Learning disabilities FOLS supporting information
Diagnostic information for referrers
In FOLS we receive referrals from a wide variety of professionals. We understand that, because of this, some referrers may not be familiar with diagnostic criteria for learning disabilities and autism, and therefore they may not know what evidence to supply at the point of referral. This can cause significant delays in the triage process and may impact service users accessing our service.
If sufficient diagnostic evidence is not provided at the point of referral, it is likely the referral will not be accepted. We are not able to source diagnostic reports for referrers, and often do not have access to health information due to information sharing protocols. Referrers are therefore expected to make reasonable efforts to source diagnostic reports.
To support referrers, we have put together guidance for what is considered to be sufficient diagnostic evidence. This is to ensure fair and equitable access to our service and is based on:
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‑5)
- International Classification of Diseases, 11th revision (ICD‑11)
- National Institute for Health and Care Excellence (NICE) guidelines
- British Psychological Society (BPS) guidance
We strive towards person‑centred care and all decisions are made on a case‑by‑case basis. In circumstances where the diagnostic report cannot be sourced, please contact the FOLS office (01924 316112, fols.referrals@swyt.nhs.uk) to discuss this prior to making the referral.
Diagnostic criteria for a learning disability
All three of the criteria below must be met.
- Significant impairment of intellectual functioning
Evidenced by a formal measure of Intellectual Quotient (IQ) showing performance two standard deviations below the mean. This would usually be evidenced using the WAIS‑IV. - Reduced ability to cope independently (impaired adaptive functioning)
This may be assessed through a normed and validated tool such as ABAS‑III, Vineland, Functional Living Scales, or a comprehensive occupational therapy/functional assessment. - Age of onset before adulthood, with lasting effect on development
For example, exploration of the person’s developmental history highlighting onset and presence in childhood. Where diagnosis occurs later in life, cognitive assessment should be supplemented by assessment of premorbid functioning and differential diagnostic consideration.
Diagnostic criteria for autism
- Persistent deficits in social communication and social interaction across multiple contexts
- Restricted, repetitive patterns of behaviour, interests, or activities, as shown by at least two of the following:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or rigid thinking patterns
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper‑ or hypo‑reactivity to sensory input or unusual interest in sensory aspects of the environment
- Symptoms present in the early developmental period (even if not fully recognised until later)
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning
In line with NICE guidance, an autism assessment must include a developmental history (from the person and/or someone who knows them well, such as a family member) and an observational element. The assessment report should clearly address the diagnostic criteria and include relevant information on mental health, trauma history, other neurodevelopmental conditions, and physical health to support differential diagnosis.
What is not accepted for learning disability or autism
- Autism Quotient (AQ) questionnaires or similar screening tools, as these are not diagnostic
- Letters or non‑diagnostic reports that reference a diagnosis without a formal diagnostic assessment
If you are unable to provide a diagnostic report, please include clear evidence explaining how the person meets the diagnostic criteria above. This may also include information on reasonable adjustments, services involved (past and present), and the level of daily support required.
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