THE ROLE OF SCREENING TOOLS IN INITIAL DIAGNOSIS

NZPsS CONFERENCE August 2009

Marian PowerConsultant Psychologist

Australian Council for Educational Research

FEATURES OF SCREENING TOOLS

Purpose – indicator for further

investigation

Response format

Standardisation

Administration time

Scoring

SCREENERS ACROSS THE LIFESPAN

Early Childhood – ADEC

Childhood and Adolescence – CAPP

Adults – APP

Elderly – NUCOG

ADECAUTISM DETECTION IN EARLY CHILDHOOD

PurposeTo screen for autistic tendencies in young children

Candidates12 months–3 years of age

Administration10–15 minutes

ComponentsScoring sheet, Manual, Training DVD

ADEC BEHAVIOURS

►Nestling into caregiver

►Response to name

►Upset when line of blocks is disturbed

►Gaze switching (tiger or car)

►Eye contact in game

►Functional play (toy telephone or car)

►Reciprocity of a smile

►Pretend play

ADEC BEHAVIOURS

►Gaze monitoring – follows point

► Imitation

►Responds to verbal command

►Demonstrates use of words

►Anticipatory posture to be picked up

►Use of Gestures: wave/blow kiss

►Ability to switch to new task

►Response to everyday sounds

SCORING THE ADEC A score of 0, 1, or 2 is assigned to the

presence or absence of each of the 16 behaviours.

The aggregate score is compared to normed cut-off scores that suggest:

Low risk (no further action)

Moderate risk (review child)

High risk (further testing required) Very high risk (formal autism assessment

strongly recommended)

IMPORTANCE OF EARLY DETECTION

Prior to the ADEC, children with autistic disorders could not be easily identified until they were three or four years of age.

This is a serious issue because research indicates children with autism are more responsive to early interventions before difficult behaviours become entrenched.

Early diagnosis can lead to significantly better quality of life and developmental outcomes, with subsequent major savings in health care costs estimated to be between $4.5 and $7.2 million annually in Australia alone.

WHAT HAPPENS WHEN THE ADEC SUGGESTS THE PRESENCE OF AD?

Why do you need a diagnosis? services support intervention

What next? Author argues that the core-deficit linked

behaviours should be the target of intervention to minimise the emergence of traditional autistic behaviours.

Dr Young has written SPECTRA, an intervention program

http://shop.acer.edu.au/acer-shop/group/SPEC

Developed in Australia by Dr Shane Langsford

(University of Western Australia), Professor

Stephen Houghton and Dr Graham Douglas.

Oriented to the DSM-IV-TR, PsychProfiler

provides an accessible and affordable

screener that can be used in the early

identification of disorders prior to formal

diagnosis.

Candidates2–17 years of age

Administration10–15 minutes per form

Components3 Screening Forms:

Self – 111 itemsParent – 111 itemsTeacher – 91 items

Screens for20 disorders

Child and Adolescent PsychProfiler (CAPP)

Candidates18+ years of age

Administration25 minutes per form

Components2 Screening Forms:

Self – 190 itemsObserver – 190 items

Screens for23 disorders

Adult PsychProfiler (APP)

Generalised anxiety disorder Obsessive-compulsive disorder Panic disorder*

Post-traumatic stress disorder Separation anxiety disorder^

Specific phobia*

Attention-deficit/hyperactivity disorder Conduct disorder Oppositional defiant disorder Expressive language disorder Motor and vocal tic disorder Tourette’s disorder

SCREENS FOR:

* Not included in CAPP^ Not included in APP

SCREENS FOR:

Phonological disorderDysthymic disorderMajor depressive disorder*

Anorexia nervosaBulimia nervosa Disorder of written expressionAntisocial personality disorder*

Asperger’s disorderAutistic disorderMixed receptive-expressive language disorderMathematics disorderReading disorder

* Not included in CAPP

Increased early identification and intervention

Improved identification of disorders

Improved referral practices

Better assessment of outcomes

Improved accessibility to assessment services

A more objective and reliable tool

Increased efficiency of clinical practice

Assistance with Differential Diagnosis

Improved communication of sensitive issues

BENEFITS OF THE PsychProfiler INCLUDE:

Psychologists Psychiatrists General Practitioners Paediatricians Special Needs Teachers Speech Pathologists School Counsellors Chiropractors Mental Health Nurses

CURRENTLY USED BY:

Gathering Data

Paper-and-pencil Forms; or

Direct input into software

Scoring and Reporting

Software – ‘unlimited’ reports

USER OPTIONS

All items on the CAPP and APP require

responses to be made on a six-point

ordered scale pertaining to the

perceived frequency of the behaviour:

SCORING THE PsychProfiler

Never

Rarely

Sometimes

Regularly

Often

Very Often

The summation of the items within

each disorder produces a screening

score for that disorder. If the

screening score meets or exceeds

the screening cut-off score, the

individual is designated as a positive

screen.

SCORING THE PsychProfiler

Free Trial Version of CAPP / APP

is available from:

www.acer.edu.au/psychprofiler/

(Limited to 5 reports each)

NUCOGNEUROPSYCHIATRY UNIT COGNITIVE ASSESSMENT TOOL

Brief neurocognitive screening tool

Assesses five major cognitive domains: attention, memory, language, executive and visuospatial functions

Used to screen for neurocognitive functioning, aid diagnosis and intervention

AUTHORS

Mark Walterfang Consultant Neuropsychiatrist, Royal Melbourne Hospital

Dennis Velakoulis Director of Neuropsychiatry, Royal Melbourne Hospital

FEATURES

Global assessment, assesses domains of cognition (has breadth and depth)

Sensitive to presence of illness and change Paper and pencil format; brief, portable and

minimal materials required 15 minutes to administer, easy to perform Clear guidelines for administering and scoring Scores can be put online, made available on

PDA Test can be administered by non-medical or

non-clinical personnel Tool has strong reliability, validated against

other instruments (e.g. MMSE)

NUCOG COMPONENTS

Manual

Interview Schedule

Subject Completion Sheet

MULTIDIMENSIONALITY

Five domains of function (each score /20) Attention Memory Visuoconstructional Executive Language

Multiple items in each domain

SENSITIVITY AND SPECIFICITY: DEMENTIA VS NON-DEMENTIA

NUCOG 80 / 100 Sensitivity: 0.88 Specificity: 0.84

MMSE 24 / 27 Sensitivity: 0.72 / 0.86 Specificity: 0.92 / 0.78

LEGEND

A Total – Attention

B Total – Visuoconstructional

C Total – Memory

D Total – Executive

E Total – Language

81-year-old Global cognitive

impairment CT - vascular

pathology Perseveration

CASE 1

61-year-old man Memory problems Dx early AD

CASE 2

NUCOG = 77

45-year-old man FHx-FTD ‘Depression’

CASE 3

NUCOG = 82.5

MMSE = 30

55-year-old female professional

Independent ?depressed since

divorce ‘memory problems’ Sick leave, running

farm Driving Dx – Alzheimers

disease

CASE 4

Marian PowerCONSULTANT PSYCHOLOGIST

Phone +61 3 9277 5411

Email power@acer.edu.au

www.acerpsychology.com.au

Australian Council for Educational Research