AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES IN WATERLOO AND WELLINGTON

Transcription

1 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES IN WATERLOO AND WELLINGTON Nikhil Koushik, PhD., C., Psych Heather Jennings MSW, RSW, RECE

2 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES Dr. Nikhil Koushik Clinical Psychologist Child & Adolescent Mental Health Heather Jennings MSW, RSW, RECE Preschool Diagnostic and Treatment Services Child and Adolescent Outpatient Services Grand River Hospital A Day in Psychiatry Wednesday November 7 th, 2018 Bingeman s Conference Centre Kitchener, Ontario

3 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES DR. NIKHIL KOUSHIK DAY IN PSYCHIATRY 2018 Declaration of Conflict of Interest: We DO NOT have any affiliation (financial or otherwise) with any for-profit or not-for-profit organizations. I have received an honorarium for this presentation from the Grand River Hospital Foundation. We DO NOT INTEND to make therapeutic recommendations for medications that have not received regulatory approval (e.g off-label use).

4 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES HEATHER JENNINGS DAY IN PSYCHIATRY 2018 Declaration of Conflict of Interest: We DO NOT have any affiliation (financial or otherwise) with any for-profit or not-for-profit organizations. I have received an honorarium for this presentation from the Grand River Hospital Foundation. We DO NOT INTEND to make therapeutic recommendations for medications that have not received regulatory approval (e.g off-label use).

5 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES DR. NIKHIL KOUSHIK & HEATHER JENNINGS This 2018Day in Psychiatry educational event has received unrestricted educational grants from the following organizations: Lundbeck Otsuka Janssen Purdue 02/11/2018 5

6 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES DR. NIKHIL KOUSHIK & HEATHER JENNINGS DAY IN PSYCHIATRY 2018 Mitigating Potential Conflicts of Interest: Not applicable

7 AUTISM SPECTRUM DISORDERS: SCREENING IN PRIMARY CARE AND ACCESSING RESOURCES DR. NIKHIL KOUSHIK & HEATHER JENNINGS DAY IN PSYCHIATRY 2018 Learning Goals A. Appreciate the diagnostic criteria for Autism Spectrum Disorders (ASD) DSM V B. Review best practices for screening in ASD C. Review common differential diagnoses in ASD D. Understand how to access resources in the community

8 Let s start with a story.

9 WHY CARE ABOUT THIS TOPIC? 1) 1 in 66 Canadian children is diagnosed with an ASD (National ASD Surveillance System, March 2018). 2) General physicians or other community providers are frequently still the point of first contact for children with ASDs. 3) Screening and early diagnosis are essential for timely implementation of interventions.

10 WHAT IS AN AUTISM SPECTRUM DISORDER (ASD)? Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with impairments in social communication and a pattern of repetitive stereotyped behaviours. Onset is early in childhood and the presentation changes with development over the life span (POND Network).

11 WHAT ARE THE CHARACTERISTICS OF ASD? Image taken from Autism Ontario website.

12 ASD IN DSM-5 Social-Communication Restricted and Repetitive Behaviours and/or Interests (RRBs)

13 WHAT ARE BEST PRACTICES FOR SCREENING? Identify children at risk of ASD Red Flags Identified Initial Developmental Assessment Anagnostou et. al., (2014)

14 WHAT ARE RED FLAGS? Red Flags for ASD in 12-to-18 month old children. Social Communication Language Play Visual or other sensory and motor skills

15 WHAT ARE OTHER RECOMMENDATIONS FOR SCREENING? Spend time in structured play activity with the child. Gather detailed information about family history, sleep, gastrointestinal issues, neurological conditions.

16 WHY USE A STANDARDIZED SCREENING QUESTIONNAIRE? It increases the ability to identify children who may have an ASD (Robins, 2008). It is cost effective and easily available.

