Table 5.

Potential improvements in diagnostic assessment services for children with possible autism spectrum disorder with increased resources

Code	Paediatrics (n=72)		CAMHS (n=46)		Illustrative quotes
	N	%	N	%
More MDT specialist clinicians	60	83.3	24	52.1	‘Access to a wider range of appropriate professionals during the assessment for example, speech and language and occupational therapy. Access to more assistant psychologists to collate relevant documents and developmental history to reduce the time required to complete the ADI-R’ (CAMHS)38 ‘Commission medic time to provide physical examinations when these are needed’ (CAMHS) ‘Inclusion of occupational therapy/psychiatry in assessment pathway’ (paediatrics)
Provide more support: before, during and after diagnosis	29	40.2	23	50.0	‘Workers with the role of managing those waiting; so a liaison worker to ensure they get the help they need while waiting’ (CAMHS) ‘Increase our postdiagnostic offer to children and families’ (paediatrics)
Reduce waiting list and improve timeliness	27	37.5	15	32.6	‘See people more quickly and reduce wait between stages of assessment’ (CAMHS) ‘Reduce waiting time from referral to assessment as well as time from first appointment to completed assessment’ (paediatrics)
Expand resources and capacity	17	23.6	12	26.1	‘Access to more assessment resources’ (CAMHS) ‘Have greater clinic room capacity so that the numbers of assessments carried out monthly can increase’ (paediatrics)
More holistic approach/better identification/support for co-existing conditions	4	5.6	9	19.6	‘More holistic assessments for example, could provide …educational assessment for all children’ (CAMHS) ‘More comprehensive assessments—could include cognitive assessments…comorbidities including tics, Fetal Alcohol Syndrome’ (CAMHS) ‘Have a service which is able to manage the emotional and mental health issues associated with autism and to assess for trauma presentations and attachment difficulties’ (paediatrics)
Increase ways of joint working	12	16.7	4	8.7	‘We could do more consultations and direct joint working with community child health paediatricians’ (CAMHS) ‘Every child seen in a joint appointment with community paediatrics and SaLT’ (paediatrics)
Improve information gathering and observation	12	16.6	3	6.5	‘More observational visits’ (CAMHS) ‘More time for direct observations in multiple settings (including home and school)’ (paediatrics)
Improve administration support and technology	5	6.9	9	19.5	‘Technology to help gather and store information’ (CAMHS) ‘Key administrative co-ordinator who would organise all steps of the patient journey through the assessment process. Would type all letters and could act as a single point of contact for the pathway. Would coordinate all information from education etc’ (paediatrics)
More training	10	13.9			‘Better education of educational professionals especially early years about how to spot children and refer them early’ (paediatrics) ‘Offer bespoke training across the borough on gathering appropriate information and the implementation of our recommendations’ (paediatrics)

ADI-R, Autism Diagnostic Interview-Revised; CAMHS, Child and Adolescent Mental Health Service; MDT, multidisciplinary team; SaLT, speech and language therapy.