SIGN 145-compliant diagnostic report in practice
An autism diagnostic report is your official record and the foundation for any future support. For example, it could be used to access benefits, workplace accommodations and education support. It isn't just a clinical document - it's also a legal document that may be scrutinised in various legal contexts: courts, tribunals, and legal proceedings treat diagnostic reports as expert evidence when making decisions about disability discrimination, capacity assessments, criminal proceedings, or family law matters.
Your report should be a formal, professional document that is both clinically and legally recognised and it should be a stand-alone document - comprehensive and clear enough on its own without needing any additional explanations.
The report should be compliant with the requirements of SIGN 145 (simplified version for patients) and contain the following:
A clear and unambiguous diagnostic statement: The report must state clearly whether or not a diagnosis of autism spectrum disorder (ASD) has been made. It should also include any other relevant diagnoses or co-occurring conditions that have been identified during the assessment.
Detailed rationale for the diagnosis: The report should provide a thorough and well-reasoned explanation for the diagnosis. This includes:
Evidence from multiple sources: It must clearly reference information from the assessment, including interviews, observation, and standardised diagnostic tools (e.g., ADOS-2, ADI-R). It should also reference accounts from family members or people who knew you in childhood.
Differential diagnosis: The report should demonstrate that other potential conditions (such as anxiety, ADHD, or a learning disability) were considered and ruled out where appropriate. This is a critical step to ensure the diagnosis is accurate.
Multidisciplinary Team (MDT): The report should list the names, roles, and professional registration numbers of every clinician involved in your diagnosis. This confirms that a qualified, multidisciplinary team made the diagnosis.
It's important to understand that having multiple people involved in the assessment does not automatically constitute a 'multidisciplinary team'. The term 'multidisciplinary' specifically refers to different clinical and medical disciplines working together - such as psychiatry, psychology, speech and language therapy, or occupational therapy. Each discipline brings specialised training and expertise to assess different aspects of autism. Non-clinical personnel - regardless of how many people are involved - cannot provide the varied clinical perspectives that a truly multidisciplinary assessment requires. A true multidisciplinary team means multiple qualified clinicians from different medical specialties, each regulated by their respective professional bodies and legally authorised to contribute to a diagnosis.
Imagine a scenario where a registered nurse ('RN') acts as the lead diagnostician in an autism diagnostic assessment, supported only by two non-clinicians. This might be presented as a ‘multidisciplinary team’, but in reality it breaches both SIGN 145 and the NMC (Nursing and Midwifery Council) Code of Conduct. Even with autism-specific training, a nurse cannot differentiate autism from other conditions in adults that may present with similar traits as ASD and which requires input from psychology, psychiatry, or related specialties. Being experienced or trained in autism does not qualify non-clinicians or a nurse alone to lead the assessment. Furthermore, by acting as lead diagnostician the nurse would be practising outside their competence in breach of Article 13 of the NMC Code of Conduct.
Summary of assessment findings: The report should summarise the key findings from the assessment, including:
Your developmental history.
Your current strengths and challenges.
The way your autism impacts your daily life.
The results of any psychometric tests or tools used.
Post-diagnostic recommendations: A good report doesn't end with a diagnosis. It should include a clear set of recommendations for support, which may cover:
Suggestions for your GP or other healthcare professionals.
Advice for work or education settings.
Recommendations for accessing support groups or services.
Signatures: A diagnostic report should be signed by the qualified clinician(s) who were part of the assessment process and who are professionally registered. The signature of a diagnostician confirms that they stand by the clinical content and conclusions of the report. This is a critical part of the document's legal and clinical validity. The person who signs it should be a clinician who has the legal and professional authority to make a diagnosis, such as a psychiatrist or a clinical psychologist. Crucially, the signature should be accompanied by their professional title and their official professional registration number. This number allows the patient to verify their credentials on a public register like the GMC or the HCPC, ensuring the report is both valid and legally defensible.
Copy for your records: The report is your property. You have the right to receive a copy of it and to ask for a further explanation if anything is unclear.
A summary letter for your employer or educational institution: You should be able to - in addition to your full diagnostic report - receive a shorter version of the report for an employer. This is called a 'confirmation letter' or a 'summary letter'. It's designed to be a brief document that confirms your diagnosis and recommends workplace accommodations without disclosing private medical details. It is considered a matter of good practice rather than a legal requirement to be provided with one, however most clinicians understand the need for a summary letter for employers or educational institutions.