New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

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Part 1: Diagnosis and initial assessment of ASD 1.1 Identification and diagnosis Part 1 Summary of recommendations Recommendations: Grade 1.1.1 Early identification of children with autism spectrum disorder is essential. Early identification enables early intervention and is likely to lead to better function in later life. B 1.1.2 A formal whole population screening programme for the identification of ASD is not recommended. B 1.1.3 Health and education professionals should take regular opportunities (at least at 8–12 months, 2–3 years and 4–5 years) to discuss the child’s development with parents as part of ‘surveillance’ to detect and respond rapidly to any developmental concerns. C 1.1.4 Age of detection/diagnosis of all developmental problems, including ASD as a specified disorder, should be audited. C 1.1.5 Parental inquiries regarding developmental concerns about their child must be taken seriously and addressed appropriately. B Good Practice Points: 1.1.6 At each health or educational professional encounter, concerns should be elicited regarding child development. 1.1.7 All health and education professionals involved in care of children should know referral pathways for those children about whom concerns are raised. The benefits of the early identification of children with ASD are well recognised by parents and professionals (Recommendation 1.1.1). Identification of some health conditions is undertaken by ‘screening’, which is defined as the formal identification of a previously unrecognised disease or condition by the application of tests, examinations or other procedures that can be applied to a whole population. However, the United Kingdom National Autism Plan for Children (NAPC) review of the literature found no supporting evidence for implementation of a population-screening tool for identification of people with ASD 11 (Recommendation 1.1.2). Their findings supported the consensus that parents or professionals with knowledge of normal development can identify ASD. Early identification of ASD can only take place with regular developmental surveillance by parents and/or health and early education professionals. 36 New Zealand Autism Spectrum Disorder Guideline
Part 1: Diagnosis and initial assessment of ASD 1.1.a Early childhood Early surveillance The Tamariki Ora Schedule currently includes developmental surveillance which is undertaken at all contacts with a Well Child nurse 27 . Developmental surveillance is a shared parent–health professional activity which uses both parties’ knowledge about the child to monitor the child’s ongoing development. On occasions, the surveillance process may identify children whose developmental progress varies significantly from the expected pathway. Regular surveillance enables early identification of areas of developmental concern. To facilitate early identification of children with ASD, best practice in New Zealand requires adherence to procedures currently employed by health care practitioners: • proactive monitoring, or surveillance, for developmental milestones at all Well Child visits • eliciting parental or carer concerns about development and behaviour at each contact with a health care (or education) professional (as recommended in the Well Child Handbook) 27 . This requires that all professional encounters with young children, including contacts with daycare providers and early childhood teachers, should be viewed as opportunities to elicit developmental information and concerns (Recommendations 1.1.3 and 1.1.4, Good Practice Point 1.1.6 and 6.1 Professional learning and development). Although many parents are aware by 18 months that their child is different, formal diagnosis of autism has often been delayed in the past 28 . Retrospective surveys in the United Kingdom have indicated that 60% of parents report that they were first to suspect a problem, compared with 10% who remembered that it was the health visitor, while for 7% it was the school staff who first acknowledged concern 29 . Although skilled community health and education staff can assist parents in the recognition of a problem, many parents comment that the response of professionals to their expressed concerns was to either offer inappropriate reassurance or give the impression that the parents were being ‘over anxious’. Although similar information is unavailable in New Zealand, the experience of those working in the area of ASD suggests that the situation is likely to be no different. Studies 30-32 show that a valid clinical diagnosis can often be made by the time the child is aged 2 to 3 years. However, diagnosis is more difficult in young children who are more able, and in those with significant general developmental delay (eg, a mental age below one year). The opinion of the committee which developed the NAPC in the United Kingdom, supported by experience in New Zealand, is that there have been a number of barriers to early diagnosis 11 . These include: failure to recognise symptoms, denial that there may be a problem, failure to get a referral, lengthy waiting time for an appointment, inadequately trained staff for diagnosis and separate waiting lists for each professional group. Successful identification of ASD in young children and the effectiveness of intervention programmes are dependent on the ability of primary care providers to monitor children’s development and initiate referrals in a timely manner. Well Child nurses, general practitioners (GPs) and other members of the primary health care team are therefore central to early identification. Consequently, the importance of primary care practitioners cannot be overemphasised. This has implications for the education of primary care health providers. Indeed, all professionals who come into contact with children, whether in health care services, early childhood education centres or primary schools, should receive training in ‘alerting signals’ of possible ASD (Recommendation 6.1, Professional learning and development). Part 1 New Zealand Autism Spectrum Disorder Guideline 37
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New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

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