Health professionals need to work more closely with mental health, social care, education and voluntary services to ensure that children and young people with possible autism, as well as their parents or carers, receive the appropriate care and support they need, the National Institute for Health and Clinical Excellence (NICE) has said.
This call came as NICE launched new guidance, 'autism spectrum disorders in children and young people: recognition, referral and diagnosis'. Recommendations in the guidance include:
- Setting up local autism multi-agency strategy groups with managerial, commissioner and clinical representation from child health and mental health services, education, social care, parent and carer service users and the voluntary sector
- Forming a multidisciplinary 'autism team' in each area. This group should include a paediatrician and/or child and adolescent psychiatrist, a speech and language therapist and a clinical and/or educational psychologist
- Ensuring every child who has an autism diagnostic assessment gets a case coordinator from the autism team
- Ensuring every autism diagnostic assessment includes an assessment of social and communication skills and behaviours through interaction with and observation of the child or young person and consideration of any coexisting conditions
- Developing a profile of the child's or young person's strengths, skills, impairments and needs during their assessment. With consent, this profile can be shared with those involved in the child's education to help ensure the assessment will contribute to the child or young person's individual education plan and needs-based management plan.
Dr Fergus Macbeth, director of the centre for clinical practice at NICE, said: "This is the first of three NICE guidelines to focus on this condition. The recommendations emphasise the importance of local organisations, such as the NHS, local authorities and schools, working together to help ensure children and young people with autism as well as their parents or carers are able to access the support they need."
Gillian Baird, consultant paediatrician at Guy's and St Thomas' NHS Foundation Trust, London and chair of the guideline development group, added: "While the NHS is responsible for diagnosing autism, all services that support the wellbeing of children and young people, including education and the voluntary sector, can play a crucial role in recognising the possible signs and symptoms of autism. The NHS-led multi-agency strategy groups recommended in the NICE guideline will hopefully lead to more joined up working between these key services through training, integrated assessment and increased parent/carer partnership."
Anne Marie McKigney, consultant child psychologist at Aneurin Bevan Health Board and guideline developer said: "Around 70% of people who have autism will have co-existing conditions such as intellectual disability, attention deficit hyperactivity disorder and obsessive compulsive disorder. This can often mean that the child or young person's autism is less likely to be diagnosed accurately and efficiently which can lead to further stress and anxiety. "As more children and young people are being identified as being on the autism spectrum, it is important that the NHS is able to cope with the increased demand on diagnostic services. Establishing local teams of experts with a designated case coordinator for each individual and working collaboratively with families and other agencies will greatly support this."
Penny Williams, principal speech and language therapist for autism at Mary Sheridan Centre for Child Health, London and guideline developer added that there is a broad range of symptoms associated with autism within the areas of social interaction, language development and unusual patterns of thought and behaviour, which can include intense interests and/or repetitive behaviours. "Levels of understanding and the availability of services vary greatly across the country," she said. "The NICE guideline calls for healthcare professionals involved in diagnosis to assess the child or young person's social and communication skills and behaviours through listening to parents, carers and other professionals involved with the family and by interaction and observation of the child or young person. Equal priority should be given to both the differential diagnosis and in identifying an individual's strengths and needs."
To see NICE's guidance, click here.