Back to referral guidelines
Print Friendly, PDF & Email
Primary care management and referral guideline Primary care management and referral guideline

Autism Spectrum Disorder – Management and referral guideline

Purpose

Primary care management and referral guidelines contain condition-based information for GPs about when to refer a patient, assessment and management measures that should be taken prior to submitting a referral, and what should be included in a referral to the relevant outpatient department or specialist service.

Introduction

  • Autism spectrum disorder (ASD) is a collective term for the neurodevelopmental disorders previously known as autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome.
  • These conditions cause challenges with communication, social interaction, and behaviour, and affect 1 in 100 children worldwide.
  • Learning, thinking, and problem solving abilities can range from gifted to severely challenged.
  • Onset is before aged 3 years, although some children show early signs in the first few months.
  • Some causes of ASD include genetic, fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, untreated phenylketonuria, antenatal and postnatal complications.
  • There is no link between ASD and immunisations.

Assessment

Diagnosis is complex and will not be completed in a single general practitioner visit – follow up appointments will be required to gather sufficient information.
Take a detailed history:

  • Look for difficulties in 3 main areas:
    • Impaired social interaction
      Impaired social interaction

      • Not responding to their name being called, despite having normal hearing
      • Rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
      • Not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
      • Little interest in interacting with other people, including children of a similar age
      • Not enjoying situations and activities that most children their age like e.g., birthday parties
      • Preferring to play alone, rather than asking others to play with them
      • Rarely using gestures or facial expressions when communicating
      • Avoiding eye contact
      • Taking people’s speech literally, and being unable to understand sarcasm, metaphors or figures of speech
    • Delayed communication
      Delayed communication

      • Delayed speech development (e.g., not speaking at least 10 different words by age 2 years), or not speaking at all
      • Frequent repetition of set words and phrases
      • Speech that sounds very monotonous or flat
      • Preferring to communicate using single words, despite being able to speak in sentences
      • Seeming to talk “at” people, rather than sharing a two-way conversation
    • Behaviour with restricted and stereotyped interests
      Behaviour with restricted and stereotyped interests

      • Repetitive movements such as flapping hands, rocking back and forth, or flicking fingers
      • Absence of symbolic play – playing with toys in a repetitive and unimaginative way e.g., lining blocks up in order of size or colour, rather than using them to build something
      • Preferring a familiar routine, and getting extremely upset if there are changes to their normal routine
      • Developing a highly specific interest in a particular subject or activity
      • Hypersensitive or hyposensitive to sensory input e.g., lights, smells, fabrics, food textures, pain
      • Comforted by deep pressure, being wrapped up, tight clothing, rocking, bouncing, jumping, repetitive motor behaviours (stimming)
  • Consider:
    • impact on individual and family function.
    • onset (usually before age 3 years) and time course of concerns.
    • presence or absence of concerns across settings. Request collateral information from education settings e.g., school report card.
  • Ask about other important areas of history:
    • Family history of neurodevelopmental disorders e.g., ASD, ADHD, learning difficulties, mental health issues.
    • Relevant past medical history, looking for risk factors, associated conditions, or conditions which may impact on ASD presentation.
      Relevant past medical history

      • Antenatal events including maternal drug or alcohol exposure
      • Neonatal events e.g., preterm or low birth weight
      • Irritability
      • Attainment of developmental milestones and any evidence of developmental regression
      • Medical or surgical conditions – consider constipation which can negatively impact on behaviour
      • Fussy eating – consider risk of iron deficiency
    • Psychosocial history
      Psychosocial history

      • Family situation
      • Parental mental health
      • Substance abuse within household
      • Parental disability
      • Parental relationship issues
      • Child protection involvement
  • See Raising Children Network – DSM‑5: Autism Spectrum Disorder Diagnosis.

Determine if any significant developmental concerns – see Children’s Health Queensland Red Flags Early Identification Guide.
Arrange or perform initial investigations:

Management

Request early intervention
If autism is suspected, make an early request for assessment and intervention rather than taking a “wait and see” approach.

Educate parents or carers about possible diagnosis of ASD and provide resources for further information – see Resources for families.

To confirm diagnosis, request assessment from Child Development Program (if available) if the child is younger than 9 years, or refer to your local General Paediatrics service

  • The paediatric team may require an education report or questionnaire to be sent to the child’s school. Ask for parental consent for this and if granted, document in the referral along with details of the child’s school.
  • Waiting times for public diagnostic assessment is typically several months.
  • Consider private paediatrician which may be accessible and affordable for some families.

Optimise the patient’s general health.

  • Provide dietary advice and supplementation (e.g., iron) if evidence of nutritional deficiency.
  • Optimise sleep patterns.
  • Manage constipation if problematic.

Consider a GP Mental Health Care Plan and referring to a paediatric psychologist for further assessment and intervention.
Consider a General Practice Management Plan and Team Care Arrangement and requesting allied health assessment and intervention. This can be done before confirmation of diagnosis.

  • Occupational therapy
  • Speech pathology
  • Physiotherapy

Ensure family‑based intervention and support is in place.

Once diagnosis is confirmed, assist with application for funding through National Insurance Disability Scheme (NDIS). See also Early Childhood Early Intervention.

When to refer

  • Request diagnostic assessment via:
    • Child Development Program (if available) if the child is younger than 9 years, or
    • Refer to your local General Paediatrics service
  • Consider allied health assessment and intervention:
    • Occupational therapy
    • Speech pathology
    • Physiotherapy
    • Psychology
  • If parents need support, consider parenting programs.

Referring to your local paediatric services

Public

Check the patient’s catchment area before requesting assessment. When services are available in the patient’s local area, refer the patient to the local hospital.

Queensland Children’s Hospital

1. Referral can be made by either:

  • GP Smart Referral via BP or Medical Director
  • Secure messaging
    Secure messaging
    Send a written request to the Referral Centre via eReferral
    (Medical Objects ID: RQ402900084, HealthLink ID: qldrchld):

    • To download templates, see Referral Forms.
    • If unable to attach investigations or use secure messaging, fax to 1300 407 281.

    For more information, contact the Referral Centre:
    P.O. Box 3474, South Brisbane QLD 4101
    Phone 1300 762 831
    Fax 1300 407 281

2. Check the minimum referral criteria and insert the required information into referral.

Private

Search for a provider via the National Health Services Directory.

Guideline approval and disclaimer

Guideline approval history
Version no. 1.0 Approval date 17/06/2018 Review date 01/06/2022

Disclaimer

The information contained in this GP referral and management guideline is intended for information purposes only. The information has been prepared using a multidisciplinary approach with reference to the best information and evidence available at the time of preparation. No assurance is given that the information is entirely complete, current, or accurate in every respect.
This guideline is not a substitute for clinical judgement, knowledge and expertise, or medical advice. Variation from this guideline, taking into account individual circumstances may be appropriate.
This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for the following:
  • ●  Providing care within the context of locally available resources, expertise, and scope of practice.
  • ●  Supporting consumer rights and informed decision making in partnership with healthcare practitioners including the right to decline intervention or ongoing management.
  • ●  Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where necessary.
  • ●  Ensuring informed consent is obtained prior to delivering care.
  • ●  Meeting all legislative requirements and professional standards.
  • ●  Applying standard precautions, and additional precautions as necessary, when delivering care.
  • ●  Documenting all care in accordance with mandatory and local requirements.
Children’s Health Queensland disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable.

Resources

For health professionals

For families

Contact details

Hospital Switchboard
(Ask for the General Paediatric Registrar)
t: 07 3068 1111

feedback
Fact sheet footer