Should you have any further questions, please do not hesitate to contact Customer Service on

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1 Aspect Assessments provide assessments for individuals with autism across the lifespan. A comprehensive assessment can identify developmental difficulties and determine the interventions, strategies and supports that will assist someone to reach their potential. Our assessments also include information about an individual s strengths, talents and interests so that support plans can be tailored to their particular goals and aspirations. Autism assessments (diagnostic assessments) are conducted by our specialist staff who are trained in the use of gold standard assessment instruments (Autism Diagnostic Observation Schedule and Autism Diagnostic Interview). An autism assessment will determine whether someone has autism and provide detailed information about their strengths and support needs. For very young children (under 2) My Early Development assessment identifies any developmental delays and/or early signs of autism. My Support Profile is a comprehensive assessment that can support people on the autism spectrum at times of transition (starting primary school or high school, preparing to leave school) or assist in accessing appropriate funding and supports (Helping Children with Autism Package, the National Disability Insurance Scheme, Disability Allowance). These assessments provide current information about social skills, behaviour, everyday living skills and current support needs. My Skills assessments are assessments of specific areas of functioning i.e. speech and language, cognitive (IQ) and occupational therapy (motor skills and sensory issues). These assessments can also be combined with Autism Assessments and My Support Profiles if required. Children aged under 13 years of age are eligible for a Medicare rebate (approx. $340.00) on our assessment fee (for autism assessments only), which is claimable after the assessment. In order to claim this rebate, the child must have been referred directly to our service by a private Paediatrician or Child Psychiatrist before the assessment date. In addition, the Paediatrician/Child Psychiatrist must trigger the appropriate Medicare item as part of the referral process. Payment is on the day of the assessment and can be made using bank cheque, money order, credit card or EFTPOS. Please note that we cannot accept CASH payments. Enclosed is an intake form, consent form and background information questionnaires. If you would like to proceed with an assessment, please complete and return the applicable forms as soon as possible. Please include copies of any reports that have been previously completed (e.g. Paediatrician s report, psychometric assessment, speech and language assessment, school report). Once we have received the completed forms, we will be in contact with you to organise a suitable time for the assessment. Please send all information to: Aspect Assessments, Autism Spectrum Australia (Aspect), PO Box 361, Forestville, NSW 2087 or mailto:customerservice@autismspectrum.org.au or Fax: (02) Should you have any further questions, please do not hesitate to contact Customer Service on Autism Spectrum Australia (Aspect) ABN Building 1, Level 2, 14 Aquatic Drive Frenchs Forest NSW 2086 PO Box 361 Forestville NSW 2087 T

2 Please indicate assessment required by ticking appropriate box in table below ASSESSMENT TYPE INITIAL ASSESSMENTS REVIEW ASSESSMENTS (CHILD) REVIEW ASSESSMENTS (ADULT) MY SKILLS ASSESSMENTS FOR AGES COST WITH DIAGNOSTIC 1 LETTER COST WITH FULL DIAGNOSTIC REPORT My Early Development 12 months to 2 years Autism Assessment 2 years onwards 1220* 1750* Autism Assessment with Cognitive assessment 2 years onwards N/A 2450* My Support Profile 4-18 years 1050 My Support Profile with Cognitive assessment 4-18 years 1650 My Support Profile 18 years onwards 1050 Plus IQ 18 years onwards +600 Plus Executive Functioning 18 years onwards +200 My Skills - Cognitive 2 assessment My Skills Comprehensive 3 language assessment My Skills Articulation assessment 4 years onwards 1050 From 18 months 690 My Skills Motor 4 assessment My Skills Sensory 5 assessment From 18 months * Medicare rebates may apply 1 Diagnostic letter includes: Diagnostic conclusion Severity Level General recommendations Additional information in full report: Summary of family, medical and developmental history Summary of previous interventions Full record of information obtained from assessment instruments Appendix outlining tailored recommendations i.e. strengths and support needs across functional areas for NDIS planning purposes For school entry it is highly recommended that a cognitive assessment is included in My Support Profile. Speech and language assessments and/or occupational therapy assessments can be added to an Autism Assessment for those wanting a multi-disciplinary assessment report.

