A National Guideline for the Assessment and Diagnosis of ASD
The page provides a summary of the National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia.
In summary, the Guideline:
- Aims to support improved diagnostic practices and consistency nationally and ensure that future diagnostic assessments are in keeping with best practice guidelines. The Guideline is evidence based and aims to support equitable and accessible processes for diagnosis of Autism Spectrum Disorder.
- Includes 70 recommendations for Diagnostic Assessment of Autism Spectrum Disorder in Australia.
- Provides web links to relevant resources.
Members are encouraged to read the full Guideline.
The role of Speech Pathology Australia
Thanks to Robyn Stephen who was the representative of Speech Pathology Australia (the Association) on the Steering Committee for the Project, and who was unstinting in the contribution of her considerable time, knowledge and expertise on behalf of the profession.
The process and opportunity to provide input and feedback during the development of the Guidelines is outlined under Feedback and Revision, on page 6.
The Association provided feedback which influenced the information included in 12.2 Intellectual and/or Communicative Capacity (pages 54 to 56). This section promotes the importance of differentiating between difficulties with verbal communication and intellectual disability, the role and value of providing Augmentative and Alternative Communication (AAC) options, and the involvement of speech pathologists with experience in AAC “to identify resources and supports that will facilitate the ability of individuals to participate communicatively, including to reflect their thoughts and feelings, indicate their preferences and choices, and make decisions.”
There have been concerns from members over the past several months that speech pathologists were no longer recognised as able to contribute to diagnosis of ASD, particularly by the NDIS. The Guidelines clearly identify speech pathologists as appropriate members of the Consensus Diagnostic Team.
Social Interaction and/or Communication domains are identified as domains which may be included in an assessment to address areas of uncertainty in the diagnostic decision (Table 7, page 44).
The Association’s feedback included concerns from members regarding the appropriateness and reliability of diagnosis based on a single diagnostician’s findings. We would encourage members to share any experiences with the Association, where they feel there are adverse impacts for people with ASD arising from single clinician diagnosis.
Recommendations for the Assessment Process
The Assessment should include a Comprehensive Needs Assessment and a Diagnostic Evaluation.
Comprehensive Needs Assessment
At the initial identification of possible ASD features, the Comprehensive Needs Assessment should include a Medical Examination relevant to neurodevelopmental disorders, and an Assessment of Function.
The Comprehensive Needs Assessment may or may not support the provision of a Diagnostic Evaluation
Speech pathologists are listed as one of the professions whose information and observations can be used to support the Comprehensive Needs Assessment and Diagnostic Evaluation.
Speech pathologists have been identified as one of the professions able to undertake an Assessment of Functioning as part of the Comprehensive Needs Assessment. Recommendations regarding the Assessment of Functioning are on pages 28 to 32.
The relevant information in the report is outlined on pages 12 to 21 of the PDF version of the Guidelines.
The Diagnostic Evaluation may be provided by a Single Clinician where high diagnostic confidence can be achieved.
Single clinician diagnosis can be provided by selected medical practitioners or selected psychologists (Recommendations 37 to 40, pages 37 to 38).
Where a single clinician is unable to provide a high level of diagnostic confidence based on their assessment, a consensus team diagnostic evaluation is recommended. This may be in the case where the presentation is more subtle or complex.
Speech pathologists are included amongst the professions that be part of the Consensus Team Diagnostic Evaluation.
Recommendations about the Diagnostic Consensus Team (numbers 47 to 50) are on pages 42 to 43, and those about the process of information collection by the Consensus Team (numbers 52 to 56) are on pages 43 to 45.
Initiating a Referral
The Guideline seems to assume that primary health care providers will provide the first point of contact for community members who have “health concerns” (6.1, pg. 25). Although GPs are identified as the most likely primary health care provider to be offering primary health care, allied health practitioners are also listed.
The Guideline provides recommendations regarding the professional training that primary health providers should have to enable them to support a referral for an ASD Assessment (Recommendation 17, page 25) as well as for information collection, decision making, and outcomes, including information to include in a referral.
The role of the NDIS Early Childhood Early Intervention Partner (as a potential referrer) is unclear.