According to the current NICE guidelines, the diagnosis of ASD in under-19s must be made in a multidisciplinary way, from a team that consists ideally of a Child & Adolescent Psychiatrist or Neurodevelopmental Paediatrician, a Speech & Language Therapist (SaLT) and/or a Clinical and/or Educational Psychologist – but should at the very least contain at least two different disciplines. To be able to provide the face-to-face element of the multi-disciplinary assessment Psychiatry-UK have teamed up with the OWL Therapy Centre.
The Owl Centre* specialises in ASD assessments and therapy services. They include Speech & Language Therapists, Occupational Therapists and Clinical Psychologists. OWL operates a face-to-face service. To enable this, OWL has bases in many parts of England and Wales.
* The OWL Centre offers school or home visits throughout Bedfordshire, Berkshire, Buckinghamshire, Cambridgeshire, Gloucestershire, Greater Manchester, Hampshire, Hertfordshire, Kent, Central London, North London, North West London, South London, Northamptonshire, Oxfordshire, South Wales, Surrey, West Midlands and Worcestershire; and in parts of Herefordshire, Warwickshire and Wiltshire.
An ASD assessment must include information about the child/young person’s strengths and difficulties from multiple sources – the child/young person, parents and/or carers, education staff, and perhaps other informants. Supporting information is sought via forms and questionnaires and there needs to be a structured observation of the child/young person. OWL Therapy provides the individual assessment of the child by undertaking an ADOS (Autism Diagnostic Observation Schedule), face to face with the child/young person. Staff from OWL can in principle do school observations, but these have been replaced with a questionnaire for teachers to fill in, which is better in some ways, and is preferable during the time of Covid.
Information from school
There must be some information from school – questionnaire answers and/or Classroom Observation – but this will not be available from anyone who is out of school, although opinions from a past school should be sought.
The ADOS (Autism Diagnostic Observation Schedule)
This is a research-based structured assessment of the individual child, with built-in scoring, which requires intensive training to carry out. Despite the views of some Local Education Authorities and others, it is by no means infallible, so it would be a mistake to rely on it too much. In a few cases, it may not be necessary, if the evidence for an ASD diagnosis is convincing without it, if the young person does not give consent, or if it is clear that the young person would not cooperate adequately. However, most independent organizations, including ours, are reluctant to complete an ASD assessment without the ADOS, since this could invite criticism from other professionals, and, in a worst-case scenario, result in a Local Education Authority not accepting our report. The ADOS can be done: at one of OWL’s offices; at the child’s home; or after the Classroom Observation at the same school visit.
In more complex cases, additional assessments/services may be required in order to reach a conclusion re ASD.
The fee structure is variable depending on which pathway the assessment process follows, such as whether classroom observations are required or if second line assessments are recommended based on the outcomes of first line assessments. So, the minimum and maximum fees can range anywhere between £1700 and £3575.
A Stage 1 assessment involves gathering background information and history.
If you are not sure that a full stage 1 ASD assessment is required, it is recommended that you book a 1a generic assessment.
If an ASD assessment has been recommended or you want to proceed to a full assessment, it is recommended that you book a combined 1a and 1b appointment.
The child and adolescent consultant team will first offer you a 60 minute generic assessment for parent(s) and child over secure video link to gain a better understanding of your child’s difficulties and make recommendations about next steps.
If further assessment for ASD is indicated then you will be offered an ASD Initial Assessment. This is a 60 minute assessment for parent(s) and child/young person over secure video to explore the child’s strengths and difficulties in more detail and to gain more information about ASD features/behaviours. Questionnaires and background information will be requested from parents and school where applicable.
Combined 1a and 1b: £720
This is a 2 hour assessment for parent(s) and your child/young person over secure video link which explores the child/young person’s history, strengths and difficulties and possible ASD features/behaviours. It seeks to provide the same level of detail as the Stage 1a and 1b appointments. Questionnaires and background information will be requested from parents and school where applicable.
Stage 2: £800 (plus travelling expenses)
The Stage 2 assessment is arranged via an external partner (OWL Therapy) and involves a face to face ADOS assessment with a specialist speech and language therapist or clinical psychologist. The practicalities will vary depending on where in the country you are.
The ADOS is written up and shared with your Consultant. If the findings are inconclusive then further services may be recommended.
A virtual meeting between the OWL Therapist and your Consultant (£175 for 30 mins) may be required in more complex cases.
Stage 3: £180
This is a 30 minute feedback appointment with parents and/or child/young person, where applicable. You Consultant will arrange a feedback appointment during which the outcome of the assessment will be shared and recommendations made. A diagnostic report will be produced (which combines reports from Stage 1a &b and Stage 2).
Extra cost of report, in a suitable style to be included in an EHCP – £300.
The following may be required and are an additional cost:
• Classroom Observation – £100 (plus travelling expenses).
This may be required if the school information provided is unclear/inconclusive.
• A Speech & Language Therapist (SaLT) assessment – £200 or £300 if 2 sessions.
Language delay or dysfunction can be a part of ASD, but in some cases can be an alternative diagnosis.
• Sensory Assessment (Occupational Therapist) – £400.
Many children with ASD have sensory sensitivities that are very handicapping, such as: fear of loud noises; dislike of certain textures of clothing; or distaste for certain foods. So it is important to detail these as clearly as possible, both to help determine the diagnosis, and to understand the child’s particular difficulties. A specially trained Paediatric Occupational Therapist can not only do a thorough sensory assessment with this in mind, but can also recommend treatments.
• A ‘Psychometric Assessment’ – fee on request.
This more-or-less means an IQ test, although there is a bit more to it than this. Such skilled testing requires an Educational Psychologist or a Clinical Psychologist. There are certain characteristics of the result, or the child’s behaviour during testing, that may suggest or refute ASD. It is also important to know whether the child has either a very low or a very high IQ, both of which can mimic ASD. Since this is an expensive test, the team will not recommend it unless there is a compelling need for the information it could provide.
• Paediatric opinion – fee on request.
Some children with possible ASD should see a Consultant Community Paediatrician. This is necessary to look into the possibility of an underlying or coexisting medical condition (such as a chromosome anomaly, tuberous sclerosis, Foetal Alcohol Spectrum Disorder, or rarer causes of Learning Disability). A few children may need referral onwards to a Paediatric Neurologist. Both of these should be available on the NHS, but waiting times vary.
1. You think your child is on the Autism Spectrum.
You can choose a Stage 1a appointment to gain further advice. Your consultant will be able to advise whether further assessment is required. If so, you would then book a stage 1b appointment. Or you could book a combined stage 1a and 1b appointment. Your consultant will then be able to advise whether further assessment is required. If so, you would then book a Stage 2 ADOS.
Your consultant may advise that additional services are required – this is more likely with complex presentations.
2. You have been advised by another professional that your child needs an assessment for ASD.
You can choose to book separate Stage 1a and Stage 1b appointments or to have a combined appointment. Your consultant will be able to advise whether further assessment is required. If so, you would then book a Stage 2 ADOS