Autism describes the differences in social communication and social interaction, along with repetitive and restricted behaviours. Identity-first language (i.e., “autistic people” rather than “people with autism”) is used throughout this page as this is in line with a range of Greater Manchester autism standards and strategies. This also aligns with research based on the response of over 3,000 people, led by the National Autistic Society (NAS) and the preference of our young autistic people involved in this project. Some people prefer ‘’person with autism’’ so it is always important to ask what language the individual is comfortable with.
Social communication includes changing or adapting how you speak to fit a social situation, for example, speaking quietly in a library or speaking more casually when with friends. People with social communication differences may find it hard to understand tone of voice, sarcasm, or engaging in ‘small talk’. Social interaction is about how you use eye contact, facial expression, body language and gesture. Repetitive and restricted behaviours can include things like an insistence on things being the same, repeated words or movements, intense interests, and sensory differences. If there are differences in all three of these areas that significantly impact on a person’s ability to function in their day to day lives it may be appropriate to consider further assessment via the local autism pathway.
It is estimated that one in one hundred people are on the autism spectrum and there are around 700,000 autistic adults and children in the UK (National Autistic Society) – their website contains a useful description and the video below:
The definition of autism has changed over the years, other associated terms such as Aspergers are now no longer detailed in diagnostic manuals. Every individual with autism has a range of strength and needs. In an ever evolving climate of criteria and research, one thing remains constant; autistic people have the same rights as non-autistic people and with the right support after diagnosis and reasonable adjustments all help allow autistic people to feel understood and valued in their communities.
We know that around half of people with autism have a learning disability and around 70% of people with autism also meet diagnostic criteria for at least 1 other (often unrecognised) physical or mental health problem, such as sleep problems, eating problems, epilepsy, anxiety, depression, problems with attention, dyspraxia, motor coordination problems, sensory sensitivities, self-injurious behaviour and other behaviour that challenges (sometimes aggressive) (NICE guidance). These coexisting difficulties can significantly impact a person’s quality of life and that of their families or carers.
How is autism diagnosed in Bolton?
Early identification of need remains a crucial part of a diagnostic journey. In Bolton, our autism diagnosis process is called the Bolton Social Communication and Interaction Pathway (BSCIP). In Bolton we continue to commit to a multiagency pathway which is underpinned by the relevant diagnostic guidance we must follow. Within the multiagency team there are two main referral routes into the pathway. The first is usually through community paediatrics and looks at under 11s where there are concerns regarding their development or medical conditions. The second is through usually CAMHS who support over 11s often who may have other mental health conditions which can make it difficult to make a differential diagnosis (tease apart mental health and social communication and interaction needs).
What is needed to make a referral?
Autism is a lifelong diagnosis and as such there needs to be robust evidence from the team around the child or young person before referring into the pathway. This may include assessments and advice given by the child’s health visitor, for a school age child or young person this will include interventions and strategies put in place via the early help process. This process forms part of the evidence gathering stage and helps schools identify through the graduated approach what might help in meeting a child’s needs. The lead professional may make referrals on to other agencies including Speech and Language Therapy, Behaviour Support Services, Ladywood Outreach or Educational psychology to help gather the information. The young person, parent or carer will be asked for their views.
Ladywood Outreach are specialist teachers who gather information for children in Bolton schools and settings. They do this through a detailed observation and provide a written report for every child listed for BSCIP panel. The team attend panel meetings and complete structured assessments such as Autism Diagnostic Observation Schedule (ADOS-2). After the panel, the team complete post diagnostic meeting in the setting with the parent or carer and setting staff. The team also deliver Early Bird plus and Teen life to families who have had a recent diagnosis.
Behaviour Support Services
Schools can request Behaviour Support Services to gather information prior to a referral being submitted to BSCIP. They help identify underlying needs by completing observations and assessments, attending meetings with the family, and completing a report to alongside the school’s information. A representative from the Bolton Behaviour Support Service is a member of the panel.
Educational Psychology
On request from early years settings and schools, Educational Psychologists gather information on children through a range of means including observation, working directly with pupils and consulting with staff and parents / carers and produce a report as required. A representative from the Bolton Educational Psychology Service attends panel meetings and completes structured assessments such as the Autism Diagnostic Observation Schedule (ADOS-2).
Community Paediatrics
Community Paediatrics offer appointments in community clinics in the Bolton area. You will be seen by a Paediatrician or an Advanced Nurse Practitioner. The clinician will talk to you about your concerns to gather some background details and information about how they are at home. They will observe social communication and interaction skills in the clinic setting – this may be through play and/or by chatting to the child and may include a medical examination to consider medical causes for your child’s strengths and needs.
CAMHS
CAMHS contribute to the multiagency pathway for autism diagnosis in Bolton. This might include leading on cases referred through BSCIP via school or evaluating young people for autism who may already be open to CAMHS for concerns around their mental health or behaviour or already receiving treatment for conditions such as ADHD. The assessment of young people may involve gathering information through parent and child interview; observation and structured assessment such as Autism Diagnostic Observation Schedule (ADOS-2).
Speech and Language Therapy
Speech and Language Therapists contribute to the multiagency pathway for autism diagnosis in Bolton. Speech and Language Therapists are trained to assess the speech, language and communication needs of the child or young person, this includes looking at how someone’s ability to understand and use language can affect how they interact with people and the world around them. Speech and Language Therapists can help identify differences in social communication and how to support where there are challenges in this area.
Next steps:
All the above forms a piece of the diagnostic jigsaw puzzle which is essential in reaching the right outcome.
Referrals to the BSCIP panel are made by the lead professional for children and young people with a Bolton GP. BSCIP meetings aim to gather accurate information about your child’s social communication skills in terms of strengths as well as any difficulties they may be having. This is where professionals from a range of backgrounds come together to carefully consider the information received and think about the appropriate next step.
They may decide to:
Arrange a further assessment such as an Autism Diagnostic Observation Schedule (ADOS-2)
Give a diagnosis of Autistic Spectrum Disorder based on the information provided
Further information may still need to be gathered and plans will be made about how to do this
It may be decided that based on the evidence supplied your child’s social communication skills do not currently require further assessment.
All the above options will be shared with you and the professional who referred you.
What is an ADOS?
The Autism Diagnostic Observation Schedule (ADOS-2) is a sequence of play and social activities that are completed with the child or young person. It uses a range of age appropriate activities to assess social communication skills. The ADOS activities provide an opportunity to observe the child’s social and communication skills and any repetitive behaviours that happen frequently. The assessment tends to take between 45 and 60 minutes. There are usually two professionals present during the ADOS; one conducts the assessment while the other observes the assessment and makes notes.
There are four different ADOS modules, one of which is selected according to the child’s age and language ability.
What is post diagnostic support?
Post diagnostic support should be needs led. This means that if your child has been identified as requiring some additional support or reasonable adjustments as part of the pathway, that this provision should be offered to them. This should happen whether you get a diagnosis of autism or not. In Bolton, there will be an individualised description of your child’s needs with signposting to appropriate services and support. For those diagnosed with autism, there is the following offer of post diagnostic support, these courses are developed by the National Autistic Society and delivered by trained Bolton practitioners:
We are currently working to further develop this offer based on feedback from our Bolton Parent Carer Forum and the GM Autism Consortium work streams.
Autistic Girls
We are really pleased to share the Autistic Girls Resources for Schools, which is a guide to understanding and supporting internalised presentations of autism in Bolton.
