Centre for Autism
RECOGNISING ASD IN CHILDREN
AND YOUNG PEOPLE
Tom Loucas, Speech and Language Therapist, Co-director Centre
for Autism
Iona Wood, Trainee Consultant Practitioner (Speech and Language
Therapist)
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OUTLINE
• Patient journey
• NICE guidance and recognising ASD
• Observe and support: “Dynamic assessment”
• Examples of observe and support to help with
recognising ASD
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• Initial identification/concerns
• Referral for assessment and
waiting for an appointment
• Diagnostic assessment
• Post-diagnosis
Observe and support
“Dynamic assessment”
“PATIENT” JOURNEY
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NICE GUIDELINE
• Recognising and diagnosing ASD in children and
young people (CG128, 2011)
• Improving early recognition by raising awareness
of the signs and symptoms
• “Consider the possibility of autism if there are
concerns about development or behaviour, but be
aware that there may be other explanations for
individual signs and symptoms.”
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SIGNS AND SYMPTOMS TABLES
• Intended to alert professionals to the possibility of
ASD if concerns have been raised
• Not to be used alone, but to help professionals
recognise a pattern of impairments
• Reciprocal social
• Communication skills
• Unusual restricted and repetitive behaviours
• Observe and offer support to manage behaviours
causing concern
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SIGNS &SYMPTOMS: PRESCHOOL
• Spoken Language
• Reduced/infrequent use of language for communication
• Responding to others
• Absent/delayed response to name, despite normal hearing
• Interaction with others
• Reduced or absent initiation of social play with others, plays alone
• Eye contact, pointing and other gestures
• Reduced/absent use of gestures to communicate
• Unusual, restricted, repetitive behaviours/interests
• Repetitive or stereotyped play
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SIGNS &SYMPTOMS: PRIMARY
• Spoken Language
• Talking 'at' others rather than sharing a two-way conversation
• Responding to others
• Subtle difficulties in understanding other's intentions
• Interaction with others
• Reduced/absent ability to share in social play or ideas of others
• Eye contact, pointing and other gestures
• Reduced or absent social use of eye contact
• Unusual, restricted, repetitive behaviours/interests
• Dislike of change; can leads to anxiety or other forms of distress
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DYNAMIC ASSESSMENT
• Observe and support.
• Not a ‘diagnostic’
assessment.
• Must not delay an
onward referral if
there is sufficient
evidence of
difficulties.
“Dynamic
assessment”
• Active process
• Responsive
• Adult participates and
adapts support
according to the child’s
needs and responses
to input.
Focus is on identifying the child’s skills and learning potential.
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OBSERVE AND SUPPORT
• Observe:
Assess the child's current needs
• Identifies strengths.
• Supports partnership with families.
• Support:
Introduce strategies to support the child. • Provides intervention.
Observe the child's response to support
and modify support as needed.
• Gathers information on what works
well in real-life, natural situations.
• Review:
Have there been any changes?
Have changes generalised to other
situations?
• Can support with decision makingBUT- don’t delay referral if sufficient
evidence of difficulties.
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EARLY YEARS
• Katie is 3 years old.
• There are no concerns about her language ability.
• She enjoys playing with dolls and animals and will
make up stories.
• Stories can be repetitive and Katie will often become
frustrated when other children try to play with her.
• She rarely responds to her name and doesn’t usually
respond to group instructions.
• She will often ‘tell off’ the other children and doesn’t
respond to ‘authority figures’ as expected.
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OBSERVE AND SUPPORT KATIE
• Attention- absent/delayed response to name.
Observation: Katie does not respond to her name when
playing.
Support: Increase motivation and praise.
Ensure that Katie is motivated to respond to her name by taking
into account her interests, e.g., by immediately showing her a
favourite book/toy or offering an enjoyable activity.
• Ensure success, e.g., by minimising distractions, being close
to Katie.
• Offer praise when Katie she responds to others.
• Consider person/time/environment/activity/setting.
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OBSERVE AND SUPPORT KATIE
• Play- repetitive or stereotyped play.
Observation: Stories can be repetitive and Katie will
often become frustrated when other children try to play
with her.
Support: Introduce a structured play activity.
• Support the structure visually using pictures.
• Give opportunities for turn taking with other children
within the play activity.
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PRIMARY AGED CHILD
• George is 8 years old and attends mainstream school.
• He is described as a perfectionist. He will often rub out his work
and become anxious if others try to stop him from doing this.
• He gets agitated and tearful easily when there is a supply
teacher taking the class.
• Group work can be challenging and George becomes frustrated
if the group do not accept his ideas.
• George can be very blunt and will say what he is thinking
regardless of who he is talking to, e.g ”that was not a very
interesting story”
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OBSERVE AND SUPPORT GEORGE
• Reduced ability to share ideas of others
• Observation: George becomes frustrated if the
group do not accept his ideas
• Support: Teach social rule using a Social StoryTM
• Children work together in groups in class. Children share their ideas
about what to do. Every one’s ideas are important. I get annoyed
when other children do not agree with my idea. Other children can
be annoyed because I insist my idea is best. I will work on listening
to other children’s ideas, when I am working in a group.
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OBSERVE AND SUPPORT GEORGE
Mr B
Wednesday
Ms A
Tuesday
Monday
• Dislike of change
• Observation: George gets agitated and tearful
easily when there is a supply teacher taking the
class
• Support: Support for change with a visual timetable
Ms A
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SUMMARY
• Professionals working with children and young
people have a key role in recognising risk of ASD
• NICE guideline provides resources to support
recognising risk
• Careful observation
• Without relying on single instances of concerning behaviour
• Talking with parents
• Offering support
• As a way of testing concern
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THANK YOU FOR LISTENING
[email protected]
[email protected]
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