Enhancing Local Diagnostic Capacity:

The Autism InitiativeNicky Jones-Stokreef, MD, FRCPCCTN and Orillia Soldier’s Memorial Hospital

Amber Bartlett, M.Sc., S-LPSimcoe County Preschool Speech and Language

Services

SYMPOSIUM 2008

Outline

Justification for new model Description of Simcoe County model ADOS: description and video clips Physician and Parent Feedback Outcomes Next steps Take Home Message

Prevalence of ASD

American CDC: 4.5 – 9.9/1000 8 yr olds (2000)

Manitoba and PEI: 3.8-4.1/1000 5-9 yr olds (2002)

Montreal School Board: 6.7/1000 8 yr olds (2003)

Population of children 0-9 2006 Census: Simcoe County

11.3 % of population (422,204)Barrie: 17,200Orillia: 3,080

2862 is the number of children 0-9 years predicted to have ASD in Simcoe County

Report of the Senate Standing Committee on Social Affairs, Science and Technology, 2007

Pay Now or Pay Later: The Final Report on the Enquiry on the Funding for the Treatment of Autism_______________________________

Significant wait times for diagnosis a problem

Shortage of well trained professionals contributes to wait times

National Autism Strategy

Motion M-172 adopted by parliament Dec 5, 2006 ASD is a critical issue Develop a national strategy

                                    

Diagnosis of ASD

Early ID is crucial to the success of early intervention

Children can be identified with signs of ASD by the time that they are 18 to 36 months of age

Simcoe County Preschool ASD Diagnosis Initiative

Children’s Treatment NetworkPaediatricians of Simcoe

CountySimcoe County Preschool

Speech and Language Program

Description of Model

Refer for diagnostic assessment Components of Diagnosis

Community S-LP Assessment ADOS assessment by trained S-LPs General paediatric consultation Developmental paediatric back up

Description of Model

Innovative Collaborative Use of local resources Enhancing partnerships Ongoing education Multiple access points

Partnerships

Our partnerships have included: Primary care physicians Paediatricians Early Intervention services Psychology Behavioral Services Autism Ontario

Red Flags awareness campaign Next Steps document

Red Flags Diminished, atypical, or no babbling or

gesturing by 12 months Lack of response to name by 12 months No single words by 16 months Diminished atypical or no 2 word spont

phrases by 24 months Loss of language or social skill at any age Lack of joint attention www.autismspeaks.org/video/glossary.php

Role of Community S-LP

Prioritize Language assessment Eligibility for ADOS Participate in further assessment

and follow up

Role of Community Team Members

Invited to attend ADOS Attend the paediatrician

appointment Follow up and intervention

Role of ADOS Trained S-LPs

Coordination of Assessment process

Administering and scoring ADOS Reporting to general paediatrician Linking with community S-LP

Role of Developmental Paediatrician

Ongoing education of S-LPs and paediatricians

Reviews ADOS tapes to ensure reliability of results

Provides further consultation in ambiguous cases

Role of General Paediatrician

Developmental history Physical examination Integrates ADOS results with their clinical

opinion/assessment and information from other community team members

Provides a diagnosis if appropriate Investigations and next steps Follow up

Standardized Assessment: ADOS In our model Modules 1 and 2 are being

administered by the 5 validating S-LPs The ADOS is a standardized tool which

entails: Setting a social scene that is minimally

supported Social presses Communicative temptations Observing social initiations, play and atypical

behaviours

Standardized Assessment: ADOS

Highly specific and sensitive Correctly identifies 95% of those

with Autism Correctly identifies 92% not in the

Autism Spectrum Maps onto DSM IV TR criteria

Video Clips

Feedback from paediatricians

Most feel comfortable with preschool ASD diagnosis, most of the time

Know where to refer if unsure Use community information

Feedback from parents

Most referred for diagnosis by EI Services (7/11)

All families waited 4 months or less Majority satisfied with S-LP All families seen by paediatrician

within 5 weeks of ADOS

Feedback from parents Paediatrician follow up appointment

All felt appointment was thorough Most felt the diagnosis was clear Most were provided with adequate info

on where to go/what to next All were all offered second appointments All received a letter or report of diagnosis

Outcome 42 children seen for ADOS since Sept 07 Most are diagnosed with ASD All are hooked up with appropriate EI

services and paediatrician Inconsistencies remain in process and

investigations 3 families required referral to

developmental paediatrician

Further feedback from families Statistics Practice Guideline Educational seminar for general

paediatricians Link with psychology assessment How to further increase capacity:

increasing demand continues

Next Steps

Take Home Message Enhancing Diagnostic Capacity

Build on available local resources Improve collaboration and communication Targeted education Evidence based practice Quality control

If you have concerns regarding Red Flags for ASD please talk to your team members and refer for an S-LP assessment