17 HOW DO YOU KNOW WHEN A SCREENING MEASURE IS GOOD? Status of the Person Has Autism No Autism Screen Result Autism + No Autism -

18 WHAT ARE COMMONLY USED SCREENING TESTS FOR ASD? Young Children Modified Checklist for Autism in Toddlers (MCHAT-R) Screening Tool for Autism in Toddlers and Young Children (STAT) School Age Children and Older Social Responsiveness Scale, 2 nd Edition (SRS-2) Social Communication Questionnaire (SCQ) Childhood Autism Rating Scale, 2 nd Edition (CARS-2) Adults Autism Spectrum Quotient (ASQ)

19 WHERE CAN I FIND SCREENING TOOLS? MCHAT-R autism speaks Canada Autism Canada

20 WHAT IS NEW IN ASD SCREENING IN 2018? Targeting underserved populations Janvier et al., (2018)- The Developmental Check-In Mazurek et al., (2018)- ECHO Autism STAT Innovative approaches to screening Kanne, Carpenter & Warren (2018)- Mobile Health Shorter more efficient screening Topcu et al., (2018)- the TIDOS 02/11/

21 DIFFERENTIAL DIAGNOSIS: GENERAL COMMENTS Examining consistency and pervasiveness of symptoms across time and settings Thorough Developmental History Age of symptom onset Constellation of symptoms

22 DIFFERENTIAL DIAGNOSIS OF ASD IN CHILDREN Intellectual Disability Specific Language Impairment Stereotypic Movement Disorder Sensory Impairment Severe Reactive Attachment Disorder Mood Disorders Anxiety Disorders Obsessive Compulsive Disorder ADHD Tics/Tourette s Learning Disabilities

23 REFERENCES Robins, D.L. (2008). Scrreening for autism spectrum disorders in primary care setting. Autism, 12(5), Anagnostou et al., (2014). Autism spectrum disorder: advances in evidence-based practice. Canadian Medical Association Journal, 186(7), Angie, et al., (2015). Factors influencing autism spectrum disorder screening by community pediatricians. 20 (5), e20-e24. Penner, et al., (2017). Community general Pediatricians Perspectives on Providing Autism Diagnoses in Ontario, Canada: A qualitative study. Journal of Developmental and Behavioural Pediatrics, 38(8), Province of Ontario Neurodevelopmental Disorders Network (POND). Autism Canada- Screening Tools. Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition, Revised Versions (DSM-IV-TR). American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5). American Psychiatric Association, Autism Ontario.

24 REFERENCES Towle, P.O & Patrck P.A., (2016). Autism Spectrum disorder screening instruments for very young children: A systematic review. Autism Research and Treatment, Erikksson, J.M., (2013). RAADS-14 Screen: Validity of a screening tool for autism spectrum disorder in an adult psychiatric population. Molecular Autism, 4(1), Bolte, S. (2012). The Social Responsiveness Scale for Adults (SRS-A): Initial results in a German Cohort. Journal of Autism and Developmental Disorders, 42(9), Modified Checklist for Autism in Toddlers- Revised. Lord, C. (2012). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry. 69(3), Gotham et al., (2007). The Autism Diagnostic Observation Schedule: revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), Sharma, Wolfson & Hunter (2011). Confusion and inconsistency in diagnosis of Asperger s Syndrome: A review of studies from 1981 to Autism, 16(5), Ruzich et al., (2015). Measuring autistic traits in the general population: A systematic review of the Autism Spectrum Quotient in a non-clinical population of 6900 typical adult males and females. Molecular Autism, 6(2).

25 REFERENCES Janvier, Y.M., Coffield, C.N., Harris, J.F., Mandell, D.S., & Cidav, Z. (2018). The Developmental Check-In: Development and initial testing of an autism screening tool targeting young children from underserved communities. Autism (published ahead of print). Mazurek, M.O., Curran, A., Burnette, C., & Sohl, K. (2018). ECHO Autism STAT: Accelerating early access to autism diagnosis. Journal of Autism and Developmental Disorders, Kanne, S.M., Carpenter, L.A., & Warren, Z. (2018). Screening in toddlers and preschoolers at risk for autism spectrum disorder: Evaluating a novel mobile health screening tool. Autism Research, 11, Topcu, S., et al., (2018). Comparison of tidos with m-chat for screening autism spectrum disorder. Psychiatry and Clinical Psychopharmacology, 28(3), 1-7. Witwer & Lecavallier, (2009). Autism Screening Tools: An evaluation of the Social Communication Questionnaire and the Developmental Behavioural Checklist- Autism Screening Algorithm. Journal of Intellectual and Developmental Disability, 32(3), /11/

26 What do I do once I suspect a child may have an ASD? 02/11/

27 AGENDA Where to connect a patient and their family if querying ASD Where to connect a patient and their family when ASD Diagnosis is confirmed 27

