Download SCAS additional referral information form - word

London Borough of Camden
Integrated Service for Disabled Children
SCAS
Kentish Town Health Centre
2 Bartholomew Road
London
NW5 2BX
Tel:
Fax:
020 3317 2200
020 7813 8680
SCAS additional referral information
The Social Communication Assessment Service (SCAS) conducts specialist Autism assessment and
diagnosis of school-aged children with social communication difficulties. SCAS is a multidisciplinary
team which is part of the integrated service for disabled children (MOSAIC).
Autism is based on the triad of impairments which includes difficulties with the following:
social interaction, reciprocal communication, stereotyped and restricted patterns of
behaviours. SCAS assessments are based on these triads of impairments.
The clinical picture is not attributable to the other varieties of pervasive developmental
disorder; specific developmental disorder of receptive language with secondary socioemotional problems; reactive attachment disorder or disinhibited attachment disorder: mental
retardation (F70-F72) with some associated emotional or behavioural disorder.
Head office: Greater London House, Hampstead Road, London, NW1 7QY
www.camdenproviderservices.nhs.uk | www.cnwl.nhs.uk
SCAS additional referral information
Name of child
Date of birth
Address
Name of caregiver
Caregiver contact details
Email
GP
School
Name of referrer
Referrer contact details
Date form filled in
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Please note that the SCAS team may consider gathering further information including
conducting a brief school observation before concluding about accepting this referral
Consideration needs to be given to assessments for conditions that may coexist with Autism or
provide a differential diagnosis. Please indicate below which other professionals have been
involved and provide any documentation from other services to assist with a potential
assessment. Failure to do so will cause delays to this referral
If the child has a Statement please provide SCAS with a copy
Developmental history - Please discuss the following questions with the parent or carer:
How old was the named child when parents/carers
started worrying about their development?
What were the parents/carers concerns?
Was there any delay in language development?
Was there any delay in motor development?
Current or previous professional involvement:
Professional
Name
CAMHs
Contact details
Report included?
Y/N
Educational Psychologist
Y/N
Speech and Language
Therapist
Occupational therapist
Y/N
Paediatrics
Y/N
Social Worker
Y/N
Other:
Y/N
SCAS additional referral information
Y/N
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NICE clinical guidelines1 provide a summary of signs and symptoms typical of possible autism in
school aged children. Below you will find these signs and symptoms of autism, this is not an
exhaustive list, but will provide SCAS with a basis to why this referral was made.
Where the child named above presents with signs of Autism please provide examples and detailed
descriptions for the subheadings below:
Spoken language
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Spoken language may be unusual in several ways:
– very limited use
– monotonous tone
– repetitive speech, frequent use of stereotyped (learnt) phrases, content dominated by excessive
– information on topics of own interest
– talking ‘at’ others rather than sharing a two-way conversation
– responses to others can seem rude or inappropriate
Responding to others
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Reduced or absent response to other people’s facial expression or feelings
Reduced or delayed response to name being called, despite normal hearing
Subtle difficulties in understanding other’s intentions; may take things literally and misunderstand sarcasm or
metaphor
Unusually negative response to the requests of others (demand avoidant behaviour)
1
National Institute for Health and Clinical Excellence. (2011) Autism: Recognition, referral and diagnosis of children
and young people on the autism spectrum. CG128. London. National Institute for Health and Clinical Excellence
SCAS additional referral information
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Interacting with others
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Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
Reduced or absent social interest in people, including children of his/her own age – may reject others; if interested
in others, may approach others inappropriately, seeming to be aggressive or disruptive
Reduced or absent greeting and farewell behaviours
Reduced or absent awareness of socially expected behaviour
Reduced or absent ability to share in the social play or ideas of others, plays alone
Unable to adapt style of communication to social situations, for example may be overly formal or inappropriately
familiar
Reduced or absent enjoyment of situations that most children like
Eye contact, pointing and other gestures
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Reduced and poorly integrated gestures, facial expressions and body orientation, eye contact (looking at people’s
eyes when speaking) and speech used in social communication
Reduced or absent social use of eye contact, assuming adequate vision
Reduced or absent joint attention shown by lack of:
– gaze switching
– following a point (looking where the other person points to – may look at hand)
– using pointing at or showing objects to share interest
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Ideas and imagination
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Reduced or absent flexible imaginative play or creativity, although scenes seen on visual media (for example,
television) may be re-enacted
Makes comments without awareness of social niceties or hierarchies
Unusual or restricted interests and/or rigid and repetitive behaviours
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Repetitive ‘stereotypical’ movements such as hand flapping, body rocking while standing, spinning, finger flicking
Play repetitive and oriented towards objects rather than people
Over-focused or unusual interests
Rigid expectation that other children should adhere to rules of play
Excessive insistence on following own agenda
Extremes of emotional reactivity that are excessive for the circumstances
Strong preferences for familiar routines and things being ’just right’
Dislike of change, which often leads to anxiety or other forms of distress (including aggression)
Over or under reaction to sensory stimuli, for example textures, sounds, smells
Excessive reaction to taste, smell, texture or appearance of food or extreme food fads
Other factors that may support a concern about autism
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Unusual profile of skills or deficits (for example, social or motor coordination skills poorly developed, while
particular areas of knowledge, reading or vocabulary skills are advanced for chronological or mental age)
Social and emotional development more immature than other areas of development, excessive trusting (naivety),
lack of common sense, less independent than peers
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