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The purpose of this paper is to address the fact that under current Education Skills Funding Agency (ESFA) funding guidelines, diagnostic assessments for apprentices with additional learner needs are deemed an ineligible cost, which has the potential to reduce access to additional funding and support.

The approach of this paper is to critically evaluate the surrounding literature, government reports and Mencap review produced since the apprenticeship levy and present the implications of these funding guidelines relating to access to apprenticeships and the practical effects of apprentice’s experience and development.

The finding presented by this paper is that the definition of diagnostic assessments as an ineligible cost reduces the quality of training delivered by providers and assurances to apprentices that they will be fully supported from the start of their training.

The limitation of this research was the minimal amount of government/ESFA documentation addressing this subject within apprenticeships.

The practical implications of this paper relate to the on-going delivery of apprenticeship training in the UK, and the detrimental effect of reducing access to diagnostic assessments for apprentices with undiagnosed additional learner needs under the current wording of the Education Skills Agency guidance.

The government policy is currently under review to address this area which is considered an ineligible cost for supporting apprentices with recognised additional learner needs.

The value of this paper is to align with recent Mencap review and collaboratively readdress the ESFA’s current positioning of diagnostic assessments for apprentices with undiagnosed learning difficulties and disabilities as an ineligible cost and non-standardised requirement.

The Leeds Autism Diagnostic Service (LADS) is an all IQ service accepting professional and self-referrals, from age 18, for diagnostic assessment. LADS is unusual compared to other diagnostic services in England, in that it accepts self-referrals. The purpose of this paper is to compare diagnostic outcome between self-referrals and other referral sources.

This is a service evaluation of all 692 referrals for diagnostic assessment into LADS, over a three year period, from 2016 to 2018. The diagnostic outcomes were compared between self-referrals and other referral sources. Secondary analysis looked at age and gender differences between these groups.

There were 98 self-referrals over three years with autism diagnosed in 65 per cent. In total, 594 other referrals were received during this time period, with autism diagnosed in 44 per cent. This showed a significant difference of 21 per cent with 95% confidence intervals of 10–31 per cent (p=0.0001) using a n−1 χ² test. In total, 59 per cent of self-referrals were from patients identifying as female, which compared to 35 per cent identifying as female from other referrals. This was a difference of 24 per cent with 95% confidence interval of 14–34 per cent (p<0.0001) on the n−1 χ² test.

Factors which may influence the ability to generalise from these results are: that LADS covers a large mainly urban and suburban area with a range of ethnic and socioeconomic diversity; that LADS is an all IQ service unlike some other autism diagnostic services; historical and service-related factors unique to Leeds may be dissimilar to other locations. It was beyond the scope of this evaluation to perform a qualitative analysis to compare the referral sources, but this may be an area for further study.

This evaluation supports the use of a self-referral route for adult autism diagnostic services on a local level and may support its use more widely in other services.

This evaluation, in demonstrating proportionately significantly higher autism diagnosis from self-referrals is likely to be reducing the work load of professionals who would normally make referrals. Alternatively, it may be capturing a subgroup of the autism population who would not otherwise have sought diagnosis. In either scenario, it supports and is consistent with a patient centred approach to accessing appropriate diagnostic services.

The authors are not aware that any previous evaluation of this nature has been conducted and feel this evaluation supports the use of a self-referral pathway in adult autism diagnostic services.

This literature review identifies instruments for diagnostic assessment of cognitive impairment in prison populations. The purpose of this paper is to promote procedures for early screening and identification of cognitive impairment using instruments appropriate to prisons.

A targeted literature review identified studies on screening and diagnostic assessment of adults in jails, prisons, police watch-houses (custody suites), rehabilitation facilities and forensic settings or community settings for offenders. Discriminant validity, suitability, reliability and feasibility of instruments in correctional and forensic settings are presented.

From 135 peer-reviewed articles relating to diagnostic assessment of cognitive impairment, 15 instruments were considered appropriate for use in prison settings.

Selection of instruments for prison use considers suitability of the instrument(s) and clinical workforce capability. Cultural and gender validity of the instrument, its feasibility for use in the prison environment and cost and time to administer are also important. Using appropriate tools as part of a staged and targeted process in the screening and diagnosis of cognitive impairment is demonstrated by two case vignettes presented in this paper. As this was a desk review, the authors did not evaluate the instruments.

Identification of instruments that are suitable for diagnosis of cognitive impairment in forensic populations informs the rehabilitation of offenders with cognitive impairment in prison and upon release to probation and parole.

The Adult Asperger Assessment (AAA), comprising the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire is a commonly used screening tool designed to identify adults who may benefit from a further clinical assessment for autism spectrum disorder. The purpose of this paper is to investigate the usefulness of this screening measure in a clinical setting.

This retrospective cohort study comprised of 192 service users referred for diagnostic assessment of Autism by a specialist service of the National Health Service. The authors evaluated the diagnostic accuracy of the AAA by investigating if the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire were able to predict the diagnostic outcome of Autism in a clinical setting.

Scores from the Relatives Questionnaire can accurately predict diagnostic outcome. No evidence of accuracy for the Autism Questionnaire or the Empathy Quotient was apparent. Based on the findings, the authors recommend clinicians are cautious when interpreting results of the AAA.

