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Autism diagnostic evaluation in multiple settings: Who should really be evaluating my child?

Posted Dec 12 2008 1:28pm
A review of: Marian E. Williams, Monique Atkins, Tamara Soles (2008). Assessment of Autism in Community Settings: Discrepancies in Classification Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0668-1

This is a very informative examination of autism diagnostic practices in different settings. The authors compared assessment practices in three settings: 1) Public schools, 2) Programs for evaluating special education eligibility (regional centers), and c) A hospital-based outpatient mental health clinic. The study included 29 children (22 boys) between ages of 23 months to 5 years, who had been evaluated at more than one of the centers described. Regional centers had the highest rate of ASD positive diagnoses (57%). That is, 57% of the kids received a diagnosis of ASD at such centers. This compared to 54% at school-based centers and 41% at the hospital-based center. Most surprisingly however, only 45% of the time did all three centers agree on the diagnosis.

So the question is... who is right?

One way to try to answer that question is to see what procedures were used by the different centers to reach the diagnoses. In general the ‘best practices’ for ASD assessments call for the use of a multi-angle approach that includes: a) review of the records, b) interview with the parent, c)direct observation of the child in more than one setting, d) standardized measures, e) and assessment of cognitive and adaptive functioning. Do all three settings follow these guidelines?

Here is the percentage of cases in which each setting followed the best practices guidelines:

Regional Centers: 8%
School-Based Evaluation: 21%
Hospital-Based Evaluation: 76%

Here is the percentage of cases in which each setting used the ADOS – likely the most comprehensive and valid ASD assessment battery available:

Regional Centers: 0%
School-Based Evaluation: 25%
Hospital-Based Evaluation: 96%

This study suggests that hospital-based settings appear to provide assessments that most closely follow the best practices guidelines. It also suggests that not following these guidelines may result in the over-diagnosis of autism cases (57% vs. 41%). However, this does not necessarily mean that most school-base or independent centers do not follow these guidelines. I am certain that many do. However, these results should help parents be more aware at the possible differences in assessment practices at different settings. Thus, when considering an assessment at any setting, parents should feel free to ask about the nature of the assessment, and should make sure sure that such assessment meets best practices guidelines.
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