Transcript National-Conference-ASD-diag-2012

National Conference 2012
Education and Learning Directorate
Annual Conference 2012 for
Educational Psychologists in Scotland
The contribution of educational
psychologists to multi-agency assessment
and diagnosis of autism:
a national perspective
Shirley Paterson & Carolyn Brown
National Conference 2012
Education and Learning Directorate
Session Outline
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Current national context
Update re ASD diagnostic criteria
National data research
National research:key themes & outcomes
Development of Autism Identification &
Intervention Framework for EPS (NAIIF)
National Conference 2012
Education and Learning Directorate
UK context/national guidelines re
diagnosis
• NICE Guidelines (2011)
• SIGN Guidelines (2007)
• Scottish National Autism Strategy (2011)
National Conference 2012
Education and Learning Directorate
National Autism Strategy
ASD Diagnosis: recommendations
• Rec 19 diagnosis – guidelines for adults
• Rec 21 national waiting lists overview
• Rec 22 initiatives to address training issues re
diagnosis
• Rec 23 comparing diagnostic processes between
adults & children
• Rec 24 national directory of ASD diagnostic
teams
• Rec 25 update of quality diagnostic standard
National Conference 2012
Education and Learning Directorate
ASD diagnosis & ASD National
Reference Group
Oversees 6 Sub-groups:
• Achieving best value
• Cross agency collaboration
• Diagnosis, intervention & support
• Employability etc
• Research
• Users/carers
National Conference 2012
Education and Learning Directorate
National Autism Strategy
Ten indicators for best practice
• A multi-agency care pathway for assessment,
diagnosis & intervention to improve the
support for people with ASD & remove
barriers
• Services that can demonstrate that service
delivery is multi-agency in focus &
coordinated effectively to target meeting the
needs of people with ASD.
National Conference 2012
Education and Learning Directorate
Changing Diagnostic Framework –Revision of DSM
Diagnostic categories
DSM-IV
• Autism
• Asperger’s Syndrome
• Pervasive developmental
disorder not otherwise
specified (PDP-NOS)
Proposed DSM-V
• Autistic spectrum disorder
National Conference 2012
Education and Learning Directorate
A single diagnostic category – why?
Differentiating autism disorders has been
found to be inconsistent and variable over
time and contexts and often associated
more with severity, language level or
cognitive ability rather than features of the
autism disorder.
National Conference 2012
Education and Learning Directorate
Diagnostic domains
DSM-IV
• Qualitative impairment in
social interaction (at least
2/4)
• Qualitative impairments in
communication (at least 1/4)
• Restricted repetitive and
stereotyped patterns of
behaviour, interests and
activities (at least 1/4)
• Delays in at least 1 domain
pre-3
Proposed DSM-V
• Persistent deficits in social
communication and social
interaction across contexts
(3/3)
• Restricted, repetitive patterns
of behaviour, interests or
activities (2/4, including
hyper/hypo sensory
reactivity)
• Symptoms present in early
childhood
• Symptoms together limit and
impair everyday functioning
National Conference 2012
Education and Learning Directorate
Three diagnostic domains to two –
why?
• Deficits in social communication and social
behaviour seen as inseparable
• Delays in language not unique to or
universal in ASD – more something that
influences the presentation of symptoms
rather that defines diagnosis
• More demanding thresholds within 2
domains increases clarity and specificity
without reducing sensitivity
National Conference 2012
Education and Learning Directorate
Proposed revision adds dimension of
severity
• Level 1 – ‘requiring support’
• Level 2 – ‘requiring substantial support’
• Level 3 – ‘requiring very substantial support’
National Conference 2012
Education and Learning Directorate
Potential issues
• Will impact on clinical practice
• Concerns that diagnostic populations will
not match
• Loss of Asperger’s Syndrome as
diagnostic label – impact on existing
population
• Assessing severity
National Conference 2012
Education and Learning Directorate
Examples of EP involvement
South Lanarkshire
• Health-led central waiting list for
diagnosis/identification
• Assessment process – key health
practitioners involved
• Eps contacted for contribution when
child/yp’s name reaches top of waiting list
• Eps have been asked to be part of a redesign
National Conference 2012
Education and Learning Directorate
Examples of EP involvement
Fife Context
• WASP (West Fife autism spectrum pilot) –
schools/eps
• Establishment of diagnostic care pathways
• GIRFEC/GIRIF
• Education ASD Strategy
• ASCA (autism spectrum community
assessment)
National Conference 2012
Education and Learning Directorate
Pre-Pathway Services
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Post code lottery of service provision
Cases passing from one service to another
Lack of communication between services
Conflicting opinions/ advice
Lengthy waiting times (3 years)
Parental confusion/frustration
National Conference 2012
Education and Learning Directorate
3 Stage Pathway
• Stage 1 Recognition of Difficulties
– Primary Care Staff-> 2 services,
• refer on to
• Stage 2 (ASCA) Community Based Assessment
– Multi-agency/ disciplinary professionals
• refer on to
• Stage 3 (FAST) Specific Assessment
– Specialist multi-agency/disciplinary Team with specific
experience/training.