It should be acknowledged that the results may not be generalisable to whole populations. Also, the authors used the full item versions of the scales; therefore, the findings are most applicable to studies which did similar.

This study highlights the need for investigation into the lack of validation of commonly used screening measures in autistic populations.

The purpose of this paper is to explore and highlight the main elements of an autism spectrum disorder assessment in adults. It features significant challenges for the clinical teams responsible to undertake the assessment. This paper aims to explain the importance of the wider needs assessment in accordance to the Autism Act and Autism Strategy.

The paper describes the main symptom domains for an ASD diagnosis, according to the two basic diagnostic manuals. It provides compendious summary of the available diagnostic tools and the significant comorbidities people with ASD present with including other neurodevelopmental disorders, mental or physical health problems, challenging behaviour and risk issues.

The paper proposes that all National Health System professionals should be able to recognise possible signs of ASD and accordingly refer individuals for a comprehensive assessment to secondary services. It highlights the importance of a wider needs assessment as part of a broader approach to addressing the needs of those with suspected ASD.

The paper aims to improve the gaps which remain in the referral and diagnostic process of people affected by ASD.

Through a comprehensive assessment the paper aims to improve the educational, social and personal functioning of people with ASD as well as the quality of life of their parents and carers.

The paper assembles a wide range of relevant considerations in regards to potential ASD in one place, and can be used to inform a comprehensive understanding of the assessment/diagnosis process.

Autism is a spectrum condition, yet many autism services limit access based on IQ score. The Department of Health 2009 enabled enthusiastic clinicians in Leeds with a strong interest in autism to apply for funding to develop an all IQ adult autism diagnostic service and here we present the experience. The paper aims to discuss this issue.

The process of establishing and then expanding the service is described. Details of the diagnostic pathway and tools used are provided.

The number of referrals was higher than expected – a baseline of 20 per year rose to 150 per year as soon as the service opened. Other unexpected findings include relatively low diagnosis rates (32 per cent), high rates of past trauma and patient dissatisfaction when a diagnosis of autism is not given.

To date, the service has assessed 517 patients, and plans are underway to collaborate with the local adult ADHD team to form a unified adult neurodevelopmental disorders service.

Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people.

Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline.

Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis.

Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence.

The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.

This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are appropriate. Differentiating among neurodevelopmental disorders such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder and intellectual disability can be a complex process, especially, as these disorders have some overlapping symptoms and often co-occur in young children. This series of case studies aims to present commonly overlapping symptoms in children who present to clinics with developmental concerns.

This paper presents three case studies that were completed at a free community ASD screening clinic in Southern California.

The case studies have common presenting behaviors and symptoms (e.g. social communication difficulties) that often co-occur across diagnoses; explanations for the final diagnoses are given in each case.

Conclusions from these three cases cannot generalize to all children being seen in clinics for neurodevelopmental concerns.

This series of case studies highlights commonly overlapping symptoms in children who present for differential diagnosis with social and/or behavioral concerns. Implications for educational placement and intervention are discussed.

These cases highlight the challenges involved in the differential and dual diagnostic process for young children with developmental concerns. Diagnostic considerations can affect later educational placement and opportunities for socialization.

This series of case studies provide practical information for clinicians about how to effectively differentiate between commonly occurring neurodevelopmental disorders, particularly given recent changes to the Diagnostic and Statistical Manual, 5th edition (DSM-5).

The paper aims to provide an overview of the current situation with diagnosis and assessment in autism spectrum disorders (ASD).

The paper is a review of literature combined with personal observation of practice.

Diagnosis cannot be determined by any one tool. It is a clinical judgement. A solo experienced clinician can make a diagnosis. Wider assessment is needed post diagnosis and needs a team.

Specialist multidisciplinary teams to assess people with ASD should be set up for adults as well as for children.

The paper is of value to those who are designing and providing diagnostic and assessment services. It provides a new review, covering a wider area.

This chapter will explore how assessment might look in next generation learning spaces where we have the potential to merge physical and virtual activities. Students now have ready access to a world of resources within their classroom and this fundamentally changes the nature of learning and assessment. The trend toward gamification of learning and assessment will be examined and the issue of assessment in new educational environments such as MOOCs will be explored. The impact of the semantic web (Web 3.0), where web objects and their context are all linked and objects have memory of how an individual student used them on previous occasions, will be discussed.

Next generation learning spaces encapsulate the affordances of both physical and virtual spaces and yet many assessment tasks are still designed as if students occupied only one of these spaces. Teachers will need to design more authentic, meaningful tasks that will engage students in using the full range of their capabilities and available resources, both physical and virtual. Students come together physically to engage in the social construction of their knowledge and can use the virtual spaces to broaden the social dimension of their learning environment.

Gamification of learning and assessment will require new approaches to defining tasks as teachers will need to decide how to incorporate diagnostic, formative, and summative assessment components within a more holistic educational environment. Game theory will be blended with learning theory in curriculum design and will result in the redesign of learning and assessment activities that are based on engagement (flow), user needs, and an evidence-centered design approach.