3 Aspect Assessments INTAKE FORM Client Details Full Name of Person (Client) to be assessed: D.O.B.: / / Is client of Aboriginal descent? Country of Birth: Yes No Is client of Torres Strait Islander descent? Client s Parent/Carer Details (if applicable): Male Female Yes No Marital Status of Parents (if applicable): Mother s Name: Father s Name: Address: Address (if different): P/C: P/C: Home Phone: Home Phone: Work Phone: Work Phone: Mobile Phone: Mobile Phone: Address: Address: Is the client under the guardianship of Family & Community Services? Yes No Is this report required for a legal matter (eg. Family Court)? Yes No Name of preschool/school attending (if applicable): Yr: Address: P/C: Contact person: Phone: address: Is the child in a support class? Yes No Referral Details Referred by: Parent Self GP Paediatrician Psychologist Other: (Please attach/send copy of referral, if applicable) Name of Referrer (if other than Parent/Self): Address: P/C: Reason for Referral: Payment will be made by: Client Parent School FaCS/Agency NDIS

4 Aspect Assessments Assessment Consent Form Name of Client: Part A - Permission for Consultancy I give permission for a professional from Autism Spectrum Australia (Aspect) to act as a consultant: to seek all relevant information as required from schools, clinics, and other educational and health services; to undertake any appropriate and relevant psychological assessments; to provide us/me and any other professionals/services involved, with advice and assistance with educational/behavioural programs that are appropriate and relevant; We/I understand that the service will provide us/me with any reports and assessments and that we/i as parent/s or guardian/s will be full participants in any and all decisions which might be made about our child; We/I understand that all material will be treated with respect for our rights to privacy and confidentiality; We/I will advise Autism Spectrum Australia if this assessment has been requested as a result of any current legal proceedings, e.g. Family Court matter; We/I confirm legal guardianship of this child. We/I understand that fees for consultancy and assessment services will apply, as per attached Fee Schedule. Fees are payable at the time of the appointment. Part B Consent to Maintain Records/Information I hereby consent to Autism Spectrum Australia (Aspect) maintaining records (either paper or electronic format) about the services provided. I understand that: these records are owned by Aspect; information within these records will be shared with other staff within Aspect on a need to know basis, if and only when the staff require the information to carry out their duties; my consent will be obtained if any records need to be released to another agency or if another agency is contacted to provide information; I can ask to see records and receive a copy; records are archived by Aspect for a set period of time according to policy and will eventually be destroyed; photos/video footage may be kept in records but will not be used for any other purpose without consent; I understand that all information obtained will be kept confidential. Name of Client/Parent/Guardian: I acknowledge that I have read, understand and agree to the above information.

5 Aspect Assessments Parent/Carer Background Information Questionnaire Please complete for pre-school and school aged children only (Do not complete for a My Skills Assessment) Name of Client: The following questions will provide Aspect Assessments with preliminary information about your child. Please answer these questions with as much detail as possible. Which of the following best describes your child s current speech/language abilities (please circle) Non verbal or uses single words only Uses short phrases, e.g. I want drink, Daddy go car, Mummy come here Uses fluent speech, e.g. I went to the shop and bought a lolly, Last week I got an award for spelling. 1. Does your child regularly repeat words, phrases or sentences exactly as he/she has heard in the past, in an unusual way? 2. For children with fluent speech only - is it easy to have a conversation with your child? 3. Does your child look at people when talking/listening to them? 4. Does your child show interest in other children, e.g. watching them, talking to you about them, playing with them? 5. Does your child prefer to play on their own rather than with others? 6. Does your child ever approach other people inappropriately?

