International Meeting for Autism Research: How Are Diagnostic Tools Used In Clinical Practice? Evidence From a Nationwide Survey of Children's Diagnostic Services In Wales, UK

How Are Diagnostic Tools Used In Clinical Practice? Evidence From a Nationwide Survey of Children's Diagnostic Services In Wales, UK

Friday, May 13, 2011
Elizabeth Ballroom E-F and Lirenta Foyer Level 2 (Manchester Grand Hyatt)
1:00 PM
S. R. Leekam1,2, D. Wimpory3, J. Lidstone4, C. Ramsden4 and H. Morgan5, (1)Park Place, Cardiff University, Cardiff, United Kingdom, (2)Park Place, Cardiff University, Cardiff, Wales, (3)Psychology, Bangor University, Bangor, Gwynedd , Wales, (4)Psychology, Cardiff University, Cardiff, Wales, (5)Children's Health and Social Services Branch, Welsh Assembly Government, Cardiff, Wales
Background:  Standard diagnostic tools such as ADI-R, ADOS, DISCO and 3di are routinely used to screen research participants for inclusion in research studies. However when it comes to their clinical use in diagnosis, the scores on these instruments guide rather determine diagnostic decisions.

Objectives:   The objective of this research was to clarify the extent to which standardized diagnostic instruments contribute to the diagnostic process for clinicians diagnosing children with ASD.

Methods:   A questionnaire study was carried out, recruiting psychiatrists, paediatricians and clinical psychologists and other clinicians involved in diagnosing children with ASD throughout Wales, UK. There were 118 respondents (an estimated response rate of 57%). The content of the questionnaire study was informed by an initial qualitative focus group study. This dealt with issues related to clinicians' evaluation and use of clinical tools. For the questionnaire study, questions were asked about elements of assessment used in the diagnostic process and the use and perceived value of specific diagnostic tools.

Results:   Results showed that while observation and history taking were routinely used in clinical practice for virtually all cases, the four standardized diagnostic tools—ADOS, ADI-R, DISCO and 3di—were used by only 55% of respondents. Of these, the most extensively used, by 48% of the sample, was the ADOS. Of those who did use ADOS and ADI, 75-81% used the tool in its entirety and usually used the scoring system to complement their clinical judgement. Of those who had received training on the ADOS and ADI, only a very small proportion had followed up their training to qualify to a recognized standard of agreement (i.e., standards required for research use and/or in-house training of colleagues). Furthermore, some clinicians who have undertaken formal training on diagnostic tools use those tools in a minority of cases. For example, one third of clinicians who have attended ADI training use this tool in less than 50% of cases. There was evidence that clinicians highly valued the standardization and objectivity offered by all diagnostic tools. They also appreciated the evidence base of the tools and positive reactions of parents to them. Barriers to the use of the tools included time and other resources. However, qualitative data also strongly indicated that formal instruments should not be over-emphasized compared with professional clinical judgement and practice.

Conclusions:   Clinicians in Wales, UK, do not necessarily make use of standardized diagnostic tools to guide their clinical judgement when making a diagnosis of ASD. If this picture is common elsewhere in the UK or internationally, this has broader implications for research recruitment, international comparisons, and the development of a consistent conceptual understanding of ASD.

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