Enhanced Screening Methods Increase Percentage of Children with ASD Diagnosed in a Clinical Setting
Current guidelines from the Academy of Pediatrics (2010) recommend that children suspected of having Autism Spectrum Disorders (ASD) should receive a comprehensive evaluation. As one of the only specialty clinics in our state, and one that serves a diverse and often economically disadvantaged population, our clinic is faced with high demand for diagnostic assessments. Historically, all children referred for an autism evaluation received a full psychological assessment in our clinic, which led to very long waiting lists. In 2012, 896 children were referred for diagnostic assessment, and 299 of these were evaluated during a one year period. Of those children, only 53% were found to meet DSM Criteria for ASD. Given this high rate of children who did not have ASD, significant changes were made in 2013/2014 to our screening and triage efforts, with the goal of focusing our diagnostic assessment appointments on children who were most in need of diagnostic assessment, specifically to assess for ASD.
The present study examines whether specific methods of triage and screening helped to reserve diagnostic testing appointments for children with symptoms specific to ASD. More specifically, it examines the utility of reviewing records and conducting a comprehensive diagnostic interview prior to full evaluation.
During 2013/2014, we added new procedures to our intake process. First, we began to request records (e.g. school IEP’s, previous testing, pediatrician’s notes and rating scales) at the beginning of the process. Records were reviewed by a clinical intake team that determined whether the child showed symptoms indicative of ASD. Children whose records indicated that an evaluation was warranted were scheduled for a diagnostic interview. A full assessment (i.e., cognitive/development measure, adaptive measure, and ADOS-II) was scheduled after the interview only when clinically indicated.
In the year subsequent to the intake changes (October 2014 to October 2015), 2,346 referrals were reviewed by the team. Based on the review of records, 860 children were referred out to community providers or referred straight to treatment programs in the center, rather than being scheduled for an assessment. Of the remaining children, 920 received a diagnostic interview and 632 (69%) of these were brought back for a full testing battery. Of those receiving full diagnostic assessments, 68% met diagnostic criteria for autism spectrum disorder.
Utilizing an initial record review and diagnostic interview enabled the clinic to refer out a full 1061 children (45% of the initial referrals) to more appropriate services. Of the children who were scheduled into full diagnostic assessment appointments, 68% met criteria for ASD, as compared to the 53% who met criteria previous to the enhanced intake efforts. These procedures have refined our ability to identify children who are showing red flags for ASD and helped to reserve lengthy testing appointments for children most in need. As the need for autism assessment and treatment planning rises across the globe, this work furthers the goal of finding ways to efficiently and accurately identify children with ASD so that important intervention efforts can begin as soon as possible.