6 7. Does your child seem aware of or interested in the feelings of others? 8. Does your child spontaneously offer comfort to others if they are hurt, ill or distressed? 9. Does your child have any special routines or things that he/she likes to do in a particular way or order? 10. How does your child cope if his/her activities are interrupted? 11. Has your child become preoccupied or obsessive about a particular object/subject or activity? 12. Does your child regularly display any unusual physical mannerisms or repetitive body movements, e.g. hand flapping or flicking, toe walking, spinning? 13. Does your child have any unusual sensory interests or sensitivities, e.g. sniffing books, over-sensitive to particular noises or to touch? 14. What is most likeable about your child? 15. What does your child enjoy doing most?

7 16. What do you think are your child's strengths? 17. How does your family bring out the best in your child? For example, what do family members do that helps him/her? 18. What other places or people bring out the best in your child? For example, parks, organised activities, therapy services... Why do you think this is?

8 Aspect Assessments Teacher/Service Provider Questionnaire Please complete for pre-school and school aged children only (Do not complete for a My Skills Assessment) To assist with our assessment, we would greatly appreciate you completing this questionnaire. Please answer these questions with as much detail as possible as your observations and comments are a critical component of the assessment process. Name of Client: School/Centre: Name of person completing this questionnaire: Role (e.g. Teacher, Director, Speech Therapist, etc) : Contact number: Address: Date questionnaire was completed: Communication 1. Which of the following best describes this child s current speech/language abilities (please circle) Non verbal or uses single words only Uses short phrases, e.g. I want drink, Daddy go car, Mummy come here Uses fluent speech, e.g. I went to the shop and bought a lolly, Last week I got an award for spelling. 2. Does this child regularly engage in reciprocal conversation with peers? 3. Does this child regularly repeat words, phrases or sentences exactly as he/she has heard in the past? 4. Does this child play imaginatively with other children?

9 Social Skills 1. Does this child show interest in their classmates? 2. Does this child have any particular friends or a best friend? 3. Does this child regularly show and share their interests and achievements with others? 4. Does this child spontaneously offer comfort to others if they are hurt, ill or distressed? 5. Does this child have any difficulties with group work or cooperative play? 6. Does this child consistently respond to the approaches of others? 7. Does this child make appropriate eye contact? 8. Does this child use gesture to communicate, eg. pointing, beckoning someone to come, using their hands to indicate size or direction?

10 Interests, Behaviour & Skills 1. Does this child display any strong or unusual interests? 2. Does this child have difficulty with changes in routine or at times of transition? 3. Does this child regularly display any unusual physical mannerisms or repetitive body movements, eg. hand flapping or flicking, spinning? 4. Does this child regularly display any unusual sensory interests or sensitivities, eg. sniffing books, over-sensitive to particular noises? Academics 1. How is this child or young person doing academically in comparison to peers (eg. Previous numeracy/literacy results)? Requires significant curriculum adaptation Below average Average Above average 2. What are the child's academic challenges? 3. Does this child require additional supports within the classroom or playground? No Yes (please provide details

11 Strengths 1. What do you think is most likeable about this child? 2. What are this child's favourite hobbies or activities? 3. What do you think are this child's strengths? 4. What aspects of school help to bring out the best in this child? For example, strategies, subjects activities, peers/staff... Clear Form Form Print Form

