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ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

The number of UK children seen with complex behaviour difficulties where there is a history of exposure to alcohol and/or drugs prenatally appears to be increasing at an alarming rate. Community paediatricians work with vulnerable children and also act as medical advisers to adoption panels, so they have a unique overview of the unmet needs of looked after children affected by Foetal Alcohol Spectrum Disorders (FASD). This article reports on two simple audits of children seen in a community paediatric clinic setting. The first audit counted the number of children seen during a period of two-and-a-half years between April 2010 and August 2013, where there was a clear prenatal history of alcohol exposure. This audit also specifically looked at how many of these children might have Foetal Alcohol Syndrome (FAS) or FASD. Seventy-two children were given such a diagnosis within the time frame. The second audit reported on children looked after and children put forward for adoption during a 12-month period from January 2013 to December 2013. It reported a history of prenatal exposure in 55 out of 160 health assessments for looked after children (34%) and in 34 out of 45 medicals for adoption (75%).

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Objectives of the Study1. To assess the level of death anxiety among elderly people. 2. To associate the level of death anxiety with the selected demographic variables. Hypothesis H1: There will be significant level of death anxiety among elderly people. H2: There is significant association between levels of death with the selected demographic variables of the elderly people.