Autism

1. Preparation (2-3 minutes)

• Review the child’s history (if available): Gather background information from prior medical records or pre-appointment forms. Look for red flags like developmental delays, behavioral concerns (eg anger, meltdowns or emotional volatility, aggression, non-compliance, stress), or family history of neurodevelopmental disorders ( eg ID, epilepsy, learning difficulties)

• Review the Blue Book and Early Childhood nursing notes including growths charts and developmental progress

• Set goals for the visit: Focus on screening for autism , developmental delay and ADHD traits using validated tools while observing the child’s behavior.

2. Introduction and Parental Concerns (3-4 minutes)

• Establish rapport with the child and caregiver(s). Ask open-ended questions such as:

  • "What are your main concerns about your child’s development or behavior?"

  • What are main three specific areas of concern in your child's behaviour that you would like to develop?

  • Can you give me a recent example of when this occurred, how it affected the family, and what you did in response to try and develop this concern?

  • "When did you first notice these concerns?"

  • "Have pre-school teachers, day care teachers,  or other caregivers also expressed similar concerns, or not so much?"

• Prioritize their concerns to guide your screening focus.

3. Structured Screening (10-12 minutes)

Autism Spectrum Disorder (ASD):

• Use a brief validated screening tool:

  • •  such as the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) (for children under 5) 

    • or the Social Communication Questionnaire (SCQ) (Note this is proprietary use only , for children over 4). 

    • Social Responsiveness Score :Note once the child is as school the school counsellor may perform a, which is a useful screening tool for ASD.

  • Ask targeted questions about social communication and repetitive behaviors:

    • Does the child make eye contact?

    • How do they interact with peers?

    • Are there unusual repetitive movements or rigid routines?

• Observe: Note the child's behavior during the consultation (e.g., response to their name, eye contact when you ask the child a question, ability to engage in reciprocal interactions).

Attention-Deficit/Hyperactivity Disorder (ADHD):

• Use a tool like the Vanderbilt ADHD Diagnostic Parent Rating Scale or Conners Abbreviated Symptom Questionnaire for a quick assessment.

  • Ask about specific behaviors:

    • Inattention: Difficulty sustaining attention, forgetfulness, losing items.

    • Hyperactivity: Fidgeting, excessive talking, inability to sit still.

    • Impulsivity: Interrupting, difficulty waiting their turn.

• Gather examples of these behaviors at home and school.

4. Developmental Milestones (2-3 minutes)

• Ask about key milestones (walking, talking, playing with others) to gauge developmental progression.

• Focus on areas of concern like speech delay or motor difficulties.

• Ask the Child and Family Nurse to have filled out the Ages and Stages Questionnaire and check in the Blue Book

Note the current best approximate level

5. Summarize and Plan (3-4 minutes)

• Discuss findings: Share whether the screening results align with autism, ADHD, or other developmental concerns.

• Provide next steps:

  • Recommend a formal evaluation by a developmental pediatrician, child psychologist, or child psychiatrist.

  • Refer to early intervention services if needed.

  • Provide resources like handouts or websites about ASD and ADHD.

• Offer support: Acknowledge parental concerns and emphasize the importance of early identification and intervention.

Tools for Future Use:

• Downloadable forms: M-CHAT-R, Vanderbilt ADHD scale.

• Apps or websites for quick scoring of screening tools (e.g., Autism Navigator).

• Local referral pathways for developmental assessments or early intervention program

4. Summarize Findings and Plan Next Steps (3-4 minutes)

• Discuss Observations:

  • Share initial impressions based on the screening tools and consultation.

• Recommend Further Evaluation:

  • Advise a comprehensive assessment by specialists, such as developmental pediatricians or child psychologists.

• Provide Resources:

  • Offer information on local services:

    • The Assessment Centre | The Psychology & Consultancy Group

      • Address: 50 Bultje Street, Dubbo NSW 2830

      • Phone: 0422 751 794

      • Website: The Assessment Centre

    • Quantum Behaviour

      • A pediatric clinic in Central West NSW offering clinical and allied health supports.

      • Website: Quantum Behaviour

• Early Intervention Emphasis:

  • Highlight the importance of early referral, as timely intervention can lead to better developmental outcomes.
    Google Sites

Additional Considerations:

• Cultural Sensitivity:

  • Be mindful of cultural factors that may influence the family's perception of developmental concerns.

• Follow-Up:

  • Schedule a follow-up appointment to discuss referral outcomes and ongoing support.

By following this structured approach, you can efficiently utilize the 20-minute consultation to screen for ASD and ADHD, provide valuable insights to caregivers, and facilitate timely referrals for comprehensive assessments.