autistic spectrum disorders ( asds ) are developmental disorders estimated to affect 1 in 150 children . increasing professional awareness has led to higher levels of diagnosis and support , possibly explaining the recorded rise in prevalence over the last 30 years . asd is commoner in males ( m  :  f autism 4  :  1 , aspergers 10  :  1 ) . genetic factors are complex , and no single gene mutation or chromosome abnormality has been linked , although the condition has the highest heritability of any psychiatric disorder ( approximately 90% ) ; the risk of having a second child with autism is increased by 2030 . the national autism plan for children ( napc ) emphasises the importance of early intervention and close collaboration between parents and professionals and provides a gold standard for services . benefits for parents include increased capacity to seek information from external sources and make use of available health services . this service involved sessions from child and adolescent psychiatrists ( cap ) , community paediatricians ( cp ) , camhs practitioners , specialist speech and language therapists ( salt ) , and educational psychologists ( ep ) . in addition to the core symptoms , there are other common features , such as abnormalities in sleep and mood . for a diagnosis of asds to be made if there are concerns during developmental screens , specific screening for autism is strongly encouraged . most commonly used is the autism diagnostic observation schedule ( ados ) ; however not all characteristics may be demonstrated during the test . difficulties can become more apparent when changes in routine occur , for example , starting a new school , and this is often when children are referred . the diagnosis of autism , however , is often not made until 2 to 3 years after symptoms are recognized . there are considerable demands on parents as they accept and adjust to their child 's communication and social interaction impairments . many people seek information on their own , from other parents , websites , books , and autism groups and newsletters . children and families want accessible mental health services which provide support when needed and involve them as users . they also want to know what services are available to help them support their child . the napc guidelines address identification , assessment , diagnosis , and access to early interventions for children with asds . stage 1 is a general multidisciplinary developmental assessment for any child with possible developmental problems . the assessment should be completed and fed back to the family within 17 weeks of referral . the napc states that feedback to parents should include information about services , for example , the national autistic society ( nas ) . in manchester , all scait professionals receive training in assessing asds . referrals from educational psychologists , health visitors , and school nurses are accepted if the general practitioner or a paediatrician is informed . parent intervention programmes can enhance interaction with children , promote development , and increase parental satisfaction and mental health . scait offers five 2-hour sessions : understanding asd , understanding and managing behaviour , understanding and working with the education system , enabling your child 's communication and understanding , and further resources for you and your child . to assess parental satisfaction with scait assessments and compare the service with the napc guidelines . parents and carers of the 35 children diagnosed with asds from december 2008 to may 2010 were invited to participate . participants were invited to have a telephone or face - to - face alternative to complete the questionnaire . a previous manchester audit tool was enhanced to provide further information about the postdiagnostic group ( appendix 1 ) . questionnaires were scored according to total satisfaction , and satisfaction in each of the 4 areas of the assessment process . thirty - five questionnaires were posted , and 20 ( 57% ) parents participated , with 1 father responding . of the 20 participants , 1 parent completed the interview via telephone and the other 19 returned the questionnaire by post . the child 's age at diagnosis and the present time showed 2 peaks ( figure 1 ) , consistent with transition to primary and secondary school . most parents ( 86% ) were especially satisfied with the assessment process ( table 1 ) , but less happy with the information received before and after the assessment . most parents felt they were well informed about the assessment before the appointment , with 65% receiving information . however , 14 would have liked to have known the different parts of the process , and 8 wanted to know the questions they would be asked . about half of parents would have liked to have known the name and professional background of the clinician ( table 2 ) . nineteen parents felt they were definitely listened to carefully , with the final patient choosing yes to some extent . additionally , 18 parents felt they were able to discuss their concerns and give feedback at the time of assessment , and 80% felt the assessment could not have been communicated differently . the family who needed an interpreter reported that the information they were provided with before the appointment was very poor , although they believed the actual process was good . notably , 85% of parents would have liked a letter with a plan for further assessment and appointment dates . most parents had received a report which 65% claimed to definitely understand , with 20% understanding to some extent . eighteen parents had the opportunity to give feedback at the time of the assessment . however , 59% stated they either did not have any say or only to some extent . all of the parents said they were able to ask questions at following meetings . with regards to the postdiagnostic workshops , 8 parents received information regarding the aims . when parents are invited to attend the sessions , written information about the course is also sent with the letter . every respondent was happy with the assessment process , with 60% reporting it to be very good , 100% of parents said they were definitely treated with trust and dignity . after the assessment , 100% of patients were happy with the level of information they had regarding the process . although 18 parents received additional information in some form , 6 felt they had not received enough information about the condition and future interventions . with regards to the postdiagnostic workshops , only 15 parents said they were invited to attend . the reasons for this were not explored , although one patient did report moving house . when asked why they were unable to attend , childcare was a key theme as was timing . looking at the time interval from referral to diagnosis , great variance was apparent ( figure 2 ) . the average time was 46 weeks with only 6 diagnoses reported in the recommended time frame of 17 weeks . of note , the child with the shortest timeframe from referral to diagnosis was the least satisfied , while the longest timeframe elicited the highest satisfaction score . the results show 2 peaks , with satisfaction higher at the times of school transition ( 35 and 1012 year olds ) . one weakness was size , although sampling the past 18 months allowed the collection to be achieved within the allocated timescale . if the study was increased to the past 3 years , the results may show a more significant trend , although parents might find the process harder to recall . parents wanted more information regarding diagnosis and management . a longer follow - up appointment after diagnostic feedback could allow needs to be individually assessed . during this appointment , professionals could discuss the purpose of the postdiagnostic workshops . the information provided during these workshops is obviously most beneficial when attending the group sessions , as they are interactive and parents have the opportunity to share experiences and strategies . however , if all parents received the written information provided within these sessions , it would be helpful to those who could not attend . as childcare and timing were the commonest reasons for nonattendance , this could be addressed by combining all 5 sessions into 2 days within school hours . written communication could be enhanced by a standardised response letter from the scait team . this could include the role of scait , the purpose of the assessment , the appointment time , the assessment structure and timescale , the name and profession of all clinicians , and possible question areas . this should help ease parent 's anxiety and ensure that scarce appointments achieve maximum benefit . the initial page should contain a standardised format with the outcome clearly stated , the individuals and professional roles of those involved , and the date of the diagnosis . although , most parents were happy with the assessment service , satisfaction could be increased by providing more information about the assessment as well as the condition . it is important to actively involve parents in the sessions , allowing them to build a trusting relationship with the health professionals involved as children may need support from the team for many years . giving each family the time to discuss their concerns will also help tailor individual needs and further increase parental satisfaction . the fact that parents are considerably more likely to have a second child with asds emphasises the importance of engaging families . the study was fed back to scait , and standardized letters and workshop information sheets have already been implemented . furthermore , the team will complete the audit loop by undertaking the audit again in 18 months time . this study has provided a key opportunity to offer a value - added service with service - user feedback .