Characteristics of Children Referred for Evaluation of Autism Spectrum Disorders In a Community-Based Mental Health Setting

Background: The community mental health (CMH) system significantly contributes to providing care for children with ASD given their high rates of co-occurring psychiatric problems (e.g., anxiety, mood, attention, disruptive behaviors). This system may also contribute to identifying ASD, particularly for school-age, high functioning children who may be more diagnostically complex. Recent research (Brookman-Frazee et al., 2010; Joshi et al., 2010) indicates that a significant minority of children in these settings have ASD and are older with higher functioning diagnoses (Asperger’s Disorder; PDD-NOS) and significant diagnostic comorbidity. Identification of children with ASD in CMH settings is difficult due to their clinical complexity, therapists’ limited training in evidence-based screening and diagnostic practices, and the high proportion of youth from minority or non-English speaking families (Mandell et al., 2002).  Limited research has examined the feasibility of identifying ASD using evidence-based diagnostic practices in CMH settings and the characteristics of children suspected of ASD. 

Objectives: This study’s aim was to examine the characteristics of children served in CMH settings who are referred for and receive evidence-based ASD assessment. This type of research is consistent with the goals of the 2010 Interagency Autism Coordinating Committee “Strategic Plan for ASD Research” which emphasizes the need for research in ASD assessment and diagnosis with emphasis on community settings and school-age children and adolescents.

Methods: Data were extracted from CMH data (clinical evaluation reports). Eight CMH providers (psychologists; pre-doctoral psychology interns) were trained by a certified ADOS trainer. CMH providers referred children receiving CMH services (therapy or therapy/ medication management) who were suspected of an ASD based on clinician report and scores on screening measures. Trained providers administered the ADOS, gathered developmental history, and integrated information to determine diagnosis.    

Results: Nineteen children were referred for ASD assessment. Children were an average of 12.05 years (SD = 3.41; range: 6-17 years) and 58% male. They were 47% Caucasian, 47% Latino/Hispanic, and 5% African American. Those referred had an average of two non-ASD diagnoses (range: 1-4) (anxiety, mood, disruptive behavior, and ADHD disorders were most common) and 58% had two or more comorbid diagnoses. Approximately 53% (n=10) fell within the ASD or Autism categories on the ADOS, and of this subset, 70% (n=7) were ultimately diagnosed with an ASD. Of those receiving an ASD diagnosis, 72% had at least two co-occurring non-ASD diagnoses, 71% received diagnoses of Asperger’s Disorder or PDD-NOS, and most were Average to Low Average in cognitive functioning.  

Conclusions: Children referred for ASD evaluation in this CMH setting were an average age of 12 years, diagnostically complex with the majority having at least two co-occurring disorders, and nearly half were Latino/Hispanic. Approximately 37% received a final diagnosis of ASD and these children were generally higher functioning (average cognitive functioning and diagnoses of Asperger’s Disorder). The clinical and age characteristics of these children are consistent with research conducted in similar service settings. These data underscore the need for increased targeted ASD screening efforts, especially towards those who are higher functioning and have overlapping or comorbid problems.