Quality statement 2: Assessment and diagnosis

Quality statement

People having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems.

Rationale

People with autism may have coexisting physical health conditions and/or mental health problems that, if unrecognised and untreated, will further impair the person's psychosocial functioning and could place additional pressure on families and carers. Because of their social communication difficulties, some people with autism may find it particularly difficult to communicate their needs and to access mainstream health and social care services.

Quality measures

Structure

Evidence of local arrangements to ensure that people having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems.

Data source: Local data collection.

Process

The proportion of people having a diagnostic assessment for autism who are also assessed for coexisting physical health conditions and mental health problems.

Numerator – The number of people in the denominator who have an assessment for coexisting physical health conditions and mental health problems.

Denominator – The number of people having a diagnostic assessment for autism.

Data source: Local data collection.

Outcome

Reduced morbidity from unidentified physical health conditions and mental health problems that affect the psychosocial functioning of the person with autism.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that there is sufficient provision of staff with suitable experience to ensure that people having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems.

Health and social care practitioners ensure that people having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems, and that any findings are shared with the person and their family and carers (if appropriate) and are taken into account in the agreed personalised plan (see quality statement 3).

Commissioners commission services in which people having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems.

What the quality statement means for service users and carers

People who are having an assessment because they may have autism are also assessed to see if they have any other physical health conditions and/or mental health problems. If any other conditions are found the person is told about these.

Source guidance

  • Autism: recognition, referral and diagnosis of children and young people on the autism spectrum (NICE clinical guideline 128), recommendation 1.5.15

  • Autism: recognition, referral, diagnosis and management of adults on the autism spectrum (NICE clinical guideline 142), recommendation 1.2.10

Definitions of terms used in this quality statement

Assessment for coexisting physical health conditions and mental health problems

Note that if an autism team does not have the relevant expertise to conduct these assessments, the child, young person or adult should be referred to services that can conduct the assessment.

Children and young people

The assessment could include the following:

  • Mental health and behavioural problems and disorders:

    • attention deficit hyperactivity disorder (ADHD)

    • anxiety disorders and phobias

    • mood disorders

    • oppositional defiant behaviour

    • tics or Tourette's syndrome

    • obsessive–compulsive disorder

    • self-injurious behaviour.

  • Neurodevelopmental problems and disorders:

    • global delay or intellectual disability

    • motor coordination problems or developmental coordination disorder

    • academic learning problems, for example with literacy or numeracy

    • speech and language disorders.

  • Medical or genetic problems and disorders:

    • epilepsy and epileptic encephalopathy

    • chromosome disorders

    • genetic abnormalities, including fragile X

    • tuberous sclerosis

    • muscular dystrophy

    • neurofibromatosis type 1.

  • Functional problems and disorders:

    • feeding problems, including restricted diets

    • urinary incontinence or enuresis

    • constipation, altered bowel habit, faecal incontinence or encopresis

    • sleep disturbances

    • vision or hearing impairment.

[Adapted from Autism: recognition, referral and diagnosis of children and young people on the autism spectrum (NICE clinical guideline 128), recommendation 1.5.15]

Adults

The assessment could include the following:

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

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

  • neurological disorders (for example, epilepsy or processing problems)

  • physical health conditions

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

  • hyper- and hypo-sensory sensitivities.

[Adapted from Autism: recognition, referral, diagnosis and management of adults on the autism spectrum (NICE clinical guideline 142), recommendation 1.2.10]