Paed refuses to refer DS 3 yo with almost certain ASD to OT

[HiawathaDidntBotherTooMuch]

DS 3.1 yo is in the process of being assessed for ASD. We are probably about 9 months from diagnosis, but yak us, it is a basic certainty that he has ASD. This is shared by private salt and NHS salt and his pre school, where he has one to one support.

DS saw paed registrar in December for a developmental check. This showed what we all knew, that he was developmentally delayed, and we were told to come back in six months. I asked for a referral to OT when we saw the registrar in December, as this is what the Salt told me to do, and I understood that this was happening.

We saw the paed consultant yesterday. DS has progressed in some ways (better eye contact and concentration) but not in others (still no language, and meltdowns and tantrums are more frequent). Turns out that no referral was made, and he absolutely refused to refer as DS is very physically active without any mobility issues. But he agreed that the ASD triad of traits were very present and supported the referral for assessment for ASD. I said that DS was very impulsive, has no concept of danger, cannot do much in the way of getting dressed and undressed, and could not fathom things like shape sorters, two piece jigsaws, building duplo etc.

I don't understand why he wouldn't refer to OT. Should I push this and how?

[WaftingWilberry]

It could be that he knows the referral will be rejected - in our area OT only take referrals for 'significant physical disability' due to lack of funding, which is obviously a crap situation.

Doesn't mean that the referral shouldn't be made though, at least the OT services would have backup then for requesting more funding. Could his pre-school refer?

[Sirzy]

I was going to say the same as wafting. DS has just had his refferal to OT turned down, school nurse and peads are pushing them now to accept it but no idea if they will.

[HiawathaDidntBotherTooMuch]

Hmmm. Thanks for your replies. That may explain it. I am in Bromley. Looks like we may have to go private if we want OT then. Great.

[Sirzy]

Keep pushing. Can your HV help with a refferal?

[HiawathaDidntBotherTooMuch]

I will ask. But HV works two afternoons a week, and is very hard to get hold of. She is good at the tea and sympathy, which I dont need, but very ineffectual. She also once met a child with aspergers eight years ago apparently, so she clearly knows it all

I will push though.

[Sirzy]

Oh no, my hv was pretty similar. Was a pleasant surprise when we moved over to the school nurses and got a nurse who will go above and beyond.

Good luck, hope you don't have to fight to much

[HiawathaDidntBotherTooMuch]

Thank you

[Violet22]

My son has no diagnosis, but we started with a speech therapist and she did referral to OT. My son does have co-ordination difficulties. Would your salt be able to refer your DS. Seems mad that they can in some areas, not others.

[yakkiyakkiyogi]

I've faced a similar situation - our referral has been refused twice (once made by paed and once by dietician) - reason given was that his difficulties seem to be due to his developmental delay and he may catch up. This wasn't helped by the fact that DS (3) didn't have a dx of ASD at that time. We have only received the dx last month and the dietician is doing another referral now. In her words "the referrrals have to have just the right words" . She has also said that if this one gets refused too then she will give details of a walk in OT clinic that we can attend and once the OT there see him then they may change their mind. I'd suggest looking for any local OT walk in clinics in your area. Also SALT can do a referral too, ask them to do it considering they were advised you to ask the paed for it.

[AgnesDiPesto]

OT only does sensory profile and some advice here thats it. I didn't find it very useful as OT advice kept contradicting itself and gave impression of someone who didn't have a clue e.g. DS is under responsive to speech so needs more auditory input - DS is over sensitive to sound so needs to wear ear defenders.

I know lots of people do use OT but there isn't much in the way of official evidence to back it up so its easy for NHS to say no - for e.g. the NICE guidance doesn't recommend OT only changing the physical environment which an autism teacher could advise on

My DS has few sensory problems (so we never needed go sensory diet route) and we have solved all motor issues via ABA - breaking the skills down and teaching step by step using reinforcers - his motor issues were simply delay and lack of practice as he wasn't motivated to do things other children were. ABA also addressed lack understanding of danger

We did use the council OT attached to social care to access for e.g. extra locks, alarms, buggy etc

[bitbap18]

Can you ring OT themselves, see if they will chat to you about their criteria and whether they can help and who to get a referral from? Sometimes I've had more success doing it backwards or cutting out the middle man so to speak! Good luck!

[HiawathaDidntBotherTooMuch]

Lots of great advice here, thank you all very much. This week is manic, so I will be putting your advice into practice next week. I will update