Call to find autism early in Scotland

Scottish guidelines urging GPs to pick up autism sooner may have little impact because there are too few services to refer patients to, experts believe.

The guideline, published this month by the Scottish Intercollegiate Guidelines Network (SIGN), calls on GPs to look for signs of autism in children and adolescents, including problems with social interaction and play, speech and behaviours.

It says GPs should use the checklist for autism in toddlers (CHAT) to give strength to suspicions, but not to rule out autistic spectrum disorders (ASD).

The guideline gives advice on the value of intensive behavioural therapy, communication interventions and use of medications, such as risperidone.

But experts have cast doubt on whether it will improve access to diagnostic services and therapeutics for autism.

Essex GP Dr Jamie Nicholls, who has an autistic son, said the latest SIGN guidelines add to the 2003 National Autism Plan for Children, which he helped the National Autistic Society to compile. He said the SIGN guideline is laudable, but essentially a 'big wish list'.

'From a practical viewpoint, if there's no enforcement behind it, there's a difficulty in saying if it will be implemented,' he said.

GPs need to identify children showing traits of ASD and refer them to appropriate services for rapid referral, said Dr Nicholls.

'SIGN suggests that every area should have a referral point,' he added. 'In some areas they exist, but coverage is rather patchy.'

Dr Judy Gould, director of the diagnostic centre at the National Autistic Society, said there can be long waits for diagnosis after GP referral to specialist child development services.

'GPs are terribly important because they are the first person the parents go to. The sooner we pick up autism, the sooner we can offer appropriate management,' she said.

'In reality, we have tremendous waiting lists for children. There can be a one- or two-year wait to see a specialist team.'

Traits of autism
- Delay/absence of speech
- Little imaginative play
- Lack of social play
- Unusual/repetitive hand movements
- Unusual response to sensory stimuli

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