New HSE autism assessments may ‘harm children’ and lengthen wait lists, groups say

Advocacy groups are raising serious concerns that the Health Service Executive's (HSE) planned new autism assessments could inadvertently harm children and further lengthen already extensive waiting lists for child and adolescent mental health services (Camhs).

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could not endorse

Organizations including Neurodiversity Ireland, ADHD Ireland, and the autism charity AsIAm have echoed the reservations of the College of Psychiatrists of Ireland. The college explicitly stated it "could not endorse" the new protocol, citing "significant concerns" about the planned autism assessment and intervention pathway. This protocol, announced by the HSE and three ministers, is intended to address long waiting times for statutory assessments of needs (AON), with implementation expected by mid-2027.

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significant concerns

The proposed protocol introduces a three-tiered system for autism assessment, diverging from the current AON process under the 2005 Disability Act, which is conducted by multidisciplinary disability teams. The new approach would offer assessments through various HSE services, including Camhs, public health nurses, and primary care teams. While legislation mandates a completed AON within six months, current waiting times can reach up to 27 months, compelling many parents to seek private assessments.

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It is anticipated that the successful implementation of [the protocol] will help to reduce demand for AON.

Campaigners are particularly worried about Tier 1 assessments, which are designed as the default for "relatively clear presentations of autism" and are expected to take less than 10 hours. They fear this tier represents a move away from the comprehensive examination of a child's social, linguistic, educational, sensory, and occupational support needs. Trish Byrne, chair of the College of Psychiatrists' faculty of child and adolescent psychiatry, criticized the protocol as an attempt to "spread the load of an overwhelmed system into other systems that are already also overloaded," arguing that HSE disability services are inadequately resourced. Nessa Hill, CEO of Neurodiversity Ireland, dismissed the scheme as a "waiting-list initiative" rather than a service improvement, while Dr. Sonia Morris of ADHD Ireland warned that "harm happens when there are inadequate assessments."

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Tier 1 autism assessment is the default assessment for relatively clear presentations of autism