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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 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 2 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 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 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 3 Interacting with others 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 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 SCAS additional referral information 4 Ideas and imagination 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 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 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 SCAS additional referral information 5