Autism in children: early signs, assessment and support

The NHS describes autism as a difference in how the brain develops that affects how a person experiences the world. It is something a child is born with, not an illness and not caused by vaccines. Some autistic children have a learning disability, while others have average or above average intelligence. Autistic children are more likely to have epilepsy, anxiety, eating disorders or depression, and ADHD is more common too.

The NHS lists differences in communicating, behaviour and play, and sensory responses.

Older autistic children show many of the same signs and may also have few close friends and spend more time alone, say or do things that seem rude or inappropriate, have an advanced vocabulary and speak formally, take things literally or miss sarcasm, need rules to be followed, have rituals that disrupt daily life, and find transitions such as moving from primary to secondary school difficult.

The NHS says signs can be harder to see in girls because of masking. Autistic girls may copy how other children behave and play, be quiet in difficult situations, appear to cope socially, show fewer repetitive behaviours than boys, and be more likely to have anxiety, depression or an eating disorder. Autistic boys can mask too. Some children learn to adapt so that signs are less noticeable, which can be exhausting.

The NHS says to speak to a GP if you think your child might be autistic; they can refer for an autism assessment and tell you about local support. You can also speak to the school or nursery special educational needs coordinator (SENCo). Referral may need to come from the school, or from a health visitor for a child not yet in school.

If a referral is accepted, the NHS says it can take a few months or longer to get an assessment. NICE guidance for children says the diagnostic assessment should start within 3 months of the referral to the autism team. In England you can choose which NHS service does the assessment, which may allow shorter waiting times (Right to Choose).

A child may have one or more appointments with a team of professionals. The NHS says the team may ask about development, such as when the child started talking, take a medical history and do a physical examination, ask the child to do tasks showing how they communicate, move, think and react, observe play and interaction with you, look for signs of other conditions such as ADHD or epilepsy, read reports from the GP, nursery or school, and speak to people who know the child well. A team member may visit the school to see the child in class and at break.

You receive a report saying whether your child is autistic, what they are good at, what they might need help with and whether other conditions were found, and you may be offered a follow-up appointment and a care plan or information, including support for parents, family and carers. If you do not agree with the result, the NHS says to ask the team why, request a second opinion or pay for another assessment outside the NHS. You may also be asked to wait until the child is older if signs are unclear.

NHS assessment follows a GP, school or health visitor referral. Private assessments can be quicker; ask whether the assessment includes school observation and information, who the clinicians are, and whether the local authority or school will accept the report when considering support.