National Conference 2012
Education and Learning Directorate
FCPS EP Evaluation (Barry Howard, Nicola Jamieson)
Strengths of ASCA
• Multi-agency working: encourages
professional understanding & capacity
building in schools
• Holistic view of the child: detailed, multiagency contextual assessment across school
and home
• Reduced timescales for diagnosis
• Informed interventions: contextual
assessment helps to link assessment to
intervention & school planning
National Conference 2012
Education and Learning Directorate
Implications for practice
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Joint/shared assessment pathway process
EP Reports
Waiting times now approx 6 months (but…
Workload for EPs
Manual updated/streamlining of process
Challenge to professional boundaries – shared
skills & knowledge – language of compromises
• Capacity building in schools & across services
National Conference 2012
Education and Learning Directorate
Formal Diagnosis/Identification in Fife
collated via school returns
2005
2006
2012
Diagnosed
507
472
433
Identified
156
217
204
In ASCA
Process
Totals
0
0
128
663
689
831
National Conference 2012
Education and Learning Directorate
National Research: autism diagnosis and
educational psychologists’ involvement
What we did
• Questionnaire to Principals of all Scottish
local authority psychological services
• 97% return rate (30/31 services)
• Follow up interviews with 6 psychological
services (8 in total)
National Conference 2012
Education and Learning Directorate
1.Is there a specific service and established
pathway for autism diagnosis in your
authority? Yes 90%
2. Is there a centralised waiting list for
diagnosis? Yes 65%
National Conference 2012
Education and Learning Directorate
3. Does your service contribute regularly to
diagnostic assessments of autism?
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where case is already known to the
service YES 87%
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in all cases Yes 35%
Where there’s not an obvious pathway cases are
missed by EPs
National Conference 2012
Education and Learning Directorate
4.Capacity issues aside, should psychological
services be involved in the diagnostic
assessment process?
- where case is already known
Yes 100%
- in all cases Yes 35%
National Conference 2012
Education and Learning Directorate
5. 100% psychological services agreed that
best practice for diagnostic assessment of
autism via a multi-agency process in keeping
with GIRFEC principles
National Conference 2012
Education and Learning Directorate
6.Capacity/workload issues for your service
regarding the involvement of eps in autism
diagnostic assessment? Yes 68%
- All eps
- Specialist eps
- Time allocations
- Anticipated demand
National Conference 2012
Education and Learning Directorate
7.Additional or specific training for EPs to be
involved in autism assessment/diagnosis?
Yes 62% No 38%
- Joint training re process/procedures –
capacity building
- Autism specific eg ADOS etc
National Conference 2012
Education and Learning Directorate
8. Is there an Autism Strategy Steering Group
in operation in your authority? Yes 65%
9. Where a ASD Strategy Group was in
operation Psychological Services were
represented? 100 %
National Conference 2012
Education and Learning Directorate
10. Best practice for the involvement of
psychological services in an autism diagnostic
assessment process- key themes
• Contextual assessment & ep perspective
• Shared information for planning & intervention
• Development of joint pathways
• Diagnosis/identification on the basis of
observed behaviours
• Capacity building across universal services
National Conference 2012
Education and Learning Directorate
Conclusions/points to consider
• Diagnosis, identification, assessment semantics or pragmatics?
• Diagnostic pathways – where do EPs feed
in organisationally and around individual
children/YP?
• Specific role of the EP – both in
assessment information and post
diagnosis?
National Conference 2012
Education and Learning Directorate
Conclusions (cont)
• Skills of EPs – core and specialist? Roles
within a Psychological Service?
• Capacity/workload issues for EPs
• Training & building capacity - use of specific
diagnostic tools. Multi-agency training?
• ‘Ownership’ of the diagnosis, reports and
feeding back
• Profile of educational psychologists?
National Conference 2012
Education and Learning Directorate
Developing a National Autism
Identification & Intervention Framework
for EPs (NAIIF)
Workshop Task (see handout for details)
NAIIF Key Headings:
• Best practice principles
• Multi agency pathway involvement
• EP contribution to identification & intervention
• EP contribution to LA strategic developments