Using Evidence-Based Diagnostic Practices to Identify Autism Spectrum Disorders in Youth Served in Community Mental Health Settings

Background: School-aged children with autism spectrum disorders (ASD) are increasingly served by the community mental health (CMH) system given their high rates of co-occurring psychiatric problems (e.g., anxiety, mood, attention, disruptive behaviors). The CMH system may also help to identify ASD in school-aged, higher functioning children with diagnostically complex presentations. However, research suggests that a significant number of clinicians in community-based settings do not use best diagnostic practices to assign an initial ASD diagnosis (Wiggins et al., 2006; Williams et al., 2009). Due to the clinical complexity of these children, limited training in or use of evidence-based diagnostic practices by CMH providers, and the significant proportion of these youth from minority or non-English speaking families, identifying children with ASD in CMH settings is challenging (Mandell et al., 2002).  Limited research therefore exists on the feasibility of identifying ASD using evidence-based diagnostic practices and the characteristics of children referred for ASD assessment in CMH settings.   

Objectives: This study’s aims were to: 1) examine the characteristics of children served in a CMH clinic who received an ASD assessment from providers trained to use the Autism Diagnostic Observation Schedule (ADOS) and 2) identify the clinical characteristics associated with receiving a final ASD diagnosis in this setting. 

Methods: Data were extracted from CMH clinical records (psychodiagnostic reports). CMH clinicians from three affiliated clinics referred children receiving services (therapy or therapy plus medication management) who were suspected of ASD based on results from screening measures and clinical judgment. Eighteen CMH clinical psychologists and psychology trainees were trained by an experienced and certified ADOS trainer and conducted ASD assessments. The ASD assessments included gathering developmental history, reviewing prior psychological testing and IEP assessments, administering the ADOS (and cognitive assessments for some children), and integrating information to determine diagnosis.         

Results: A total of 62 children were referred for ASD assessment. Children were an average of 10.69 years old (SD = 3.48; range: 5-18 years) and 76% male. They were 42% Latino/Hispanic, 33% Caucasian, 12% African American, 8% Asian/Pacific Islander, and 5% Multiracial. Those referred had an average of 1.79 non-ASD diagnoses (range: 0-5; anxiety, mood, and ADHD disorders were most common) and 48% had two or more comorbid diagnoses. Approximately 70% (n=43) received scores that fell within the ASD or Autism categories on the ADOS. Approximately 56% (n=35) of the sample was assigned an ASD diagnosis by the CMH examiner, primarily Asperger’s Disorder (n=10) and PDD-NOS (n=12). Factors associated with receiving an ASD diagnosis, including provider and child clinical characteristics, will be discussed. 

Conclusions: The clinical and age characteristics of the children who received an ASD diagnosis after an ASD assessment are consistent with research conducted in similar CMH settings. These data underscore the need for further targeted ASD screening efforts in CMH setting, especially with higher functioning children with comorbid  psychiatric conditions. Findings illustrate the feasibility and utility of efforts to implement evidence-based ASD screening and diagnostic practices in CMH settings with relatively minimal extra costs.