Primary care management and referral guidelines contain condition-based information for GPs about when to refer a patient, assessment and management measures that should be taken prior to submitting a referral, and what should be included in a referral to the relevant outpatient department or specialist service.
Diagnosis is complex and will not be completed in a single general practitioner visit – follow up appointments will be required to gather sufficient information.
Take a detailed history:
- Look for difficulties in 3 main areas:
- Impaired social interaction
Impaired social interaction
- Not responding to their name being called, despite having normal hearing
- Rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
- Not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
- Little interest in interacting with other people, including children of a similar age
- Not enjoying situations and activities that most children their age like e.g., birthday parties
- Preferring to play alone, rather than asking others to play with them
- Rarely using gestures or facial expressions when communicating
- Avoiding eye contact
- Taking people’s speech literally, and being unable to understand sarcasm, metaphors or figures of speech
- Delayed communication
- Delayed speech development (e.g., not speaking at least 10 different words by age 2 years), or not speaking at all
- Frequent repetition of set words and phrases
- Speech that sounds very monotonous or flat
- Preferring to communicate using single words, despite being able to speak in sentences
- Seeming to talk “at” people, rather than sharing a two-way conversation
- Behaviour with restricted and stereotyped interests
Behaviour with restricted and stereotyped interests
- Repetitive movements such as flapping hands, rocking back and forth, or flicking fingers
- Absence of symbolic play – playing with toys in a repetitive and unimaginative way e.g., lining blocks up in order of size or colour, rather than using them to build something
- Preferring a familiar routine, and getting extremely upset if there are changes to their normal routine
- Developing a highly specific interest in a particular subject or activity
- Hypersensitive or hyposensitive to sensory input e.g., lights, smells, fabrics, food textures, pain
- Comforted by deep pressure, being wrapped up, tight clothing, rocking, bouncing, jumping, repetitive motor behaviours (stimming)
- impact on individual and family function.
- onset (usually before age 3 years) and time course of concerns.
- presence or absence of concerns across settings. Request collateral information from education settings e.g., school report card.
- Ask about other important areas of history:
- Family history of neurodevelopmental disorders e.g., ASD, ADHD, learning difficulties, mental health issues.
- Relevant past medical history, looking for risk factors, associated conditions, or conditions which may impact on ASD presentation.
Relevant past medical history
- Antenatal events including maternal drug or alcohol exposure
- Neonatal events e.g., preterm or low birth weight
- Attainment of developmental milestones and any evidence of developmental regression
- Medical or surgical conditions – consider constipation which can negatively impact on behaviour
- Fussy eating – consider risk of iron deficiency
- Psychosocial history
- Family situation
- Parental mental health
- Substance abuse within household
- Parental disability
- Parental relationship issues
- Child protection involvement
- See Raising Children Network – DSM‑5: Autism Spectrum Disorder Diagnosis.
Determine if any significant developmental concerns – see Children’s Health Queensland Red Flags Early Identification Guide.
Arrange or perform initial investigations:
Request early intervention
If autism is suspected, make an early request for assessment and intervention rather than taking a “wait and see” approach.
Educate parents or carers about possible diagnosis of ASD and provide resources for further information – see Resources for families.
To confirm diagnosis, request assessment from Child Development Program (if available) if the child is younger than 9 years, or refer to your local General Paediatrics service
- The paediatric team may require an education report or questionnaire to be sent to the child’s school. Ask for parental consent for this and if granted, document in the referral along with details of the child’s school.
- Waiting times for public diagnostic assessment is typically several months.
- Consider private paediatrician which may be accessible and affordable for some families.
Optimise the patient’s general health.
- Provide dietary advice and supplementation (e.g., iron) if evidence of nutritional deficiency.
- Optimise sleep patterns.
- Manage constipation if problematic.
Consider a GP Mental Health Care Plan and referring to a paediatric psychologist for further assessment and intervention.
Consider a General Practice Management Plan and Team Care Arrangement and requesting allied health assessment and intervention. This can be done before confirmation of diagnosis.
- Occupational therapy
- Speech pathology
Ensure family‑based intervention and support is in place.
Once diagnosis is confirmed, assist with application for funding through National Insurance Disability Scheme (NDIS). See also Early Childhood Early Intervention.
- Request diagnostic assessment via:
- Child Development Program (if available) if the child is younger than 9 years, or
- Refer to your local General Paediatrics service
- Consider allied health assessment and intervention:
- Occupational therapy
- Speech pathology
- If parents need support, consider parenting programs.
Referring to your local paediatric services
Check the patient’s catchment area before requesting assessment. When services are available in the patient’s local area, refer the patient to the local hospital.
Queensland Children’s Hospital
1. Referral can be made by either:
- GP Smart Referral via BP or Medical Director
- Secure messaging
Send a written request to the Referral Centre via eReferral
(Medical Objects ID: RQ402900084, HealthLink ID: qldrchld):
- To download templates, see Referral Forms.
- If unable to attach investigations or use secure messaging, fax to 1300 407 281.
For more information, contact the Referral Centre:
P.O. Box 3474, South Brisbane QLD 4101
Phone 1300 762 831
Fax 1300 407 281
2. Check the minimum referral criteria and insert the required information into referral.
Search for a provider via the National Health Services Directory.