Autism spectrum disorder (diagnosed or suspected)

History and Examination

• Detail the parent or carer’s concern about behaviour that leads to the concern about communication, social skills and behaviour
• If educational setting concerns are present, then a letter from the educational setting must be included in a GP referral. In the absence of a letter from the educational institution provided with the referral, the referral will be categorised Cat 3 unless they meet other non-educational criteria.
• Report presence or absence of concerning features
  • Clear documentation of any ‘suggestive features’ for Autism observed by the GP or Clinician
  • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
  • Is the child expected to be in out of home care supervised by the Department of Children, Youth Justice and Multicultural Affairs for more than 6 months?. If so, do you consider that the child’s foster placement is at risk of breaking down due to the child’s behaviour?
• Previous attempts to engage NDIS must be provided
• Confirmation of OOHC (where appropriate)

Additional referral information (useful for processing the referral)

Highly desirable information – may change triage category.

• Please comment on the duration, severity and intervention to date.
• For children below school age an assessment report from a developmental therapist such as a psychologist or speech pathologist or both. An assessment from a multidisciplinary child development service is preferred.
• For children attending school a school guidance officer or education department speech pathology report
• Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness
• Either GP assessment of current developmental status (age appropriate, some delay, significant delay) or brief comment on current school educational attainments (good, average, poor, very poor (>2 years behind))
• Has the child previously been diagnosed with ASD or other diagnosis? If so, does the child have access to Commonwealth Government Early Childhood Early Intervention Funding (ECEI- NDIS Funding)
• Is physical aggression placing family members (e.g. younger siblings) at risk? If so, provide specific details
• If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager
• Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
• School history –exclusions or suspensions

Desirable information – will assist at consultation

• Other past medical history
• Immunisation history
• Developmental history
• Medication history
• Height/weight/head circumference and growth charts with prior measurements if available.
• Other physical examination findings inclusive of CNS, birth marks or dysmorphology
• Any relevant laboratory results or medical imaging reports