1

An occupational therapist is providing therapy to a 4-year-old male with gross motor difficulties for whom autism is queried. The occupational therapist conducts an assessment of functioning in partnership with a speech pathologist within the same clinic. In this public-sector setting, the occupational therapist is able to refer the client to a service paediatrician, who conducts the medical evaluation and lead practitioner diagnostic evaluation. Based on the client’s presentation, and input from the occupational therapist and speech pathologist, the paediatrician is able to reach diagnostic outcome with certainty.

2

A child health nurse identifies early developmental concerns for an 18-month-old female. The child health nurse conducts the assessment of functioning and suggests the client consult a GP to obtain a referral to a private paediatrician, who performs a medical evaluation and a lead practitioner diagnostic evaluation, but is unable to reach a diagnostic outcome with high confidence. The paediatrician forms a consensus diagnosis team by inviting additional clinicians with expertise in the area of diagnostic uncertainty (in this case, a developmental/educational psychologist and speech pathologist). This team is unable to reach consensus on a diagnostic outcome and recommends reassessment upon a significant change in function or presentation, or when new information becomes available.

3

A 14-year-old male is referred by a GP to a paediatrician for concerns regarding social isolation and tic behaviours. The paediatrician conducts both the assessment of functioning and medical evaluation, and explores autism symptoms through a lead practitioner diagnostic evaluation. The paediatrician is unable to reach a diagnostic outcome with high confidence and invites additional clinicians to form a consensus diagnosis team (in this case a clinical psychologist and occupational therapist) who, together, are able to reach a consensus decision on the diagnostic outcome.

4

During the assessment of a 21-year-old male admitted to a forensic mental health service, a psychiatrist notes some of the presenting signs and characteristics may be explained by autism. The psychiatrist undertakes the Assessment of Functioning and Medical Evaluation, but determines that she does not have sufficient autism-specific expertise to conduct a diagnostic evaluation. The psychiatrist refers the client to a second psychiatrist with expertise in this area to complete the Lead Practitioner Diagnostic Evaluation. This psychiatrist is able to confirm with high confidence that the male does not meet all the required autism criteria, but does meet the criteria for a separate psychiatric disorder.

5

A 35-year-old female has queried an autism diagnosis for herself after her child is diagnosed as being autistic, and asks her child’s speech pathologist how she can initiate an assessment process. The speech pathologist explains the process and refers her to her general practitioner to complete the Medical Evaluation and a clinical psychologist to conduct an Assessment of Functioning. The same clinical psychologist performs a Lead Practitioner Diagnostic Evaluation and is able to reach a diagnostic outcome with high confidence.

6

Parents present to their general practitioner with concerns regarding their 3-year-old daughter’s development and behaviour. She refuses to speak to unfamiliar people, has a very restricted diet, appears to have delayed fine and gross motor skills, and has challenges with routines such as brushing her teeth and getting to sleep at night. Based on the child’s presentation and the family’s resources, the general practitioner provides a referral to a public-sector Child Development Service and shares outcomes of a Medical Evaluation with the service. Members of a multidisciplinary team (occupational therapist, speech pathologist, paediatrician) conduct an Assessment of Functioning and Consensus Team Diagnostic Evaluation, and are able to reach a diagnostic outcome with high confidence.

7

A 30-year-old female is referred by a general practitioner to a psychiatrist after identifying potential autism characteristics in herself after her daughter recently received diagnoses of autism and co-occurring ADHD. The general practitioner shares outcomes from a Medical Evaluation with the psychiatrist, who conducts an Assessment of Functioning and explores autism characteristics and differential diagnosis through a Lead Practitioner Diagnostic Evaluation. Based on the client’s Medical Evaluation, presentation, and developmental history, the psychiatrist is able to reach a diagnostic outcome with high confidence.

8

A clinical psychologist who practices in a multidisciplinary clinic is providing support to a 13-year-old female in relation to educational and social challenges. The client’s combination of strengths and challenges leads him to request input from a nurse practitioner, speech pathologist, and occupational therapist who together conduct an Assessment of Functioning. The nurse practitioner also completes a Medical Evaluation. Based on all information gathered and following consultation, the clinical psychologist proceeds with a Lead Practitioner Diagnostic Evaluating, resulting in a diagnostic outcome with high confidence.