1

Autism Spectrum Disorders: Wisconsin Best Practice Guidelines for Diagnosis and Assessment (Proposed)

Wisconsin Community of Practice on Autism Spectrum Disorders and Developmental Disabilities- ASD Diagnostic Workgroup

DRAFT June 2012

2

Autism Diagnostic Workgroup Summary

The following recommendations were generated following a series of workgroup discussions with diagnosticians located across the state. The workgroup identified several domains as essential to the assessment of autism based upon the research literature and clinical experience. The workgroup recommends that an autism assessment ultimately include each of the domains listed below. However, it is recognized that it may not be feasible to address each of the areas list below in a single encounter or in a single setting. Thus, it is the workgroup’s position that the domains listed below should be addressed for all children, but it may be necessary to complete components at different points in time. The identified critical domains include: 1. 2. 3. 4. 5.

Hearing / Audiology Developmental history and current developmental / cognitive functioning Language and communication Adaptive behavior Structured and unstructured assessment of autism symptoms through interview and observation 6. Assessment of co-morbidities to enable differential diagnosis

3

A variety of possible methods for assessment were discussed. The potential for developing a set of statewide “best-practice guidelines” for autism diagnosis was addressed and this process was supported by the workgroup. Recommendations for methods of assessment include: 1. Detailed interview regarding developmental, medical, family, educational, and intervention history 2. Standardized assessment of: a. b. c. d.

Developmental level / IQ Adaptive behavior Speech and language Hearing / audiology

3. Detailed assessment of current autism symptoms through interview and observation a. At a minimum, it is recommended that the interview include a review and assessment of current DSM criteria. Optimally, the interview would involve completing the Autism Diagnostic Interview, Revised (ADI-R). i. If it is not possible to complete the ADI-R, use of the Social Communication Questionnaire (SCQ) in conjunction with a formal observational assessment such as the ADOS may improve diagnostic accuracy. b. At a minimum, it is recommended that formal observation of autism symptoms involve administration of a standardized assessment such as the Childhood Autism Rating Scale (CARS-2). Optimally, the observation would involve an observation and interaction-based assessment such as the Autism Diagnostic Observation Schedule (ADOS). 4. Detailed interview regarding additional symptoms and co-morbidities 5. The workgroup also recommends that providers remain mindful of other types of referrals that may be appropriate when considering a diagnosis of autism. Such referrals could include: a. Referrals to medical genetics b. Referrals to other medical sub-specialties (e.g., neurology, gastroenterology, sleep specialists, etc.)

4

Wisconsin ASD Diagnostic Workgroup Participants Participants represented a sample of the identified diagnosticians around the state, and also included representation from the Medical Home Practice Group and the Department of Health Services. Co-Chairs: Rachel Fenning, Ph.D. Assistant Professor of Psychology, California State University- Fullerton Mala Mathur, M.D., Pediatrician Group Health Cooperative Participating Members: Jeffrey Crisco, Ph.D. Director, Pediatric Psychology Associates Amy Heffelfinger, Ph.D. Neuropsychologist, P.I.N.T. Clinic Tina Iyama-Kurtycz, M.D. Developmental Pediatrician, Waisman Center Bonnie Klein-Tasman, Ph.D. Psychology Department, University of Wisconsin-Milwaukee Jeffrey Marcus, M.D. Psychiatrist and Medical Director, Central Wisconsin Clinic Kevin Rooney, Psy.D. Pyschologist, La Crosse Behavioral Health Christopher Wiebusch, Ph.D. Director, Wiebusch and Nicholson Center for Autism, Inc. Peter Williamson, M.D. Neuropsychologist, Dean Health Bill Murray, Ph.D. BCBA-D Behavior Analyst, Children's Long Term Support Section, WI Department of Health Services Gail Chodron, M.A. Parent & Training and Outreach Specialist, MCH LEND Training Program, Waisman Center UCEDD

5

References Assessment, Screening, and Diagnostic Tools: Barbaro, J., & Dissanayake, C. (2009). Autism spectrum disorders in infancy and toddlerhood: A review of the evidence on early signs, early identification tools, and early diagnosis. Journal of Developmental Behavioral Pediatrics, 30, 447-459. Charak, D.A., & Stella, J.L. (2002). Screening and diagnostic instruments for identification of autism spectrum disorders in children, adolescents, and young adults: A selective review. Assessment of Effective Intervention, 27(5), 5-17. Couteur, A., Haden, G., Hammal, D. & McConachie, H. (2007). Diagnosing autism spectrum disorders in pre-school children using two standardised assessment instruments: The ADI-R and the ADOS. Journal of Autism and Developmental Disorders, 38, 362-372. Ozonoff, S., Goodlin-Jones, B.L., & Solomon, M. (2005). Evidence-based assessment of autism spectrum disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 523-540. Zwaigenbaum, L., Bryson, S., Lord, C., Rogers, S., Carter, A., Carver, L., Chawarska, K., Constantino, J., Dawson, G., Dobkins, K., Fein, D., Iverson, J., Klin, A., Landa, R., Messinger, D., Ozonoff, S., Sigman, M., Stone, W., Tager-Flusberg, H., & Yirmiya, N. (2009). Clinical assessment and management of toddlers with suspected autism spectrum disorder: Insights from studies of high-risk infants. Pediatrics, 123, 1383-1391. Professional Practice Guidelines- American Academy of Pediatrics: Johnson, C.P., Myers, S.M., & the Council on Children with Disabilities. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183-1215. Professional Practice Guidelines- American Academy of Neurology/ Child Neurology Society: Filipek, P.A., Accardo, P.J., Ashwal, S., Baranek, G.T., Cook, E.H., Dawson, G., Gordon, B., Gravel, J.S., Johnson, C.P., Kallen, R.J., Levy, S.E., Minshew, N.J., Ozonoff, S., Prizant, B.M., Rapin, I., Rogers, S., Stone, W.L., Teplin, S.W., Tuchman, R.F., & Volkmar, F. (2000). Practice parameter: Screening and diagnosis of autism: Report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55, 468-479.

6

Other State Best Practice Guidelines- California & Missouri: California Department of Developmental Services (2002). Autism spectrum disorders: Best practice guidelines for screening, diagnosis and assessment. Missouri Autism Guidelines Initiative (2010). Autism spectrum disorders: Missouri best practice guidelines for screening, diagnosis, and assessment. Division of Developmental Disabilities, Missouri Department of Health.