Forth Valley ASD Assessment and Diagnostic Services

Autism Spectrum Disorder (ASD) assessments in Forth Valley are carried out under the auspices of: Child and Adolescent Mental Health Services (CAMHS); General Adult Psychiatric Services, and Learning Disability Services as summarised below.

General Adult Psychiatric Services offer a tertiary referral model.  The referral pathway for adults (aged 18-years and over) is via their GP to the local sector Psychiatric Team in the first instance.

At present, in the majority of cases, General Adult Services follow the practice of ‘sole practitioner’ assessment which is carried out by one General Adult Consultant Psychiatrist who is duel trained in the Psychiatry of Learning Disability and has a special interest in Autism Spectrum Disorders with more than 10-years experience of assessment/diagnosis in this client group, together with post-graduate further education. There is also currently ad hoc input from a Learning Disability Clinical Nurse Specialist. The assessment service runs in concert with a whole time equivalent General Adult Psychiatry consultancy and, as such, is a limited resource.

It is recognised that best practice is for assessment to be carried out by a multi-disciplinary team and a working group has been convened to move forward this agenda.

Assessment uses international criteria for diagnosis (ICD-10) and a standardised diagnostic tool (RAADS, DISCO or the ADI-R).

The waiting time to assessment is currently around twelve months.

A recent six month audit of clinical activity demonstrated that 17 assessments were commenced over this time period of which 13 were completed to the point of diagnosis. The time-frame from initial interview to diagnosis is variable with a mean time of around 3 months.

The data base used by General Adult Services, Pims, has not historically recorded ASD diagnoses and as such centrally held data is of poor quality. It is unclear how this issue will resolve within existing staff levels.

Learning Disability (LD) Services

There is a multi disciplinary assessment team inForthValleyfor adults (16+) who have a diagnosis of LD. The Forth Valley ASD assessment team accepts referrals from any source e.g. from GP’s, Social Work, Nurses, LD Team, Care Providers and families. The referral pathway for adults (aged 16 years and over) is via the local LD team. There is no exclusion regarding the severity of the LD.

The Assessment team meet monthly; new referrals are discussed and allocated to two team members. The team has been established for over 6 years and is multidisciplinary consisting of: Psychiatry; Psychology; 2 Community Learning Disability Nurses; LD Speech and Language Therapist, and an LD Occupational therapist. All the team members are have advanced knowledge in the Autism field, either having completed Post Graduate further Education in Autism studies or have gained relevant experience within the field.

Assessment uses international criteria for diagnosis (ICD-10 or DSM V) and standardised diagnostic tools; ADI-r is used in the majority of LD assessments as per the evidence basis for tools validated for this client group. LD ADOS and DISCO have been used on occasion.

The waiting time to commencement of assessment is approximately 4 weeks. (This gives consideration to the fact that the team only meet monthly.) The length of time for assessment is very individual however in general this is approx 4 months. The team receives approximately 1-2 referrals per month.

None of the team members have any protected time to carry out this work.

Post-diagnostic support

After assessment, if an ASD diagnosis is given, a report is sent to the referrer/GP and a letter to the client confirming their diagnosis. This also includes recommendations of how best to support the client involving signposting to existing resource provisions including: Psychology; Occupational Therapy; Speech and Language Therapy, Local Authority third sector services; advocacy; employment advice and carers centres.

However, there is a paucity of specialist resources locally with no post diagnostic supports available for general information and guidance.