The East Cheshire Autism Assessment Pathway provides a service to assess children aged 0-4 years, 11 months for ASD.
The East Cheshire Autism Assessment Pathway provides a service to assess children aged 0-4 years, 11 months for ASD. In order to access the service, patients must have a GP within the geographical area covered by East Cheshire NHS Trust and have attended an appointment in the pre-school development clinic.
Our service is a diagnostic pathway. We assess referrals to determine whether an ASD diagnosis can be given. We do not currently provide direct intervention for families, but we fund post‑diagnostic support through Space for Autism. We also guide families to further support using our ASD Post Diagnosis Pack. Further information about support for Special Educational Needs and disabilities is available through the 0–25 Local Offer.
What is ASD?
Autism Spectrum Disorder (ASD), sometimes called Autistic Spectrum Condition (ASC), is a lifelong neurodevelopmental condition that affects how a person communicates and relates to others.
People with ASD are all different, and the condition can affect both children and adults. It is a long‑term condition that influences how someone understands and interacts with the world. Many individuals with ASD find it difficult to interpret spoken and unspoken communication and may struggle with social situations.
Common characteristics include repetitive or restricted behaviours, very focused interests, and sensory differences. In East Cheshire ASD is diagnosed using the DSM5 criteria which describes the following features:
- Ongoing difficulties with starting and maintaining social interactions. This can make it hard to understand or express emotions, language, and non‑verbal signals.
- Restricted, repetitive, or inflexible behaviours and interests. A person may have very strong interests, follow strict routines, repeat certain movements, or be unusually sensitive (either more or less than others) to things like sounds, lights, or smells.
NHS UK and Autism UK provide more information on Autism.
The Referral Process
Children must be seen by a paediatrician in the Pre School development clinic, before a referral to the 0-4 ASD Assessment Pathway can be considered.
If a child is four-years-old when seen in the pre-school development clinic they will be referred to the school age pathway run by CWP. Sometimes if a child has advanced language skills they will be referred to this pathway also. This is because of the assessment that are needed for older children and those with advanced language skills.
If you have concerns that a child may be Autistic, the first step is to make a referral to the pre-school development clinic, please see below:
Pre school Development Clinics Referral Criteria:
Children must be registered with an East Cheshire GP
1. Referrals are accepted from:
- East Cheshire GPs
- Health visitor, health therapists
- Consultant Paediatricians (internal) and external (transfers in)
2. Ages of children:
- Pre-school Children. (Core age of 2-4 years-old)
- Children are accepted until 31st March of the year they start school in September
3. Accepted concerns are around physical and/or learning development, such as:
- Premature babies or those with difficult perinatal/ neonatal periods and who are not under a local named Paediatrician from the time of their birth
- Motor delay e.g. late gaining head control; not sitting by 9-12 months; not walking by 12-18 months; preference for using one hand/arm under 12 months
- Speech and language delay e.g. no attempt to communicate by 12 months; no words by 12-18 months; social/communication problems including possible autism spectrum disorder
- Loss of skills at anytime
- Unusually floppy or unusually stiff especially if associated with feeding difficulties
- Significant global developmental delay
- Health Professionals can make a referral to the Pre School Development Clinic by contacting: Ecn-tr.paediatrics@nhs.net.
- Following the pre-school clinic appointment, if the Paediatrician suspects ASC, a referral is sent to the Autism Spectrum Disorder (ASD) Clinical Co-ordinator
What happens after referral?
The 0-4 Clinical Co-Ordinator receives the referral, and your child is added to the 0-4 ASD Pathway waiting list.
You’ll receive a waiting list letter and a leaflet detailing support resources.
Joining the pathway
If your child meets the criteria for assessment, an invitation pack will be sent to you by email, including:
- An invitation letter to join the assessment pathway
- Autism Pathway Flow Diagram
- Consent, initial information and parental concerns form
Important: Please return all forms promptly to avoid delays.
Following receipt of the above information, we will send the professionals involved with your child a professional concerns questionnaire.
All completed forms are stored securely in your child’s medical records.
Once the information has been received from all sources, assessment will commence.
Assessments
A framework called the DSM5 criteria is used to identify traits of ASD, from the information gathered about your child.
