Autism Spectrum Disorder (ASD) under 5 years old

ASD – Child <5

Please complete this form if you think that your child may have Autism Spectrum Disorder (ASD). It will take around 20 minutes of your time so please ensure you set aside this time in advance.

On completion, we will assess the likelihood of ASD and book you and your child for a GP consultation. There are two outcomes:

  1. We do not think your child has ASD and we may give other advice.
  2. We think your child is likely to have ASD. We will refer you to the Child and Adolescent Mental Health Service (CAMHS). Unfortunately there is currently a waiting list for this specialty of around 2 years. In the meantime it is recommended you read the
    CAMHS Self-Help Information Pack  (ASD info is at the bottom of it)

CHILD’S DETAILS

CHILD’S SYMPTOMS

Children with ASD have significant and pervasive difficulties in social interaction and understanding, social communication, inflexibility of thinking and repetitive behaviours/interests. Please tell us about these problems below, even if you have to slightly repeat yourself.
This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data.
Consent
© 2022 Kristian Turnbull