Autism in children webinar: Extended Q&A

At what age do you assess children for autism?

We can assess children for autism from the age of 3. If you have concerns about your child's social communication, interaction, sensory differences, behaviour, or development, an assessment can help provide greater understanding and identify any support they may benefit from at home, in education, and in everyday life.

The profiles and challenges faced by individuals with autism seem to vary so widely, what would you say unifies or characterises the diagnosis?

Although autism presents very differently from person to person, what unifies the diagnosis is a difference in how individuals experience and process the social world, communicate, and respond to their environment. Autistic people often share characteristics such as differences in social communication and interaction, a preference for predictability, and patterns of focused interests or sensory sensitivities. How these traits present can vary enormously depending on the individual, their age, strengths, support needs, and life experiences. This is why we talk about autism as a spectrum, not because people are 'more' or 'less' autistic, but because the profile of strengths and challenges is unique to each person.

Is there such a thing as having a child assessed too early?

There is not a single "right" age for an autism assessment, but in general, it is not usually beneficial to delay an assessment simply to see whether a child "grows out of" certain traits. While toddlers develop rapidly and some behaviours do change with age, autism itself is a neurodevelopmental difference rather than a phase. If parents or nursery staff have concerns, an assessment can help to build understanding and identify any support a child may need. Equally, an assessment should consider a child's developmental stage and be carried out by clinicians experienced in distinguishing between typical variation in development and characteristics of autism. Even when a diagnosis is not made, the assessment process can provide valuable guidance and reassurance. Early identification often means children and families can access appropriate support sooner, which can have a positive impact on their wellbeing and development.

Also, typically, how many 'in person' sessions does an Autism assessment take? Sometimes unfamiliar settings can cause my child to feel unsettled. How is this managed and is assessment time flexible in this regard?

Autism assessments typically involve 2-3 appointments, with at least one being conducted in person, although the exact process can vary between providers. We understand that unfamiliar environments can be unsettling for some children and young people, particularly those who may be autistic. Assessors are experienced in supporting individuals who feel anxious or overwhelmed, and will take a flexible, person-centred approach where possible. This may include allowing extra time, offering breaks, adjusting the pace of the assessment, and making reasonable accommodations to help your child feel comfortable and able to engage. The aim is always to create an environment where they can present as naturally as possible, ensuring the assessment is both supportive and accurate.

Where does 'Right to Choose' fit into the assessment process?

Right to Choose is an NHS pathway in England that allows eligible patients to choose their assessment provider once a GP makes a referral. It can provide access to NHS-funded ADHD and autism assessments through alternative providers, often with shorter waiting times.

My child had mild hearing loss and sometimes things are attributed this and not looking at the wider picture. Can you advise on this at all?

It is important not to assume that every challenge a child experiences is solely due to their hearing loss. While hearing difficulties can certainly impact communication, learning, social interactions and fatigue, children can also experience co-occurring needs such as anxiety, ADHD, autism, specific learning difficulties or mental health challenges. Taking a holistic view helps ensure that underlying difficulties are not overlooked and that the child receives the right support for all areas of need, rather than having everything attributed to a single diagnosis or condition.

And what is the worst level of autism in children?

Autism is not measured as 'mild' or 'severe' in a simple way. Every autistic child has a unique profile of strengths and challenges. Some children require very substantial support in their daily lives, while others may be more independent but still experience significant difficulties that are not immediately visible. The most helpful question is not 'How severe is the autism?' but 'What support does this child need to thrive?'

Does the assessment cover speech and language and occupational therapy recommendations or do those need to be in addition?

The assessment will consider areas such as communication, sensory needs and daily functioning, and we may make recommendations for Speech and Language Therapy or Occupational Therapy if appropriate. However, specialist SaLT or OT assessments are separate and may be recommended where a more detailed evaluation is required.

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Do you have any advice regarding school avoidance in a 16-year-old girl?

School avoidance in teenagers is often a sign that something is making school feel overwhelming rather than a simple refusal to attend. Common underlying factors can include but are not limited to anxiety, difficulties with friendships, academic pressures, ADHD, autism, low mood, or experiences of bullying. The key is to work collaboratively with the young person to understand their perspective and with school to put support in place to help the young person feel more comfortable in the school environment where possible. A compassionate, curious approach is usually far more effective than pressure, helping the young person feel understood while gradually rebuilding confidence and engagement with education.

Can you please suggest which school is best for autistic children? Can they still go to mainstream school?

Many autistic children and young people can thrive in mainstream schools, particularly when the right support and adjustments are in place. There is no single "best" type of school for every autistic child, as needs vary considerably. Some do well in mainstream settings with appropriate accommodations, while others may benefit from specialist resource provisions attached to mainstream schools, or specialist autism schools if their needs are more complex. The most important factor is finding a school that understands the child's individual strengths and challenges, is willing to make reasonable adjustments, and can provide an environment where they feel safe, supported and able to learn. A school that is the right fit for one autistic child may not be the best fit for another.

