Time to act on autism diagnosis deficiencies

Identification of autism, followed by appropriate intervention, has the potential to improve outcomes for autistic individuals – but Flinders University experts say that presently not enough qualified people can diagnose.

Professor Robyn Young, a specialist autism researcher at Flinders University, says insufficient time and money lay at the root of the problem.

“I doubt that thorough testing is seen as financially viable. To undertake a thorough assessment, you really need at least 3 hours – and for adults who may have trauma or comorbidities, it is even harder,” says Professor Young.

“NDIS is putting restrictions on from whom they will accept diagnoses, and in some incidences, even though psychologists have undertaken approved diagnostic training through Autism SA, they are asking for the diagnosis to be endorsed by a clinical psychologist – of whom there are shortages with expertise in this field.

“Few psychiatrists and paediatricians have the capacity to do the diagnoses privately.”

Professor Young is a strong advocate for the importance of accurate diagnoses. In recent papers she has examined the importance of this diagnosis in understanding a person’s behaviour, particularly in the forensic setting.

Professor Young’s latest publication focuses on the effectiveness of autism diagnosis for children.

While numerous screening instruments have been developed for children under 3 years of age, Flinders researchers have evaluated Level 2 screeners that aim to distinguish children with signs of autism from those with other developmental problems.

Their investigation found limitations to the current Level 2 screeners, including inadequate sample sizes, reliability issues, and limited involvement of independent researchers. They also identified a lack of comparative test evaluations under standardized conditions, hindering interpretation of differences in discriminative performance across instruments.

“We need to be more unified in our approach to screening for autism,” says Professor Young.

“We need to understand how it presents and how presentation may vary with development and we need to understand the constraints placed upon people that either prevent or enable diagnoses and intervention.

“If we can identify the behaviours early, and the impact these behaviours have on development, then we can target intervention more efficiently,” adds Professor Young.

“Not only will this enable people to get adequate support, it may prevent older people seeking diagnoses who have experienced a life of misdiagnoses and confusion.”

The paper – Autism Screening in Early Childhood: Discriminating Autism From Other Developmental Concerns, by Neil Brewer, Robyn Young and Carmen Lucas – has been published in Frontiers in Neurology (DOI: 10.3389/fneur.2020.594381).

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College of Education, Psychology and Social Work