Early years Social Communication Pathway

Early years Social Communication Pathway (including Autism Assessment)

Our pathway involves the assessment and diagnosis for children who are referred to Longlands Child Development Centre with social communication difficulties. This includes assessment for Autism and global developmental delay where appropriate.

What is a social communication difficulty?

Social communication difficulties can include difficulties communicating verbally (spoken language) and non-verbally (eye gaze, facial expression, gestures) when interacting with other people in social situations. Some children may struggle to tell other people what they want, express feelings, relate to other people and develop meaningful relationships.

What is Autistic Spectrum Disorder (ASD)?

ASD or Autism is a developmental disability which affects how people perceive the world and interact with others. Individuals with Autism have difficulties with social interaction, social communication and social imagination as well as a preference for routines. Many have associated sensory issues and some will also have a more global delay in their development or a learning disability. It is a lifelong diagnosis and cannot always be made at this age. Support from Education and other services is not dependant on a diagnosis.

Referrals

Referrals can be made from health professionals including GPs, health visitors, psychologists, hospital doctors, therapists, educational psychology and specialist early years teachers and Portage. This service does not accept self-referrals. Children must be registered with a North Lancashire GP.

We accept children from 18 months of age until the end of March in the year before they start school to ensure that assessments can be completed before they start in reception class.

Children referred between the April and August before a child starts school in the September will still be accepted for a Paediatric appointment including a developmental history and assessment. If appropriate they would then be referred to the school age pathway for assessment of Autism or monitored by their school or paediatrician as they get older.

Referrals are triaged weekly by the Early Years Speech and Language therapists and the Paediatricians and if appropriate placed on our waiting list for social communication assessment. See referral form below.

Who is involved in the pathway?

• Early Years Speech and Language therapists with experience in the assessment of social communication difficulties in preschool children
• Paediatricians with an interest in child development and preschool social communication disorders
• Preschool neurodevelopmental nurses and practitioners
• Pathway navigator - The pathway navigator will work closely with the team to provide support and advice to families whose children are on the Early Years Social Communication pathway. They will also support the understanding of the Autism pathway from initial assessment to post diagnosis support and be the main contact for families throughout of process. The navigator will provide signposting information to national and local support.

Information gathered before the appointment

On accepting the referral we will send a questionnaire to the child’s parents / carers to gain further information about the child’s strengths and weaknesses and background history.

On this questionnaire we will also ask for consent from the parent / carer to gather and share information from other professional involved with the child such as Education and other health and local authority services.

With consent we will contact the child’s nursery and any other professionals involved in their care. This helps us to get a fuller understanding of their strengths and difficulties across different settings. If the child is in a nursery or child-minding setting, we will ask them to complete a report or ‘teacher’s observation’ form to provide further information.

What assessments may be completed?

Assessment at this age needs to be done over time rather than in a single appointment as some of the children are very young at referral. The assessment also needs to be done across different settings as part of NICE guidance.

Families may be invited to a number of different appointments depending on their individual needs and we would encourage both parents to attend these appointments.

• Developmental History and developmental assessment: This will often be the first appointment with our services. In this appointment the Paediatrician will do a structured interview with parents / carers. This will include asking questions about their birth, development and medical history focussing on communication and social interaction. In this appointment or sometimes at a separate or subsequent appointment the Paediatrician or Child Development Centre nurse or Practitioner will do a developmental assessment where possible using the Schedule of Growing skills developmental tool.
• Structured autism diagnostic interview with parents and Paediatrician: This will be done at a separate appointment if more detailed information is needed.
• Assessment by the Early years Speech and Language therapist: Children will be seen by the early years speech therapist both at home and in nursery (or similar setting) with other assessments and interventions as needed.
• Joint appointment with Paediatrician and Speech therapist if needed:
• Episode of support by the Child Development Nursing team:
• Discussion at the Early years team meeting with colleagues in Education

What will happen after the assessment?

Depending on the child’s age and individual difficulties they may be monitored over time to see how they develop as they get older.

At an appropriate time when there has been sufficient observation of the child there will be a formal discussion of all the reports by the child’s Speech therapist and Paediatrician. We will decide if a diagnosis of Autism / Autistic Spectrum Disorder (ASD) is useful to explain a child’s pattern of development and behaviour.

Some children will be also identified as having a more global developmental delay or language difficulties which may explain their needs or be an additional diagnosis for the child.

At this very young age we may recognise that a child has some developmental differences compared to other children but they will not meet the criteria for a diagnosis of Autism. They may need further assessment when they are at school or sometimes as adults by the appropriate diagnostic pathway which is not led by Longlands Child Development Centre.

We cannot assess for a separate diagnosis of ADHD in preschool children.

A report summarising the assessment findings will be sent out and shared with other agencies with your consent (e.g. Nursery / GP / health visitor).

Some children may need specific interventions by the early years speech and language therapists in addition to their diagnostic assessments.

We will also refer the child to other services if required