Changes ahead: The future of autism assessments in Ireland

The HSE have been developing a new three tier pathway protocol for autism assessments.  This pathway is proposed as a solution to address the 14,000 + children who are awaiting for assessments through the Assessment of Need process (AON).

Tier one: Autism assessment through the use of screening tools. 

Tier two: Autism assessment to allow for differential diagnosis (Is the person autistic or on the autism spectrum?).  Formal assessment used here include an abbreviated measure of cognitive skills.

Tier three: An extended autism assessment which will include a full evaluation of cognitive skills, as well as consideration of other factors such as mental health and medical history.

The Psychological Society of Ireland and The Association of Occupational Therapists in Ireland have both set out their position on the proposed changes.  Both have expressed concerns over the risk of misdiagnosis, the level of clinician competency required, and the lack of requirement for multidisciplinary team input within all tiers.  

In my professional role as a speech and language therapist, I diagnose autism as part of a multidisciplinary team.  In an autism assessment, we would consider everything proposed in the three tier system, in one robust assessment.  In my experience, if someone presents as 'obviously autistic', they often have co-occurring conditions and will always need an extended assessment to determine their skills and needs, especially when making recommendations for a school placement.  Autism is an exclusion diagnosis and we have to be clear that there is no other explanation for the way someone presents.

My concern is that this new tier system is merely a new waitlist initiative, where people will find themselves waiting to get into tier three, as extended assessment will generally be needed to provide a proper differential diagnosis.  I am deeply concerned about what is ahead and do not believe that this pathway will be in line with best practice.  I have shared my concerns with the Ombudsman for Children and he has agreed to investigate.