The guidelines, 'Autism recognition, referral and diagnosis of children and young people on the autism spectrum', are the first to be developed by NICE on the condition in children from birth.
According to NICE, whereas autism was once believed to be an uncommon disorder, recent studies have found an increase in the number of children who may be affected, with at least one in 100 children now thought to be autistic.
The guidance identifies signs for nursery staff who suspect a child in their care may be autistic to look out for (see box). It lists possible risk factors, such as if a child has one or more siblings with autism, or if they were born prematurely.
The guidance also makes a number of recommendations. It says healthcare professionals in the NHS should improve how they engage with schools, early years settings and other key services to offer useful insight into the condition, so that children with possible autism receive appropriate care and support.
In particular, it advises that when children are assessed for autism, observations should be carried out in their nursery as well as in the home, as a child's behaviours can sometimes vary from place to place where they spend their time.
Other recommendations outlined in the document include:
- Establishing a multidisciplinary autism team in each Primary Care Trust area to include a paediatrician, speech and language therapist and an educational psychologist
- In autism diagnostic assessments, including analysis of social and communication skills and behaviours through interaction with and observation of the child and consideration of any co-existing conditions
- Producing a profile of the child or young person's strengths, skills, impairments and needs, which, with parents' consent, is shared with staff at the nursery or school the child attends to contribute to their Individual Education Plan and needs-based management plan.
Carol Bagnall, a specialist health visitor covering the areas of Heywood, Middleton and Rochdale in Greater Manchester, who helped develop the guidelines, said, 'Nursery practitioners don't have the same experience as health professionals. The guidelines are about making practitioners more aware of the signs and risk factors and levels of parental concern.
'Some children with autism don't "stand out" at nursery, and autistic children can often present differently, which is why the condition is referred to as autism spectrum disorders.
'Practitioners who suspect that a child has autism should speak to their area SENCO and parents.'
She added, 'If I could get one message across, it would be that parents are the experts when it comes to their children. In my experience, 99.9 per cent of parents who raise concerns about their children having autism are right.'
Signs that might suggest autism
- Problems with speech such as not speaking at all or repeating specific words or phrases
- Problems understanding and responding to other people's facial expressions, body language or feelings
- Not wanting to get physically close to people
- Not knowing how close they can get to other people
- Little imagination
- Difficulties playing with others
- Preferring to be alone
- Reacting badly to a change in routine
- Display unusual repetitive hand, finger or body movements
