How do community paediatricians work (re. autism diagnosis)?

[Yvanna]

My daughter is at the start of a possible autism diagnosis. So far she has been referred to a hospital paediatrician and had a range of medical tests and scans to rule out various syndromes and brain structure problems. Now those have been eliminated we were a bit surprised that her paediatrician says she needs another referral (now to a community paediatrician) for the autism diagnosis procedure to really begin. I just assumed that he would continue the process himself. What is the difference between a paediatrician and a community paediatrician and how do the latter 'do' autism diagnoses? Is it a very long procedure? I would really love to hear from anyone whose child has received a diagnosis from a community paediatrician. Many thanks in advance.

Oh for a set rule on this!

We've had 2 dx's from a community POaeda nd I;ve also got an ASD dx module, yet I only know about specific regions becuase it always varies so much.

A gold standard diagnosis would involve a combination of assessments by different professionals, which is why a Community Paed manages it. Expect input from speech and language, occupational therapy, physiotherapy, and maybe a psychologist for diagnostic purposes. They should also use proper, validated assessment tools (eg ADI-R, ADOS, 3Di (my personal preference), to make a diagnosis and should tell you whcih tools so you can verfiy their credibility but don't expect to see the tools (by tool I mean a standardised interview and assessments via observation and play) as this is considered to compromise their effectiveness- indeed, even at university we have to sign some in and out and there are also some we are not permitted to see.

After assessments you will get feedback, sometimes directly from Paediatrician (you should see reports as well) and sometimes from a meeting of all prodessionals where diagnosis should be discussed. I should warn you, whilst it shouldn't take more than a few months, realistically some assessments take eyars- the one for ds3 (then non verbal so far from mild) took 2-3 years before a diagnostic title was given.

A hospital Paed would have been a medical paed who deals with more physical difficulties.
ASD assessment varies from area. Some areas use consultant paediatricians, child development centres and other go through CAMHS. Other areas use a mix of both with sometimes a clinical psych doing the diagnosis. Diagnosis can take anything from less than a month to years and years.

My two were diagnosed by the community paed.

Each area seems to have their own system but at ours you have an initial appointment with the paediatrician. It takes about an hour and ivolves answering lots of questions about your child while the Paed also observes them.

At the end the Paed may ask you if you have any particular ideas about what the problem could be. When I said autism the Paed said they agreed but that there would need to be a full assessment to make sure.

You then go on the next waiting list for a multi-disciplinary assessment. In the meantime the various people (child psych, SALT, OT etc) visit your child at pre-school/school/home to do their own observations.

When you reach the top of the waiting list you are given appointments to see each person - usually they will team up if possible and do each appointment as a pair. So, for example, the SALT and Child Psych might do their tests at the same appointment.

At the end there is a big meeting where everyone discusses their findings and the Paed will give a diagnosis if appropriate.

It didn't take all that long, certainly compared to other areas I've read about on MN. I think there was a wait of around 3 months for the first Paed appointment, and then a further 3 months to get the other assessments and dx.

The most recent was over 4 years ago though so I'm not sure if they still have the same system or not.

In our experience coopertop is right, we saw community Paed in Feb and SALT separately, both referred us to combined clinic. Appointment is next week....long wait! Had a visit to nursery from Inclusion Teacher, them met with new teacher, SENCO, Head of Department and Inclusion Teacher to discuss move to school. Health Visitor also came to our house, returning after next week to offer further support and services...if we get dx! No idea how long that could take, heard of others getting immediate dx on the day others months!

Thank-you so much everyone, that's been so useful getting some idea of what to expect. Good luck to Woolytree for the appointment next week!

good luck i m at same stage as yourself,ds 3yr 10 mth has had all tests/scans,being refured to community coz hospital pead thinks very likely he has mild asd xx