Coroner concern after 'no formal autism diagnosis'

A coroner has raised concerns that a five-year-old boy who died of severe dehydration was not referred to dieticians with experience of autism, nor given a formal diagnosis for the condition.

Joshua Lee Allcock, who had complex medical needs including a food intake disorder died on 3 January 2023.

Senior Black Country coroner Zafar Siddique said the boy would only drink milk, had a limited diet and foster parents were presented "with inadequate information".

Walsall Council, which initiated care proceedings and is among those addressed by the coroner in his prevention of future deaths report, has been invited by the BBC to comment.

In his report, Siddique said Joshua died from severe dehydration due to limited fluid intake, which was exacerbated by his conditions of autism and avoidant restrictive food intake disorder (ARFID).

According to eating disorder charity Beat, ARFID is a condition characterised by avoiding certain foods or types of food, having restricted intake in terms of the overall amount eaten, or both.

The boy had suspected autism "although this was never formally diagnosed", the coroner said.

He added the child was placed into the care of foster parents on 21 December 2022 following a risk assessment by Walsall local authority and care proceedings.

Siddique said the foster carers were presented with "inadequate information about his dietary needs and were encouraged to try different foods and liquids including fruit juice".

Joshua was "reluctant to eat and drink these alternatives" and still drank milk, the coroner stated.

By 29 December, he was readmitted to Walsall Manor Hospital and was severely dehydrated, his condition declined rapidly and he was transferred to Birmingham Children's Hospital, Siddique said.

In his concerns, the coroner stated without "a formal diagnosis of autism being made, there was no onward referral to dieticians with experience of autism" and therefore an understanding of the link between autism and ARFID.

He said "there appears to be nationally a variation in practice before an assessment for autism can be made".

Siddique added he heard expert evidence that "Joshua's death wasn't an isolated incident and another autistic child died in very similar circumstances by developing dehydration".

The coroner, who gave a narrative verdict at the inquest in December 2025, issued his report to the chief executives of Walsall Healthcare NHS Trust and the council, the Birchills Health Centre practice manager and NHS England.

He said the agencies involved in Joshua's care "may wish to consider reviewing your guidance and approach for assessing children with complex medical needs of autism and ARFID".

"In my opinion, action should be taken to prevent future deaths and I believe your organisation has the power to take such action."

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