Following this your child will either be put forwards for discussion at the next available 0-4 ASD MDT meeting, or they will be invited to attend an in person ADOS assessment.
An ADOS assessment is a structured, play and conversation-based evaluation used by trained clinicians to help understand whether someone may be autistic.
We rarely observe children in settings like nurseries unless necessary.
The MDT meeting is Our Multi-Disciplinary Team (MDT) meeting where professionals discuss a patient and includes:
- Consultant Paediatrician
- ASD-trained Speech and Language Therapist
- ASD-trained Occupational Therapist
- Health Visitors and Early Years staff (on rotation)
- Clinical Co-ordinator
What Happens After Assessment?
What to expect:
A Clinical Co-ordinator will call to share the outcome. You’ll receive the full assessment report by email and post. You’ll be offered an in-person feedback appointment.
If a diagnosis is given: You’ll receive a post-diagnostic support pack. We’ll guide you to helpful local and national services.
If no diagnosis is given: We’ll signpost you to other support, such as the Cheshire East Sensory Processing website.
ASC vs ADHD – What’s the Difference?
The 0-4 ASD pathway is for autism only.
ADHD assessments start from age 6.
If ADHD traits are noticed during the autism assessment, we’ll discuss this at the MDT and may recommend a referral for ADHD assessment at age 6 via Cheshire and Wirral Partnership NHS Trust.
If you have any questions or need support, please reach out to your child’s Paediatrician or the ASD Clinical Co-ordinator.
Contact email: ecn-tr.asdpathway@nhs.net.
1. How do I know if my child is on the pathway?
If a referral has been received following your child’s appointment in the preschool development clinic the 0-4 ASD Clinical Co-Ordinator will have sent you a confirmation letter in the post. You should receive this shortly after the appointment in the preschool development clinic.
2. Will my child still be assessed if they are reaching 4 years 11 months?
Yes. If your child reaches 4 years 11 months or above, they can still be assessed by our ASD assessors.
3. How long does the assessment take?
The assessment process can vary, but generally, once invited for assessment it takes around 3 months to conclude a decision, depending on the complexity of a child’s symptoms and if the child needs an in-person (ADOS) assessment.
4. What if my child is diagnosed with autism?
If your child is diagnosed with autism, you will receive a phone call from the ASD Clinical Co-Ordinator who will deliver the diagnosis. There will be an opportunity to discuss the assessment report and future steps. We will signpost you to services, however our service is diagnostic only and we cannot offer you specific advice.
5. What if my child’s diagnosis is inconclusive?
If the ASD assessment does not result in a clear diagnosis, the MDT may recommend follow-up assessments or alternative diagnoses. It is also possible that the signs may not align with autism but may indicate another developmental or behavioural condition.
We know children develop and their presentation may change. If an inconclusive diagnosis is received it is possible for you to request a new assessment, after 6 months of the initial diagnosis decision.
6. Can my child be diagnosed with autism even if they have other conditions (e.g. ADHD, anxiety)?
Yes, it is possible for a child to have both autism and another condition such as ADHD, anxiety, or a learning disability. A thorough evaluation can help determine if multiple conditions are present.
7. Is there a waiting list for ASD assessment?
Waiting times for ASD assessment can vary due to the complexity of patient cases and the large volume of children who are referred for assessment.
Average waiting times across England for an autism assessment are now well over 1 year (often 12–18+ months) from referral to first appointment — and rising compared with previous years.
8. What if I disagree with the diagnosis decision?
If you disagree with the diagnosis decision, you can request a follow-up meeting with the ASD team, to discuss how the decision was made. If your child has received a non-diagnosis, this means that during the assessment there was not enough information at that time to be able to make a decision.
You can make a new referral for assessment once it has been 6 months since the original diagnosis decision was made.
You can withdraw your consent for your child to be part of the pathway at any time.
9. Where can I access further support?
The 0-4 ASD Diagnostic service does not provide diagnostic support, other than signposting to other support services and organisations.
The Local Offer details support and provision that families can expect from a wide range of agencies for children and young people with Special Educational Needs and/or disabilities (SEND) and for those awaiting diagnosis from birth to 25 years old.
National and Local organisations such as Autism UK, Space for Autism and Rubys Fund can also offer practical support.
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