A Model for Expanding Community-Based Autism Assessment Services

Background: In Canada, a scarcity of developmental pediatricians and limited funding for multidisciplinary assessments has resulted in long delays for these assessments. In the province of Ontario, communities such as York Region have long suffered from a lack of resources to assess preschool children suspected of having an Autism Spectrum Disorder.  As a result, many families rely on assessments that are variable in terms of adherence to best practices. The Canadian Best Practice Guidelines (Miriam Foundation, 2008) recommend that diagnostic assessments be conducted by an interdisciplinary team when possible. Further, the Guidelines suggest that the assessment include a full medical examination, administration of the ADOS and reference to DSM IV criteria.  In many underserviced communities, children have been assessed by a variety of professionals using suboptimal or non-standardized assessment tools.  These diagnostic limitations leave families faced with the possibility of an inaccurate diagnosis or a delay in diagnosis and treatment until an interdisciplinary assessment can be carried out.

Objectives: To demonstrate that an interdisciplinary model involving Speech-Language Pathologists and General Pediatricians can provide high quality preschool autism assessments thereby reducing wait times for assessment.  Methods: The Children’s Treatment Network of York and Simcoe has recently developed an innovative, collaborative model for assessment of children suspected of having ASD.  Select Speech-Language Pathologists have been trained to reliably administer the ADOS to preschool children.  General Pediatricians are able to incorporate information obtained from community partners, the results of the ADOS assessments, and their own clinical opinion when making a diagnosis of ASD. In ambiguous or complex cases, children can receive further assessment by a developmental pediatrician and/or other disciplines. Throughout the process, a Developmental Pediatrician is available to mentor and assist various team members. Children in York can now receive a diagnosis based on a standardized observational assessment with contributions from several members of the interdisciplinary team.

Results: Between September 1, 2007 and August 30, 2008, 54 children were assessed through the expanded service.  Of those, 83% received a diagnosis of ASD (n=45).  These children were an average of 38 months of age at the time of assessment (range:  23 months - 58 months).  The average wait time for the assessment was 5 months.  Previous to this expansion, children were waiting approximately 12 months for assessments. 

Conclusions: Interdisciplinary teams utilizing ADOS-trained Speech-Language Pathologists and General Pediatricians can expand existing ASD assessment services and reduce wait times and average age of diagnosis for families. These teams need to be closely supported by Developmental Pediatricians and other professionals, such as Occupational Therapists and Social Workers.  We have shown that the use of General Pediatricians integrated into an interdisciplinary model, reduced the waiting for assessment by 60%  This novel approach  adheres to best practice guidelines and can be implemented in other communities where access to developmental assessment services is limited.