1122 A service evaluation of a tailored approach to diagnosis of children with possible autism. (17th August 2022)

• Record Type: Journal Article
• Authors: Male, Ian; Silverman, Toby; Foster, Lee; Silverman, Ruth; Wright, Paul; Elson, Naomi
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A83
• Page End: A84
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.133
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Introduction: Demand for autism diagnostic assessment has increased locally from 60 to over 200 children/year, between 2015 and 2019, mirroring our national data (Parr, Arch Dis Child, 2021) finding doubling of referrals over the same period. Resulting waiting times have increased from less than 6 months to 18 months, with over 300 children on our waiting list. Some children, particularly preschool, present with very obvious signs of autism, leading the likes of Whitehouse (CRC Australia, 2018), and Zwaigenbaum (Autism Research, 2021) to question why they mostly go through the same length of assessment as children with greater diagnostic complexity, e.g. comorbidity such as ADHD, or possible early developmental trauma. They further suggest such children may be suitable for a shorter 'tiered' or 'tailored' diagnostic approach. Locally we have introduced a 'tailored' pathway for children who at initial assessment (developmental history taken by an experienced paediatrician, and developmental play and social communication assessment by Specialist Early Years Practitioner (EYP) present with clear signs of autism. They subsequently undergo nursery observation by EYP or SALT, and SALT report scored against DSM 5 criteria is provided. Further information is gathered by liaison with others involved, e.g. Portage. This is followed by feedback session with paediatrician and EYPS, including updating developmental history. Objective: To evaluate the efficacy and acceptability of this approach. Methods: Data was collected (Oct 1st 2021 to Feb 2nd 2022) on children completing the 'tailored pathway' including demographics, information available, time taken from referral to diagnosis, diagnostic outcome, clinician confidence in outcome (Likert scale from very confident to very uncertain), and parental feedback on process. Results: 11 children (mean age at diagnosis 42+/- 11 months: 8/11 male) have completed the tailored assessment, out of a total of 55 completed assessments (20%) in same time period. Median time from triage clinic to diagnosis was 24 weeks (IQR 19-40wks) compared with 79 weeks (65-106wks) (Mann Whitney p0.00018). Information included SALT report (10/11), developmental play assessment (11/11), discussion/observation with educational setting (11/11), and developmental history (11/11). All 11 received a diagnosis of Autism. Members of diagnostic team scored 'very confident' for diagnostic outcome in all cases, whilst assessment addressed broader concerns such as language and global development, sleep and continence. Parental feedback was very positive, e.g. ' I'm surprised its happening so quickly-its been amazing and stress free' 'this very much reflects his needs' 'it helps that every service involved is seeing the same picture' Conclusion: Tailored, or tiered, diagnostic assessment, utilising good information gathering from services involved, the skills of EYPs in observation of social and play development, input from SALT, and history taking and diagnostic skills of an experienced paediatrician, can enable early and safe diagnosis of children with obvious signs of autism. Parents commented on appreciating the reduced time taken, and having confidence in the professionals involved. Whilst this does not provide a one size fits all solution and further research is needed, tailored diagnostic assessment does offer a potential aid to increasing capacity and meeting current levels of demand.