28 QUERYING ASD

29 QUERYING ASD? OPTION 1 KidsAbility Autism Spectrum Disorder (ASD) Assessment Team: Clinical Team of an Occupational Therapist, Social Work, Speech and Language Pathologist, and Developmental Pediatrician, Dr. Rajguru. 29

30 WATERLOO REGION Eligibility Criteria: Children and youth, aged 2 years to school exit (18-21 years) Residents of Waterloo Region Referred by a community physician Allows for opportunity to receive other KidsAbility services such as Occupational Therapy, Speech & Language, Physiotherapy 30

31 REFERRAL PROCESS Fax the Physicians Referral Form to This must include: Box ticked indicating parent permission/consent received Patient / family demographics Specific reasons for referral Signature and billing number Supportive consultation notes and/or test results 31

32 REFERRAL FORM y.ca/uploads/autism %20Spectrum%20Di sorder%20(asd)%20 Assessment%20Tea m/physician%20refe rral.pdf 32

33 GUELPH-WELLINGTON Growing Great Kids Developmental Services and the Canadian Mental Health Association Waterloo Wellington, with clinical support from KidsAbility accept referrals for children and youth needing assessment for ASD Eligibility Criteria Children and youth, from birth to 18 years of age Residents of Guelph or Wellington County Self-referred or completed by the family, community service provider or physician 33

34 REFERRAL PROCESS Birth - 6 years Call HERE4KIDS ( ) 9:00 am to 4:00 pm. Or fax referral form to: years Call HERE247 ( ) 24hour service 34

35 REFERRAL FORM 02/11/

36 QUERYING ASD? OPTION 2 Waterloo Region Preschool Diagnostic and Treatment Services Grand River Hospital Clinical Team of a Psychologist, Neuropsychologist, Psychometrist, Social Worker, and Psychiatrist, Dr. Shrenik Parekh. 36

37 ELIGIBILITY CRITERIA Children 2.5 to 6 th birthday Residents of Waterloo Region Moderate to severe mental health related challenges in TWO or more environments Completion of a community intervention program, after which some or all of the child s challenges remain unresolved Referred by a member of Front Door Intake Team and/or Zero 2 Six Program. 37

38 REFERRAL PROCESS Refer the family to Front Door Walk-In and Access or to call: Allows for opportunity to receive other Front Door services such as Zero 2 Six inhome support. 38

39 AFTER ASD DIAGNOSIS 39

40 ASD DIAGNOSIS. NOW WHAT? Waterloo Region: Birth -18 yrs: Complete referral to Developmental Services Resource Centre (DSRC) Access to: Ontario Autism Program (9-17) and Autism Services Consultation (0-18) Tel: , Fax:

41 REFERRAL PROCESS REFERRAL-PACKAGE.pdf Fax to /11/

42 ASD DIAGNOSIS. NOW WHAT? Guelph Wellington: Birth-6yrs: Call or fax HERE4Kids to complete request intervention services. Include ASD diagnosis so that ASD coordinator can be included at beginning. Family can self-refer, but if doctor refers, ASD coordinator is immediately included. 42

43 ASD DIAGNOSIS. NOW WHAT? Guelph Wellington: 0-18yrs: Contact Access Information & Referral (AIR) for Development Services ; Access to services OR 6-18 yrs: Walk-in services on Tuesdays at HELP4Kids 485 Silvercreek Unit 1 in Guelph 11am-7pm Access to ASD coordinator and services. 43

44 REFERRAL PROCESS: AIR Fax to : Diagnosis document including: Diagnosis Level of severity according to DSM-5 Method used to diagnosis Family contact information Attn: Access Information & Referral (AIR) Questions? call / , or 44

45 REFERRAL PROCESS: HERE 4 KIDS Birth - 6 years Call HERE4KIDS ( ) 9:00 am to 4:00 pm. Or fax referral form to: years Call HERE247 ( ) 24hour service Or fax referral form to:

46 REFERRAL FORM 02/11/

47 DISABILITY TAX CREDIT If you are the physician caring for a patient that has received a diagnosis of Autism Spectrum Disorder, you are able to complete the physician portion of the Disability Tax Credit application on behalf of your patient. 47

48 QUESTIONS OR COMMENTS? 48

49 Nikhil Koushik, PhD., C., Psych Heather Jennings MSW, RSW, RECE ext / 3615 nikhil.koushik@grhosp.on.ca heather.jennings@grhosp.on.ca 49