12 Aspect Assessments ADULT INTAKE FORM Parent/family member to complete for Adult assessment only Name of Client: The following questions will provide Aspect Assessments with preliminary information regarding the client's early years. Yes 1. Did s/he join in playing games with other children easily? 2. Did s/he come up to you spontaneously for a chat? 3. Was s/he speaking by 2 years old? 4. Did s/he enjoy sports? 5. Was it important to him/her to fit in with the peer group? 6. Did s/he appear to notice unusual details that others miss? 7. Did s/he tend to take things literally? 8. When s/he was 3 years old, did s/he spend a lot of time pretending (e.g. play acting being a superhero, or holding teddy's tea parties)? 9. Did s/he like to do things over and over again, in the same way all the time? 10. Did s/he find it easy to interact with other children? 11. Could s/he keep a two-way conversation going? 12. Could s/he read appropriately for his/her age? 13. Did s/he mostly have the same interests as his/her peers? 14. Did s/he have an interest which takes up so much time that s/he did little else? 15. Did s/he have friends, rather than just acquaintances? 16. Did s/he often bring you things s/he was interested in to show you? 17. Did s/he enjoy joking around? 18. Did s/he have difficulty understanding the rules for polite behaviour? 19. Did s/he appear to have an unusual memory for details? 20. Was his/her voice unusual (e.g. overly adult, flat or very monotonous)? 21. Were people important to him/her? 22. Could s/he dress him/herself? 23. Was s/he good at turn-taking in conversation? 24. Did s/he play imaginatively with other children, and engage in role-play? 25. Did s/he often do or say things that are tactless or socially inappropriate? 26. Could s/he count to 50 without leaving out any numbers? 27. Did s/he make normal eye contact? 28. Did s/he have any unusual and repetitive movements? 29. Was his/her social behaviour very one-sided and always on his/her own terms? 30. Did s/he sometimes say "you" or "s/he" when s/he meant "I"? 31. Did s/he prefer imaginative activities such as play-acting or story-telling, rather than numbers or lists of facts? 32. Did s/he sometimes lose the listener because of not explaining what s/he was talking about? 33. Could s/he ride a bicycle (even if with stabilisers? 34. Did s/he try to impose routines on him/herself, or on others, in such a way that it causes problems? 35. Did s/he care how s/he was perceived by the rest of the group? 36. Did s/he often turn conversations to his/her favourite subject rather than following what the other person wants to talk about? 37. Did s/he have odd or unusual phrases? No

13 38. What is most likeable about your son/daughter? 39. What does your son/daughter enjoy doing most? 40. What are the strengths and/or talents of your son/daughter? 41. How does your family bring out the best in your son/daughter? For example, what do family members do that helps him/her? 42. What other places or people bring out the best in your son/daughter? For example, parks, workplace, organised activities, therapy services, education settings... Why do you think this is? Clear Form Form Print Form

14 Application to Conduct Research Staff Project Title: Pathways to diagnosis of ASD in the Australian context INFORMATION SHEET FOR PARENTS/CARERS Aspect often analyses data collected during regular service provision in order to gather important information, guide decision making and contribute to knowledge in the field. In 2016 Aspect Assessments is gathering demographic information from our clients, and data relating to the diagnostic process for families. The purpose of this research is to obtain information about the factors that influence early identification of ASD in Australia. All the information necessary for the study is obtained as part of our routine assessment protocol and no additional information will be collected. No identifying information relating to you or your child will be used and no-one will be identifiable in any published reports. All information will be stored in a locked filing cabinet and destroyed after 5 years. If you are happy to assist us in our research and help us to gather information regarding pathways to diagnosis in Australia, please complete the consent form attached to your referral paperwork. If you do not wish to participate in this research, you do not have to. Whether or not you participate in this research will not affect your relationship with Aspect or the services that you receive. If you need any additional information please contact Vicki Gibbs on You can retain this information sheet and can contact Vicki Gibbs at any point should you have any questions or concerns about this project. Autism Spectrum Australia (Aspect) ABN Building 1, Level 2, 14 Aquatic Drive Frenchs Forest NSW 2086 PO Box 361 Forestville NSW 2087 T

15 Application to Conduct Research Staff INFORMED CONSENT FORM Project Title: Pathways to diagnosis of ASD in the Australian context Consent Statement I have read and understood the information provided to me about the research project and I agree to participate in this project. I have had the opportunity to ask questions about my participation in the research project. All questions that I have asked have been answered to my satisfaction. I have ticked the statement below to indicate whether I consent to participate in this project. I consent to my child s participation in: Pathways to diagnosis of ASD in the Australian context YES NO Parent/carer s Name: Date: / / Autism Spectrum Australia (Aspect) ABN Building 1, Level 2, 14 Aquatic Drive Frenchs Forest NSW 2086 PO Box 361 Forestville NSW 2087 T