Our assessment pathway has been developed in line with international best practice guidelines; ‘Autism spectrum disorder in adults: diagnosis and management’ by NICE and ‘Sign 145: Assessment, diagnosis and interventions for autism spectrum disorders’ by NHS Scotland.
1. Referral: We accept written referrals from your GP, psychiatrist or psychologist as detailed in Referrals & Contact Us. Where possible, please include copy of all previous assessments and reports. Referrals are triaged at our multidisciplinary team meeting and we will write to you to arrange an appointment.
2. Clinical Assessment Appointment: The clinical assessment is usually scheduled for a Monday, Tuesday or a Friday. Our rooms are located in Castleknock Village, Dublin 15. The assessment can take up to 8 hours; 4 hours with each clinician. It is helpful if a parent, guardian or close relative attends with you on the day. If this is not possible, please advise in your referral letter and we can adapt our assessment protocol accordingly. We acknowledge that this a long assessment process and include refreshment breaks.
3. ASD Assessment: On the day of your assessment, we start by asking you to complete a pack of questionnaires. We score these screening instruments to guide our assessment and provide written results in your final medical report. The clinical interview is conducted by two clinicians, a consultant psychiatrist and a principal clinical psychologist. Following initial introductions, you will complete your part of the assessment with our principal clinical psychologist. Depending on the schedule for your assessment, you may meet with our consultant psychiatrist the same day or another day.
4. Findings: Following completion of your assessment, we discuss the assessment findings with you, and your family member(s) if you wish. We prepare a medical report of these findings and send this to your referrer. If you receive a diagnosis of autism spectrum disorder, we offer you a follow-up meeting within six weeks of your assessment to discuss questions you may have.
5. Intervention: A significant component of your assessment with Core Clinical is developing your individualised ASD Profile. An initial profile will be developed and included in your assessment report. If appropriate, further sessions can be scheduled with our psychologists to develop an advanced profile.
Core Clinical provides a follow-up service and follow-up therapy for adults with ASD. Should other supports, interventions and / or therapy services be required due to coexisting diagnoses, these recommendations will be outlined in the feedback session or follow-up meeting and included in your medical report.
If you would like to discuss this process in more detail, please do not hesitate to contact us.
Previous Autism Diagnosis
Generally, there are three ways in which that people access our therapy and intervention services:
1. No previous assessment --> Adults who have not previously had an assessment for autism spectrum disorder can access an assessment through Core Clinical. We suggest you attend you GP to discuss the reasons you think you may have autism and ask your GP if they feel an assessment would be helpful.
2. Previous assessment by a single discipline service --> Occasionally adults have a prior diagnosis of autism completed by a stand alone psychiatrist or psychologist. Diagnostic guidelines advise an assessment must be completed by two clinicians with specialist training in autism spectrum disorder and unfortunately, we cannot accept previous assessments by single discipline services as a means to access therapy. In these circumstances, we advise you seek copies of previous assessments, either from the service you attended or your GP, and include them with your referral to Core Clinical. We take previous reports into account when triaging referral information and adapt the assessment you need with us accordingly. Often, a full new assessment is not required but an assessment by two team members is essential. Of note, the more information available in previous reports and assessments which included an ADI-R or ADOS assessment tool are the most helpful. The cost of assessment is reduced when previous assessment information is recent and in line with international standards.
3. Previous assessment by a multidisciplinary team --> Adults may have accessed a previous assessment, particularly as a child, through a multidisciplinary team in line with international best standards for assessment and diagnosis. If you have a previous assessment by such a team, often through a CAMHS team (child and adolescent mental health service) or a private MDT child assessment service, we suggest you forward their report with your GP referral letter. In such cases, after reviewing your report and referral question, we can often offer you a therapy appointment and a repeat autism assessment is not required.
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 ASD 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.
Occasionally, in cases where individuals experience co-existing conditions such as mental illness or a history of trauma, a diagnosis of ASD can be more difficult to accurately identify. To prevent misdiagnosis in such cases, if necessary, we provide a second appointment to complete a further diagnostic test of observation.
Consensus Meeting, Feedback & 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 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 diagnosis of ASD within 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.
Sensory processing disorder is ‘a condition in which a person has difficulty organising and integrating sensory information for use’ (Vaughn 2014, p.1176). It is not a standalone diagnosis, rather it is a condition resulting from another developmental or behavioural disorder (Zimmer 2012).
In relation to ASD, sensory hyper-reactivity or hypo-reactivity or unusual interests in sensory aspects of the environment is a recognised symptom within the diagnostic criteria as outlined in DSM-5 (American Psychiatric Association 2013).The criterion suggests ‘apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement’ as examples of sensory issues seen in ASD (American Psychiatric Association 2013, p.28).
However, more detailed writings in the area suggest sensory issues can be more global and disabling and include sensory defensiveness, sensory seeking, sensory disorder, sensory dysfunction and sensory overload (Kern 2006). Individuals with ASD can struggle with sensory overload resulting in avoidance or sensory under-stimulation resulting in sensory seeking behaviours in each of the sensory modalities; tactile, oral, olfactory, visual and auditory and also in relation to proprioceptive and vestibular input (Kern 2006, Lane 2011).
Sensory Integration Therapy
Sensory processing disorder is a relatively frequent comorbid condition in ASD with research showing that over 94% of individuals with ASD have extreme levels of sensory processing difficulty in at least one sensory modality (Crane, Goddard & Pring, 2009). Greater degrees of sensory processing difficulties are seen for those with higher range IQ and those with high rates of stereotyped interests and repetitive behaviours (Wiggins, Robins, Bakeman & Adamson, 2009).
Individuals with difficulty tolerating or processing sensory information can benefit from engagement with a comprehensive treatment plan which could include sensory integration provided by a trained clinician, generally an occupational therapist (Zimmer et al, 2012). Sensory adaptations allow for reduced sensory overload and improved attention and concentration in those with ASD (Williams, 2006). Use of proactive and reactive strategies to help those with ASD and sensory processing difficulties is a critical part of this process.