This paper summarises concerns raised by families, practitioners, and service providers regarding autism diagnosis and assessment in Western Australia (WA). It highlights areas of confusion, systemic misalignment, and unintended harm.
It does not consider the broader conversation currently around CDS wait times, Foundational Supports, Thriving Kids or removing diagnosis as a barrier to support.
Current concerns
Inconsistent requirements for evidence of autism diagnosis
- Lack of alignment between NDIS, DoE, CEWA, and SCSA requirements for evidence.
- WA Department of Education (DoE) eligibility for Individual Disability Allocation (IDA) has not been updated to align with the 2023 Autism CRC Guidelines.
- DoE removed public documents from their website that clearly spelt out diagnostic and evidence criteria for conditions eligible for an IDA – these are now only available on the DoE intranet.
- NDIS and SCSA requirements are vague and open to interpretation and inconsistent application.
- Autism WA has MDT team members defined by the age of the child which perpetuates confusion in the community.
- Families transferring from interstate to WA public schools are required to meet WA DoE requirements delaying access to appropriate supports and, in some cases, leading to exclusion from school.
Increased burden on paediatricians & psychiatrists
- Catholic Education WA (CEWA) requires paediatrician conferral for a diagnosis, creating bottlenecks and extended wait times.
- Assessments completed by registered psychologists with a speech pathologist are required to have conferral by a specialist to be accepted by DoE.
Confusion about scope of practice and endorsements
- Registered psychologists argue that endorsement is not required to diagnose.
- Practitioners who have had assessments accepted previously then believe that they will continue to be accepted as evidence, leaving families at risk that they are declined.
- Families often pay for costly private assessments (up to $4,000) using a registered psychologist and speech pathologist without knowing these may not meet WA DoE or CEWA requirements.
- Inconsistent practices around lead practitioner roles: some clinics use registered psychologists with internal “conferral” by a clinical psychologist, which does not align with CRC guidelines. It also may require a second practitioner to confer the diagnosis from a different specialty under updated guidance from DoE.
Referral challenges for complex cases and adolescents
Few private paediatricians will accept referrals for complex cases including dual ADHD and autism diagnosis and ongoing management.
Concerns about quality and validity of assessments
- Variation in report quality, with some paediatricians refusing to confer diagnoses.
- Commentary in media about parents “shopping for an autism diagnosis” are unhelpful.
- Increased availability of psychiatrist telehealth assessments has raised concerns about quality and validity of autism assessments in children.
Separated and conflicted parents
- Separated or conflicted parents may prevent assessment of their child or dispute diagnoses, leading to complaints to AHPRA or legal disputes that further compromise care.
- Without a diagnosis, DoE can impute a diagnosis but are unable to apply for Individual Disability Allocation funding to support the child.
- Many paediatricians and psychiatrists as a result will not take referrals for families with family court orders.
- This is a particular risk for mothers who are experiencing coercive control either within a relationship or from their ex-partner leaving them unsupported and at risk.
Diagnostic pressure
- Reports of Department of Health and Department of Communities challenging or disbelieving parent concerns, sometimes labelling them as “maternal fabrication” or “doctor shopping.”
- Practitioners feel caught between advocating for children and defending their clinical decisions, particularly in complex or nuanced cases.
Overlooked and masked presentations
- Many children with subtle or internalised autistic traits are overlooked because standardised checklists miss nuanced signs.
- Parents find it difficult to know which practitioners have an interest in and expertise in internalised presentations.
- Missed or delayed diagnosis contributes to significant downstream risks: school refusal, anxiety, family breakdown, self-harm, and long-term mental health challenges.
Systemic issues
- Insufficient government funding for assessment and support contributes to inequity.
- Families are left in limbo between systems, with escalating pressure on emergency and mental health services.