I was just wondering if you had any recommendations for online secondary schools/homeschooling groups etc, that are particularly good for autistic children?

Locally in Oxfordshire, we would recommend connecting with the school's SENCO and the Oxfordshire SEND Information, Advice and Support Service (SENDIASS), as they can advise on home education, Education Otherwise Than At School (EOTAS), and alternative provision options where attendance at mainstream school has become difficult. A key consideration is finding an educational environment that matches the young person's individual needs, strengths and sensory profile, rather than trying to fit them into a setting that is not working.

Is there specific font size, type, coloured background that is best for those with autism to read?

There's no single font or colour scheme that works for every autistic person, but accessible design principles can make information easier to read. We generally recommend a clear sans-serif font such as Arial or Aptos, a minimum font size of 12-14pt, good spacing, and uncluttered layouts. Some people find bright white backgrounds uncomfortable, so softer tones such as cream or light grey can be helpful. The key is clarity, simplicity, and reducing visual overwhelm wherever possible.

Is it best to leave assessment for diagnosis until towards the end of first year at school? So many children struggle with starting reception.

Not necessarily. While many children find the transition into Reception challenging, difficulties that are persistent, significant, or different from what would be expected for their age may warrant earlier assessment. It is often helpful to allow some time for a child to settle into the new environment, but if concerns around communication, social interaction, attention, emotional regulation, sensory sensitivities, or development were present before starting school and continue despite support, there is usually no benefit in delaying an assessment purely because they have recently started Reception. The decision should be guided by the child's individual needs and level of impairment, rather than how long they have been in school.

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How do you respond to a child who says they hate they are different?

When a child says they hate being different, it is important to acknowledge their feelings rather than immediately trying to reassure them. You might say, "I can hear that being different feels really hard right now." Many children simply want to feel accepted and understood. Once they feel heard, you can gently help them recognise that everyone has strengths and challenges, and that their differences are just one part of who they are. The goal is not to dismiss their feelings, but to help them build self-acceptance and see that being different doesn't mean being less valued or less capable.

I have a 3yr old boy, who loves light switches. It can be annoying as the switches go on and off. Should I go with the interest or discourage it? Thinking about danger.

Many young children develop strong interests in things like light switches, and it is not usually something to discourage. Instead, we would suggest redirecting it into a safe, structured activity. You could allow supervised access to a particular switch for a set period, or provide alternatives such as battery-powered lights, torches, or sensory toys with buttons. If he is seeking the visual effect, the cause-and-effect experience, or the sensory feedback, meeting that need safely is often more effective than repeatedly saying no. However, it's important to set clear boundaries around switches that could create safety risks or disrupt the household. Following the interest while teaching safe limits tends to work better than trying to eliminate the interest altogether.

Any suggestions please for helping older teens/early 20s people with autism gaining employment/later education? Especially where they don't have qualifications.

Many autistic young people can thrive in employment or further education, even if they do not have formal qualifications. The focus should be on identifying their strengths, interests and preferred way of working, rather than concentrating solely on academic achievement. Vocational courses, apprenticeships, supported internships, volunteering, work experience and entry-level roles can all provide valuable pathways into employment while building confidence and skills. It's also important to recognise that challenges with interviews, communication or executive functioning can sometimes mask significant talents, so practical support, reasonable adjustments and a strengths-based approach can make a real difference in helping autistic young people achieve their potential.

Is there anything you can suggest supporting anxiety-based nausea or sudden onset toileting needs?

Anxiety can sometimes present with physical symptoms such as nausea, stomach aches, or an urgent need to use the toilet, particularly before school or other stressful situations. It can help to acknowledge that these symptoms are real and are part of the body's fight-or-flight response, rather than assuming they're "just anxiety." Strategies such as maintaining predictable routines, allowing extra preparation time in the morning, practising breathing or relaxation techniques, and working collaboratively with the school to ensure easy access to toilets or a safe space can reduce distress. If symptoms are persistent or severe, it's always important to seek medical advice to rule out any underlying physical health concerns alongside exploring the role of anxiety.

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From a home support perspective - what advice can you give when parents have different views such when one believes there are neurodivergent traits and is keen for the assessment to commence to the other side when a parent is reluctant and won’t help with support and routines.

When parents have different views about a child's difficulties, it's important to focus on the child's needs rather than reaching immediate agreement on a diagnosis. One parent may recognise possible neurodivergent traits and want an assessment, while the other may be unsure or concerned about labelling. Encouraging open, non-judgemental conversations, focusing on the young person's day-to-day challenges, and gathering information from school or other professionals can help create a shared understanding. In the meantime, introducing supportive routines, reducing areas of conflict, and making reasonable adjustments at home can benefit the child regardless of whether a diagnosis is ultimately made. The goal is not to 'win' the debate, but to work together to support the young person's wellbeing and development.

