Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting
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ORIGINAL PAPER
Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting C. Bernie1,2,3 · K. Williams1,3,4,5 · B. O’Connor2 · S. Rogers2,6 · T. May4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services. Keywords Autism · Intake · Triage · Access · Diagnosis · Screening · Developmental delay Autism spectrum disorder (ASD) refers to a range of presentations in which social communication impairments and restricted interests or repetitive behaviours can adversely affect one’s social participation (American Psychiatric Association 2013). Challenges typically appear in early childhood, and deficits are frequently reported across a number of developmental areas (Daniels and Mandell 2014; Zablotsky et al. 2017; Ozonoff et al. 2008; Webb and Jones 2009). Despite ongoing investigations into genetic, biological, and environmental causes of autism, there are no consistent biomarkers that can substantiate the early presence of ASD in all affected children (Williams et al. 2014; Walsh et al. * C. Bernie [email protected] 1
Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3058, Victoria, Australia
2
Department of Allied Health, The Royal Children’s Hospital, Melbourne, VIC, Australia
3
Murdoch Children’s Research Institute, Melbourne, VIC, Australia
4
Department of Paediatrics, Monash University, Clayton, VIC, Australia
5
Department of Developmental Paediatrics, Monash Children’s Hospital, Clayton, VIC, Australia
6
Department of Health and Human Services, Melbourne, VIC, Australia
2011; Anderson 2015; Ratajczak 2011). There is also a large degree of heterogeneity and crossover with other developmental or behaviourally-defined disorders in the early years, which adds complexity for diagnosticians (Malvy et al. 2004; Mitchell et al. 2011; Trillingsgaard et al. 2005). These issues, coupled with recently-reported prevalence increases and a historical undersupply of neurodevelopmental assessment services, have prevented some individuals from accessing a diagnosis in a timely or satisfactory manner (May et al. 2017; Crais and Watson 2014; Taylor et al. 2016a; E
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