Paediatric Autism Assessment Booking Form

What is Autism?

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects social interaction, communication, and behaviour. It is a spectrum disorder, meaning that the symptoms and their severity can vary widely among individuals.

In children with Autism, the symptoms are present before three years of age. It’s estimated that about one in every 100 people has ASD.

The Paediatric Autism Assessment Team aims to assess and diagnose children with Autism, so they can access the support they need. Support can be found locally by visiting Autism NI.

Autism Spectrum Test

The Centers for Disease Control and Prevention (CDC) also provides information on screening and diagnosing ASD in children. The CDC recommends developmental monitoring, screening, and formal evaluation to diagnose ASD in children. The recommended ages, tools, and resources for parents and providers to help children with ASD are also provided.

Autism Spectrum Disorder (ASD) Diagnosis and Assessment in Northern Ireland

NICE (National Institute for Health and Care Excellence) guidance states that no-one should wait longer than 13 weeks for an autism assessment from the point of referral.

Our team will aim to meet this target by completing an evidence based face-to-face autism spectrum assessment for children between the ages of 31 months to 17 years 11 months, as outlined by NICE guidelines using Gold Standard Assessments. These include ADI-R (Autism Diagnostic Interview-Revised) and ADOS-2 (Autism Diagnostic Observation Schedule). Further information regarding your child’s development, medical history and educational history will be obtained through detailed questionnaires and speaking with the parent(s)/Guardian(s) directly.

The Multidisciplinary team is made of a Specialist Speech and Language Therapist, Clinical Psychologist and Consultant Paediatrician.

All diagnosis are ratified by the team with your local trust ASD diagnosis and intervention service. A report will be sent to them, as well as you and your GP.

Private Autism Assessment Booking Form

Please complete the form below in full if you wish to self refer your child for a private paediatric autism assessment.

Once triaged for assessment, you will be contacted and offered an appointment with details about the assessment to follow and answer any questions you may have.

Should there be any difficulties submitting the form through your chosen browser; please feel free to send information directly to info@sonnyhealth.com or leave a message with our medical PA Jennifer on 07843590259

Patient Name *

First

Last

Patient Date of Birth (DD/MM/YYYY) *

Langauge(s) spoken at home

Current School or Daycare Setting *

Patient Address (including postcode) *

Name of Parent/Guardian *

Parent/Guardian Contact Number *

Parent/Guardian Email address *

Current Professional Involved *

For example: Speech and language therapist, Paediatrician, Educational Psychologist, CAMHS. Please include any confirmed diagnosis

Reason for Referral *

Please provide examples where possible, outlining the areas of developmental delay, communication skills, play skills, sensory concerns, behavioural concerns and social interaction skills

Has your child attended a formal assessment with the trust

If yes, please tell us which Healthcare Trust completed the assessment and what was the outcome?

Submit