Autism has been defined diagnostically as a neurodevelopmental disability that causes persistent difficulties with social communication and interaction, and restricted or repetitive patterns of thought and behaviour. Autistic people describe autism as the way some people communicate and experience the world around them. Autism is lifelong and prevalence rates in the UK are thought to be 1-2%.

Being autistic effects people in a variety of ways - some people find that their characteristics related to autism can be strengths, and other people may experience significant difficulties related to being autistic. Some of the common characteristics of autism are:

• Differences in communication compared to non-autistic people

• Differences in speech compared to non-autistic people

• A preference for familiarity, routine and predictability

• Sensory sensitivities or preferences

• Intense interests

• Repetitive behaviours

• Executive functioning difficulties - (working memory, planning, sequencing, task initiation, staying organised and self-control)

• Difficulties with emotional regulation

• Differences in interoception - the ability to read the body's internal cues

Diagnostic criteria for autism is described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and the International Classification of Diseases 11th Revision (ICD-11). These manuals are standard classification systems used by health care professionals to assess and diagnose a range of difficulties, including autism.

DSM-5 ‘autism spectrum disorder’ criteria: 

• criterion A: persistent deficits in reciprocal social communication and social interaction

• criterion B: restricted, repetitive patterns of behaviour, interests or activities

• criterion C: symptoms must be present in the early developmental period

• criterion D: symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning

• criterion E: these disturbances are not better explained by intellectual disability or global developmental delay.

ICD-11 ‘autism spectrum disorder’ criteria: 

• persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the range of typical functioning given the person’s age and level of intellectual development

• persistent restricted, repetitive and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the person’s age and sociocultural context

• the onset of the disorder occurs during the developmental period, typically in early childhood

• note that characteristics might not fully manifest until later in life due to increased social demands

• characteristics result in significant impairment in personal, family, social, educational, occupational or other important areas.

A child autism assessment is £2000.

Payment can be made in full prior to the assessment or in instalments. To pay in instalments a deposit of £200 is due at booking, then 50% of the remaining balance is due after the first appointment, and the remaining 50% of the balance is due once the draft report is ready.

We pride ourselves on offering a fully face to face, in-person assessment process. We can also offer some appointments on Teams, if this is your preference.

Assessments are done at your pace and we do not specify a certain number of sessions. Sometimes, for lots of reasons, an assessment needs to be done quickly (for example for an EHCP application or appeal). Sometimes an assessment needs to be taken more slowly, possibly because your child feels worried about the process or because you are juggling lots of competing demands. As a rough guide, assessments generally consist of 3 appointments - 2 assessment appointments and 1 feedback appointment. If the assessment needs to be done over more than 2 sessions there is no additional charge for this.

From the first assessment appointment to receiving feedback and the final report is usually less than 4 weeks.

At the moment we can offer assessments beginning within 4 weeks of your initial enquiry. Once the assessment begins (the first assessment appointment) it should be complete (feedback and final report) within 4 weeks.

Before the assessment begins we will do what is called a screening assessment. A screening assessment is a brief assessment looking for signs of autism. We do this because sometimes people come to us seeking a particular assessment for their child e.g. autism, but it turns out that they need a different type of assessment e.g. ADHD. The screening assessment process helps us to decide which assessment would best meet your childs needs, and gives you some reassurance that the assessment is needed. We cannot make a diagnostic decision based on the screening assessments. The screening assessment is done via questionnaires and forms that will be emailed to you. We also need to seek information from someone who knows your child well, preferably from school (often your child’s class teacher or SENCO). The forms are completed and submitted online. We will review the information and get back to you with feedback about which assessment we feel would best meet your childs needs.

The next stage of the assessment is to meet without your child. The first appointment can be done in person or on Teams. We will complete what we call a developmental history - a detailed review of your childs background and history, and their current difficulties.

The next appointment is done in person with your child. We will do an ADOS which is an observational assessment which takes approximately 1 hour. Your child will be asked to complete some puzzles, look at pictures and books, play with some toys, and answer some questions about their life.

After the 2 assessment appointments we can discuss how you would like to receive feedback. Some parents understandably want to hear the outcome of the assessment as soon as possible, and so brief feeback can be given over the phone before the report has been prepared. Sometimes parents might like to wait to receive the report so that they can read through the whole assessment, findings and recommendations. The draft report will be ready 2-3 weeks after the final assessment appointment.

Once the report has been received a feedback appointment can take place to review the report together, including recommendations.

If further support is desired we can discuss consultation or post-diagnostic work.

The standards for assessment of autism are set out by The National Institute for Health and Care Excellence (NICE). The guidance is summarised here:

Include in every autism diagnostic assessment:

• detailed questions about parent's or carer's concerns and, if appropriate, the child's or young person's concerns

• details of the child's or young person's experiences of home life, education and social care

• a developmental history, focusing on developmental and behavioural features consistent with ICD-11 or DSM-5 criteria (consider using an autism-specific tool to gather this information)

• assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours, focusing on features consistent with ICD-11 or DSM-5 criteria (consider using an autism-specific tool to gather this information)

• a medical history, including prenatal, perinatal and family history, and past and current health conditions

• a physical examination

• consideration of the differential diagnosis

• systematic assessment for conditions that may coexist with autism

• development of a profile of the child's or young person's strengths, skills, impairments and needs that can be used to create a needs-based management plan, taking into account family and educational context.

• communication of assessment findings to the parent or carer and, if appropriate, the child or young person

Autism has been understood as a spectrum and words including 'mild' or 'severe' have been used to describe the impact of being autistic. Now, people understand that autistic people, just like non-autistic people, have an individual profile of strengths and difficulties. Some autistic people have co-occurring difficulties such as ADHD, learning difficulties and mental health difficulties.

In the same way that the characteristics of autism vary between people, the impact of being autistic can be different too. Autistic people can work, have families, follow hobbies and live independently. Some autistic people have lots of support needs - at school, home or work. The impact of autism can also change over time as people move through life stages, for example school, university, work, relationships, parenthood. The impact of autism can be effected by other difficulties such as problems with health, learning difficulties or mental health struggles. Protective factors such as support systems, good physical and mental health, and positive relationships can mediate the difficulties associated with autism.

There is no treatment for autism because autism does not need to be and cannot be treated. However, some children with autism benefit from support or interventions. This support can be in a range of areas and is dependent on an individual child’s profile of strengths and difficulties, and could include:

• attending social groups with other autistic children - can be helpful if the child experiences loneliness or isolation

• school support - to make adaptations to the school environment

• post-diagnostic support - to help an older child and/or their family, or the family of a younger child, to understand autism and how it might impact them

Find out more about the consultation and post-diagnostic support we offer at NeuroNest Psychology.