Transcript Autism Diagnosis in Preschool Children

Enhancing
Local Diagnostic Capacity:
The Autism Initiative
Nicky Jones-Stokreef, MD, FRCPC
CTN and Orillia Soldier’s Memorial Hospital
Amber Bartlett, M.Sc., S-LP
Simcoe County Preschool Speech and Language
Services
SYMPOSIUM 2008
Outline
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Justification for new model
Description of Simcoe County model
ADOS: description and video clips
Physician and Parent Feedback
Outcomes
Next steps
Take Home Message
Prevalence of ASD
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American CDC: 4.5 – 9.9/1000 8 yr olds
(2000)
Manitoba and PEI: 3.8-4.1/1000 5-9 yr
olds (2002)
Montreal School Board: 6.7/1000 8 yr
olds (2003)
Population of children 0-9
2006 Census: Simcoe County
11.3 % of population (422,204)
Barrie: 17,200
Orillia: 3,080
2862 is the number of children 0-9 years
predicted to have ASD in Simcoe County
Report of the Senate Standing Committee on Social
Affairs, Science and Technology, 2007
Pay Now or Pay Later:
The Final Report on the Enquiry on
the Funding for the Treatment of Autism
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Significant wait times for diagnosis a
problem
Shortage of well trained professionals
contributes to wait times
National Autism Strategy
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Motion M-172 adopted by parliament
Dec 5, 2006
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ASD is a critical issue
Develop a national strategy
Diagnosis of ASD
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Early ID is crucial to the success of
early intervention
Children can be identified with signs of
ASD by the time that they are 18 to 36
months of age
Simcoe County Preschool
ASD Diagnosis Initiative
Children’s Treatment Network
Paediatricians of Simcoe County
Simcoe County Preschool Speech
and Language Program
Description of Model
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Refer for diagnostic assessment
Components of Diagnosis
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Community S-LP Assessment
ADOS assessment by trained S-LPs
General paediatric consultation
Developmental paediatric back up
Description of Model
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Innovative
Collaborative
Use of local resources
Enhancing partnerships
Ongoing education
Multiple access points
Partnerships
Our partnerships have included:
 Primary care physicians
 Paediatricians
 Early Intervention services
 Psychology
 Behavioral Services
 Autism Ontario
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Red Flags awareness campaign
Next Steps document
Red Flags
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Diminished, atypical, or no babbling or
gesturing by 12 months
Lack of response to name by 12 months
No single words by 16 months
Diminished atypical or no 2 word spont
phrases by 24 months
Loss of language or social skill at any age
Lack of joint attention
www.autismspeaks.org/video/glossary.php
Role of Community S-LP
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Prioritize
Language assessment
Eligibility for ADOS
Participate in further assessment and
follow up
Role of Community Team
Members
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Invited to attend ADOS
Attend the paediatrician appointment
Follow up and intervention
Role of ADOS Trained S-LPs
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Coordination of Assessment process
Administering and scoring ADOS
Reporting to general paediatrician
Linking with community S-LP
Role of Developmental
Paediatrician
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Ongoing education of S-LPs and
paediatricians
Reviews ADOS tapes to ensure
reliability of results
Provides further consultation in
ambiguous cases
Role of General Paediatrician
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Developmental history
Physical examination
Integrates ADOS results with their clinical
opinion/assessment and information from
other community team members
Provides a diagnosis if appropriate
Investigations and next steps
Follow up
Standardized Assessment:
ADOS
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In our model Modules 1 and 2 are being
administered by the 5 validating S-LPs
The ADOS is a standardized tool which
entails:
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Setting a social scene that is minimally supported
Social presses
Communicative temptations
Observing social initiations, play and atypical
behaviours
Standardized Assessment:
ADOS
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Highly specific and sensitive
Correctly identifies 95% of those with
Autism
Correctly identifies 92% not in the
Autism Spectrum
Maps onto DSM IV TR criteria
Video Clips
Feedback from paediatricians
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Most feel comfortable with preschool
ASD diagnosis, most of the time
Know where to refer if unsure
Use community information
Feedback from parents
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Most referred for diagnosis by EI
Services (7/11)
All families waited 4 months or less
Majority satisfied with S-LP
All families seen by paediatrician within
5 weeks of ADOS
Feedback from parents
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Paediatrician follow up appointment
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All felt appointment was thorough
Most felt the diagnosis was clear
Most were provided with adequate info on
where to go/what to next
All were all offered second appointments
All received a letter or report of diagnosis
Outcome
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42 children seen for ADOS since Sept 07
Most are diagnosed with ASD
All are hooked up with appropriate EI services
and paediatrician
Inconsistencies remain in process and
investigations
3 families required referral to developmental
paediatrician
Next Steps
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Further feedback from families
Statistics
Practice Guideline
Educational seminar for general
paediatricians
Link with psychology assessment
How to further increase capacity:
increasing demand continues
Take Home Message
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Enhancing Diagnostic Capacity
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Build on available local resources
Improve collaboration and communication
Targeted education
Evidence based practice
Quality control
If you have concerns regarding Red Flags for
ASD please talk to your team members and
refer for an S-LP assessment