Judith Gould and Lorna Wing offer some points to be considered when setting up an adult diagnostic service.

Points to be considered

1. Referral route and process

  • Who can refer?
  • Are self-referrals accepted?
  • Are screening materials used prior to the diagnosis and are these self-reports?
  • If yes, to above, what screening materials are used?
  • Do the outcomes of any screening material impact on type or level of diagnostic assessments carried out?
  • What other sources of information are sought?
  • Is a pre-visit/assessment contact made to explain the diagnostic process with the client and/or informants?
  • Is there a user-friendly leaflet to describe the service?

2. Diagnosis and assessment process

Where

  • What type of setting is used?
  • Is the environment ASD-friendly?


What

  • What assessments are used to carry out the diagnostic process? Are 'recognised' diagnostic tools used eg DISCO, 3di, ADI-R and/or own team's proforma for taking a developmental history?
  • What assessments are used to assess the individuals themselves? Do the assessments cover the following key areas:
    • social interaction and social understanding
    • communicative ability (including social use of language)
    • social imagination and flexibility of thought
    • cognitive profiling
    • adaptive skills
    • sensory issues
    • educational history
    • vocational and employment history.
  • Which tools are used to assess the above?


How

  • How many sessions are allocated in order to carry out the diagnosis and assessment of needs?
  • How soon after the diagnosis is this shared with the client and/or informants?
  • Is there sufficient time for clients to outline their own views?
  • Are there different types of assessments to reflect the complexity of cases or is there a standard package?


Who

  • Team
    • Is there a team representing a range of disciplines eg psychiatrist, psychologist, speech and language therapist, mental health workers, etc?
    • Have the team members undertaken appropriate training in the diagnosis and assessment of ASD?
    • Informants
      • Is there an attempt to gather information from various sources, with the agreement of the client eg spouse, partner, parents, carers, siblings, befrienders, advocate, support workers, etc?
      • Are other secondary sources explored eg previous reports, employment records, school reports/history, etc?


      Feedback

      • At what stages during the diagnostic process is verbal feedback given to the client and informants and how is this structured?
      • Is the verbal feedback given by the lead professional or the multi-agency team?
      • Is sufficient time given for questions either at feedback or later? If later, is a contact person or a protocol for contact agreed?


      Reports

      • Are the reports sent out in draft format to the client and informants before wider distribution?

      3. Post-diagnostic services

      • Once the diagnosis has been given, are there additional follow-up sessions to discuss the implications of the diagnosis?
      • Are there links with relevant services, support networks and pathways to move a client on post diagnosis?
      • If a diagnosis of ASD is not made, are there systems in place to refer the client to alternative services?

      4. Evaluation of the service

      • Are there formal and informal systems for reviewing the models used by the diagnostic team?
      • Are there opportunities for the client and other users to be involved in the evaluation of the service?
      • Does the service link up with other specialist diagnostic teams or ASD services to enhance links and networking?