National Conference 2012
Education and Learning Directorate
Annual Conference 2012 for Educational Psychologists in ScotlandThe 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
• 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 StrategyTen 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 domainsDSM-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 involvementSouth 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 re-
design
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
• 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, multi-agency 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
• 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
0 0 128
Totals 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?
- where case is already known to the service YES 87%
- 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