New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

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