New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Part 1: Diagnosis and initial assessment of ASD
1.2.a Early childhood to adolescence
The recommended pathway leading to the
assessment of a young child, older child or
adolescent with suspected ASD is summarised
below in four steps:
1. developmental surveillance
2. identification of developmental concerns and
appropriate referral
3. appropriate referral and developmental
service coordination
4. multidisciplinary assessment.
This pathway is outlined in Figure 1 which can
be found at the end of this section.
1. Developmental surveillance
All children in New Zealand should receive
developmental surveillance. For babies and
children in the early childhood years, this is
provided through the Well Child/Tamariki Ora
framework. Children and teenagers attending
compulsory sector education have educational
attainment and behaviour reviewed regularly at
school, with schools being required to formally
report to parents at least twice per year. Where
schools have a particular concern about a
student’s health, they can consult with the Public
Health Nurse linked to the school.
Parents and a range of health and educational
professionals (such as Plunket nurses and other
Well Child providers, general practitioners
(GPs), early childhood educators, playgroup
supervisors and teachers) have considerable skill
and experience in understanding the pattern of
normal child development and should, in the
course of developmental surveillance, identify
areas of developmental concern. If any concerns
become apparent to parents or professionals,
these concerns should be discussed immediately.
This discussion between parent and health or
educational professional should seek to define
the developmental concerns and gather further
information about the child’s developmental
milestones, unusual social interactions or
behaviour, the child’s general health, eating
and sleeping patterns, and potential family
and environmental impacts on development,
such as family emotional or financial stress.
Such discussions may be formal (eg, a speechlanguage
therapy screening assessment) or
informal (eg, a discussion between a parent and
a kindergarten teacher). These are not formal
diagnostic assessments.
Health and education professionals should be
proactive and should view each professional
encounter as an opportunity to elicit
developmental, health and social concerns
about the child, rather than waiting for
parents to voice concern. Routine professional
encounters include each Well Child assessment,
GP visits for intercurrent illness, and sessions
at creche, kindergarten, playgroup or school
(Recommendation 1.2.1).
A wait-and-see approach, or a desire not
to mention a concern for fear of creating
unnecessary anxiety in parents, should be
resisted, as this could lead to a delay in
providing appropriate assessment and other
services.
2. Developmental concerns
If the outcome of the discussion between the
parent and professional is that developmental
concerns are unclear, or if that professional is
not formally trained in assessing developmental
skills, the professional should seek further
advice, guidance or assessment from another
professional with expertise in assessing child
development. These professionals could
include a speech-language therapist, a child
development service therapist, or a paediatrician
(Good Practice Point 1.2.8).
If developmental concerns are confirmed
during the discussion between the parent
and professional, then onward referral for
appropriate assessment must be made, through
the developmental services coordinator.
Part 1
New Zealand Autism Spectrum Disorder Guideline 45