I have an autistic 14-year-old girl and been educating myself on autism and what this means and as a result being much more empathetic with her - but what I have noticed is she is becoming more dependent on me for her safe space and struggles when I am not home - any advice here?

It is wonderful that increasing your understanding of autism has helped you become more empathetic and supportive. Sometimes, however, as autistic young people feel safer and more understood, they can begin to rely heavily on a parent as their primary source of regulation and reassurance. The goal is not to reduce that sense of safety, but to gradually help them build confidence in accessing other safe people, places and coping strategies when you're not available. Small, supported steps towards independence, while maintaining a strong, predictable connection with you, can help them develop resilience without feeling abandoned or pushed too quickly.

Are there any books or other resources you would recommend regarding social anxiety for teenage girls, where social interaction leaves them drained (no ASD diagnosis yet but might be)?

If social anxiety is having a significant impact on a teenager's wellbeing, school attendance or relationships, we would encourage families to start by speaking with their GP and school or college pastoral team. NHS services can offer advice, assessment and, where appropriate, referral to local Children and Young People's Mental Health Services (CYPMHS/CAMHS). The NHS also provides helpful self-help resources through Every Mind Matters, and charities such as YoungMinds offer trusted guidance for both young people and parents. Where social interaction consistently feels exhausting or overwhelming, it can also be helpful to explore whether there may be underlying factors, including anxiety, ADHD or autism, so that appropriate support can be put in place. If you are considering autism, even without diagnosis, the National Autistic Society may also be a good website to look at for more information.

Can you signpost to any resources for challenging behaviours in ASD? 6 year old child, significant communication delays, and can become frustrated and violent. Has been having SALT for many years.

Challenging behaviour in autistic children is often a form of communication, particularly when there are significant speech, language and communication difficulties. Frustration, sensory sensitivities, difficulty understanding expectations, or struggles with emotional regulation can all contribute to behaviours that may appear aggressive. It is important to look at what the child may be communicating through their behaviour and identify any triggers or unmet needs. Parents may find resources from the National Autistic Society, Autism Central, and local SEND or behavioural support services helpful. Working closely with a Speech and Language Therapist and considering support from professionals with expertise in autism and behaviour can also help families develop strategies that reduce distress and improve communication.

Useful resources for families:

• National Autistic Society – guidance on behaviour, communication and understanding triggers.

• The PDA Society (if demand avoidance is a feature) – practical strategies for reducing conflict and anxiety.

• Local SENDIASS services and community paediatric teams for advice on accessing support.

If violence is escalating or there are concerns about safety, families should seek advice from their GP, paediatrician, or the professionals already involved in the child's care, as this often indicates a need for a more coordinated assessment of communication, sensory, emotional and environmental factors.

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Can you give any insight into PDA please?

PDA (Pathological Demand Avoidance, sometimes referred to as Pervasive Drive for Autonomy) is a profile often seen in some autistic individuals where everyday demands and expectations can trigger high levels of anxiety, leading to avoidance behaviours. These are not typically deliberate acts of defiance but attempts to manage an overwhelming sense of loss of control or threat. A subtle change of language to reduce the perception of demand can be useful. Declarative language can be useful here. Young people with PDA traits may respond better to collaborative, flexible approaches, offering choices, reducing direct demands where possible, and prioritising trust and regulation over rewards and consequences. While PDA is not currently recognised as a separate diagnostic category, many families and clinicians find the profile helpful in understanding a child's needs and tailoring support accordingly.

Can an overlap with trauma and autism prevent a diagnosis if too complex?

Trauma and autism can sometimes look very similar, which can make assessment more complex. However, complexity alone should not prevent a diagnosis. A thorough assessment will explore a young person's developmental history, current presentation, and the impact of any traumatic experiences to understand whether autism, trauma, or a combination of both best explains their difficulties. In many cases, clinicians identify that both autism and trauma are contributing factors and make recommendations that address each of these needs.

Is ARFID hereditary?

ARFID is often linked with autism, and because autism is highly heritable, family patterns may reflect inherited sensory and neurodevelopmental differences rather than ARFID itself. Traits such as sensory sensitivities, anxiety, and differences in how food and body signals are experienced can all contribute. ARFID is usually understood as resulting from a combination of these biological factors alongside a person's experiences, rather than from a single cause.

I heard about a link of autism to gut microbiome?

There is increasing research into the relationship between autism and the gut microbiome, and we know that gastrointestinal difficulties are more common in autistic individuals. Some studies have found differences in gut bacteria between autistic and non-autistic people, but it remains unclear whether these differences are a cause, a consequence, or simply associated with autism. While this is a revolutionary area of research, we do not currently have evidence that changing the gut microbiome can prevent, cause, or cure autism.

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