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.

An autism assessment is £2000.

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. Sometimes an assessment needs to be taken more slowly, possibly because you feel 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.

We will respond to your initial enquiry with an email to introduce ourselves and let you know more about what we offer including costs and timescales. We find that people prefer to have this information straight away. If you would like to speak to us we are very happy to give you a call to discuss what you are seeking help with and whether we might be a good fit. We can talk you through our processes, costs and timescales, as well as any other information you might need to help you make a decision about whether to work with us.

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 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 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 you well, preferably since childhood (called an informant). You can complete the forms online and submit them. We will review the information and get back to you with feedback about which assessment would best meet your needs.

The next stage of the assessment is to meet. 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 background and history, and your current difficulties. It is really helpful if someone who knows you well (again, preferably since childhood) can come to this appointment too.

The next appointment is done in person. We will further discuss your difficulties and why you are seeking an assessment.

After the 2 assessment appointments we can discuss how you would like to receive feedback. Some people understandably want to hear the outcome of the assessment as soon as possible, and so brief feedback can be given over the phone before the report has been prepared. Sometimes people 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. The feedback appointment can be done in person or on Teams.

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

Post-diagnostic support is available in a range of formats and might include the following:

 - liaison with school or college to discuss reasonable adjustments

 - post-diagnostic support to increase understanding and discuss helpful strategies to support and manage your child’s diagnosis

 - sessions with a loved one or people in support roles to increase understanding and discuss helpful strategies

Post-diagnostic support or consultation is additional service charged at £130 per session.

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

 A comprehensive assessment should:

• be undertaken by professionals who are trained and competent

• be team-based and draw on a range of professions and skills

• where possible involve a family member, partner, carer or other informant or use documentary evidence (such as school reports) of current and past behaviour and early development.

At the beginning of a comprehensive assessment, discuss with the person the purpose of the assessment and how the outcome of the assessment will be fed back to them. Feedback should be individualised, and consider involving a family member, partner, carer or advocate, where appropriate, to support the person and help explain the feedback.

During a comprehensive assessment, enquire about and assess the following:

• core autism features (difficulties in social interaction and communication and the presence of stereotypic behaviour, resistance to change or restricted interests) that have been present in childhood and continuing into adulthood

• early developmental history, where possible

• behavioural problems

• functioning at home, in education or in employment

• past and current physical and mental disorders

• other neurodevelopmental conditions

• hyper- and/or hypo-sensory sensitivities and attention to detail.

Carry out direct observation of core autism features especially in social situations.

To aid more complex diagnosis and assessment for adults, consider using a formal assessment tool, such as:

the following tools for people who do not have a learning disability:

• the Adult Asperger Assessment (AAA; includes the Autism-Spectrum Quotient [AQ] and the Empathy Quotient [EQ])

• the Autism Diagnostic Interview – Revised (ADI-R)

• the Autism Diagnostic Observation Schedule – Generic (ADOS-G)

• the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI)

• the Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R)

the following tools in particular for people with a learning disability:

• the ADOS-G

• the ADI-R

To organise and structure the process of a more complex assessment, consider using a formal assessment tool, such as the Diagnostic Interview for Social and Communication Disorders (DISCO), the ADOS-G or the ADI-R.

During a comprehensive assessment, take into account and assess for possible differential diagnoses and coexisting disorders or conditions, such as:

• other neurodevelopmental conditions (use formal assessment tools for learning disabilities)

• mental disorders (for example, schizophrenia, depression or other mood disorders, and anxiety disorders, in particular, social anxiety disorder and obsessive–compulsive disorder)

• neurological disorders (for example, epilepsy)

• physical disorders

• communication difficulties (for example, speech and language problems, and selective mutism)

• hyper- and/or hypo-sensory sensitivities.

Do not use biological tests, genetic tests or neuroimaging for diagnostic purposes routinely as part of a comprehensive assessment.

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 people with autism benefit from support or interventions. This support can be in a range of areas and is dependent on an individuals profile of strengths and difficulties, and could include:

• therapy - can be helpful if the person has struggles with their mental health

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

• school or work support - to make adaptations to the school/work environment

• post-diagnostic support - to help an individual and or/their family to understand autism and how it might impact them

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