum disorder. Hence, diagnosis relies heavily on detailed history and observation of behaviour by skilled clinicians using the ICD-10 and / or DSM-5 criteria.
International Assessment Guidelines: NICE and Sign recommend diagnosis by a minimum of two clinical disciplines trained in assessment and diagnosis of ASD.
An ASD assessment can include:
1. Screening - IQ appropriate tools for patient and carer.
2. Clinical History - based on ICD or DSM Diagnostic criteria.
3. Observational assessment - clinical and ADOS-2.
4. History of functioining outside the clinical setting.
5. Developmental History: both clinical history and ADI-R.
6. Individual profiling e.g.IQ, communication skills, adaptive skills, sensory profile where relevant.
7. Investigations e.g. Genetic testing, audiology, eyetest, MRI Brain, EEG where relevant.
8. Assessment for comorbid physical and/or psychiatric illness.
Note: A recent systematic review by Wigham et al (Autism 2018; Feb 1:1-19) advises caution when using screening questionnaires with patients with a comorbid mental illness; interpretation is less reliable as screening tools are less sensitive and specialist discrimination between autism and a mental illness is required.
The Autism Assessment at Core Clinical
At the beginning of an ASD clinical assessment, we ask you and a family member, nominated by you, to complete a number of screening questionnaires which we use to triage your information towards a more efficient assessment. This information can also assist in developing an individual profile for each person attending our service allowing for a more informative feedback session following review.
Each New Autism Assessment at Core Clinical is undertaken in a multidisciplinary format in line with international best practice. Both a psychiatrist and psychologist will interview you and your nominated family member(s) to ensure the assessment is appropriately comprehensive. We use structured interview, clinical observation and evidence-based diagnostic tools to reach a diagnosis. The assessment is expected to last 3 to 4 hours with each clinician.
Consensus Meeting, Feedback and Recommendations
Before reaching a clinical decision in relation to a person’s diagnosis, the multidisciplinary team engage in a consensus meeting. This meeting combines information gathered over the course of the assessments to allow a multidisciplinary diagnostic formulation and the development of individualised recommendations. As a team we will meet with you and your nominated family member(s) to discuss our findings and outline our recommendations. We endeavour to complete this process on the second day of your assessment. Where this is not possible due to factors such as missing information, co-existing disorders or a requirement for further assessment (e.g. IQ assessment) we will explain the reasons why and offer you options as to how to proceed.
It is our preferred practice to meet with each individual that receives a new autism diagnosis within 4-6 weeks of their assessment appointment. This follow-up session is to provide space for further discussion of the diagnosis and to address questions the individual may have.