Lyndsay Quarmby

Diagnostic evaluation for autism spectrum disorder: a survey of health professionals in Australia

Objectives There is currently no agreed Australian standard for the diagnosis of autism spectrum disorder (ASD) even though there are specific diagnostic services available. We suspected inconsistency in the diagnostic practices of health professionals in Australia and aimed to assess these practices across the nation by surveying all relevant professional groups. Design In this study, we completed a survey of 173 health professionals whose clinical practice includes participating in the diagnostic process for ASD in Australia. Participants completed an online questionnaire which included questions about their diagnostic setting, diagnostic practice and diagnostic outcomes in 2014–2015. Participants Participants covered a range of disciplines including paediatrics, psychiatry, psychology, speech pathology and occupational therapy. All states and territories of Australia were represented. Setting Participants came from a range of service settings which included hospitals, non-governmental organisations, publicly funded diagnostic services and private practice. Results There was variability in diagnostic practices for ASD in Australia. While some clinicians work within a multidisciplinary assessment team, others practice independently and rarely collaborate with other clinicians to make a diagnostic decision. Only half of the respondents reported that they include a standardised objective assessment tool such as the Autism Diagnostic Observation Schedule in ASD assessments, and one-third indicated that they do not include measures of development, cognition and language in assessments where ASD is suspected. Conclusions Reported practice of some professionals in Australia may not be consistent with international best practice guidelines for ASD diagnosis. These findings highlight the need for a minimum national standard for ASD diagnosis throughout Australia that ensures best practice regardless of the type of setting in which the service is provided.

Supports and barriers to implementation of routine clinical assessment for children with cerebral palsy: A mixed-methods study

Abstract Purpose: The purpose of this study is to investigate supports and barriers to evidence-based routine clinical assessment of children with cerebral palsy. Method: This mixed methods study included physiotherapists, occupational therapists and speech pathologists providing services to children with cerebral palsy (3–18 years) within five organizations across Australia. Four organizations initiated standardized routine clinical data collection (Commencing organizations), and one had previously mandated routine assessment (Comparison organization). Participants completed the Supports and Barriers Questionnaire (n = 227) and participated in focus groups (n = 8 groups, 37 participants). Quantitative data were summarized descriptively, qualitative data were analyzed thematically and comparisons between organizations assessed. Results: Organizational structures, resources, therapists within organizations, assessment tools, and children and families were, on average, viewed as supportive of routine clinical assessment. There were no differences between the Comparison and Commencing organizations except ‘therapists within the organization’ were viewed as more supportive by the Commencing organizations (p = 0.037). Five themes were derived from qualitative analyzes: motivation to adopt routine clinical assessment; acquiring and utilizing expertise; ensuring effective ongoing communication; availability and distribution of resources; and therapist perceptions of child and family wishes. Conclusions: Organizations experience challenges to effective and sustained implementation of routine clinical assessment. Adequate resourcing and positive, clear communication were perceived as critical for success. Implications for Rehabilitation The value of routine clinical assessment of children with cerebral palsy is undisputed. Tailored solutions to organization-specific challenges are required when implementing routine clinical assessment for children with cerebral palsy. Positive, clear communication of organizational priorities by management may assist AHPs to prioritize workload activities when changing practice.

Brief report: An exploratory study of the diagnostic reliability for Autism Spectrum Disorder

Previous research shows inconsistency in clinician-assigned diagnoses of Autism Spectrum Disorder (ASD). We conducted an exploratory study that examined the concordance of diagnoses between a multidisciplinary assessment team and a range of independent clinicians throughout Australia. Nine video-taped Autism Diagnostic Observation Schedule (ADOS) assessments were collected from two Australian sites. Twenty-seven Australian health professionals each observed two video-recordings and rated the degree to which the individual met the DSM-5 criteria for ASD. There was 100% agreement on the diagnostic classification for only 3 of the 9 video clips (33%), with the remaining 6 clips (66%) reaching poor reliability. In addition, only 24% of the participating clinicians achieved ‘good’ or ‘excellent’ levels of agreement (Cohen’s kappa > 0.6) with the original ASD assessment. These findings have implications for clinical guidelines for ASD assessments.

A pilot study of social inclusion and quality of life for parents of children with autism spectrum disorder

ABSTRACT Background Access to both childcare and early intervention for pre-school children with autism spectrum disorder (ASD) can be difficult for parents or carers and may impact on parental social inclusion and wellbeing. There is limited research investigating how specialist centres offering both services may impact on parental outcomes. Method Parents whose children were attending such a specialised childcare setting in two states in Australia (Tasmania and South Australia) were invited to participate in a mixed-methods study investigating quality of life (Qol), social inclusion and perceptions of the centres. Results Parents had typically low levels of QoL but reported a range of benefits from receiving services, including increased levels of community participation and increased competence and confidence in themselves as parents. Conclusions Childcare centres offering specialist multi-disciplinary early intervention and parental support are valued by parents and assist with social inclusion.