Assessment Of Autism Spectrum Disorder Research Articles

46 Patterns of referrals for evaluation of Autism Spectrum Disorder in the pediatric population of Saskatchewan as a predictor of diagnostic outcome

Abstract Background The Alvin Buckwold Child Development Program (ABCDP) serves Northern and Central Saskatchewan as a tertiary diagnostic centre for Autism Spectrum Disorder (ASD) but data is lacking on referrals and diagnostic outcome. Objectives This study aimed to assess if referral patterns are associated with diagnostic outcome of ASD. Design/Methods We conducted a retrospective cross-sectional study of patients from the ABCDP who were referred and assessed for ASD, or who received a diagnosis of ASD, from January 1st, 2016 to December 31st, 2018. Predictor variables were the referring clinician type and referral content. Suspicion for ASD from referrals were reported as being concerning for one, both or none of the DSM-5 core criteria for ASD (social communication and interaction “criteria A”; restricted and repetitive behaviors “criteria B”). When available, speech-language pathologist (SLP) reports were reviewed to identify concerns of social communication. The main outcome was a diagnosis or not of ASD. Risk ratio (RR) and odds ratio (OR) were estimated by simple logistic regression models to assess the association between individual variables of referral patterns and diagnosis of ASD. Results The final dataset included 527 patients after excluding 128 patients (123 were not seen at our center and 5 had a virtual assessment of ASD). A total of 365 patients received a diagnosis of ASD, 140 did not receive a diagnosis, 21 had their diagnosis deferred and one had this information missing. Referrals by physiotherapist (PT) were 46% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,46; 95% CI 1,37-1,54; p=0,022). Referrals by SLP were 25% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,25; 95% CI 1,12-1,39; p<0,0001). Referrals identifying concerns of social communication in SLP reports were 29% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,29; 95% CI 1,16-1,43; p<0,0001). Using no criteria as reference group, referrals with concerns of criteria A were about 2.7 times more likely to lead to a diagnosis of ASD (OR=2,69; 95% CI 1,427-5,054; p=0,002). Conclusion In our study population, we found that certain referring clinician type (SLP, PT) and content of referrals (concerns for social communication in SLP reports, main concerns related to criteria A) are more likely to lead to a diagnosis of ASD. These findings could be used to identify referrals with a higher risk of ASD and allocate resources accordingly.

Learning graph-based relationship of dual-modal features towards subject adaptive ASD assessment

Autism Spectrum Disorder (ASD) has been identified as one of the most challenging and intriguing problems in neurodevelopment of children. Recent research suggest that conventional assessment on the basis of explicit behavior observations can be well complemented by evaluation of intrinsic neurophysiological states via analyses of brain imaging data such as electroencephalogram (EEG). However, before any more objective and comprehensive insights for a joint ASD assessment may be obtained, research challenges still remain: (1) how to characterize the interaction relationship of features rooted from recordings in different modalities; and at the same time (2) how to adapt to the individuality of subjects. This study develops a graph-based solution towards individualized assessment of ASD subjects via construction of the relationship of the dual-modal features of eye-tracking recordings and EEG: (1) Relationship Matrix Construction: A shallow encoding module as a variant of Multi-Level Perception (MLP) derives the initial intra- and inter-modal relationship matrix of the features in both modalities; and (2) Graph-based Relationship Learning: A model based on Deep Graph Convolutional Networks (D-GCN) fuses the global information of dual-modal features to learn the final relationship matrix, which is refined in the process of parameter optimization under the regulation of ASD classification. The resulted sample-specific matrices can then be exploited to address the individuality of subjects under examination. Experimental results indicate that: (1) the proposed method is superior to both the single-modal and multi-modal counterparts in ASD classification; (2) it excels in mining hidden connections among features in different modalities in comparison with mainstream methods for correlation measurement; and (3) it holds potentials in mitigating the uncertain variations brought by the individuality of subjects in ASD assessment.

The Utilisation of Adaptive Behaviour Assessment Among Children with Autism Spectrum Disorder: A Scoping Review

Adaptive behaviour in children with Autism spectrum disorder (ASD) is defined as the degree to which the children can be self-reliant and function independently in real-life conditions. Assessing the adaptive behaviour is vital to provide insight and guide the diagnosis of ASD. Therefore, this scoping review aims to map the utilization of adaptive behaviour assessments conducted by occupational therapists for children with ASD. Published articles between 2006 and 2020 were retrieved from three databases, including Scopus, Cochrane Library, and the Web of Sciences, that included English, full-text published articles, reviews, or thesis which provide relevant highlights on adaptive behaviour assessment for ASD. Nineteen articles met the inclusion criteria. There are three themes emerged from the review: adaptive behaviour as an individual, adaptive behaviour as a society and utilising the instrument. Adaptive behaviour assessment has been used as a comprehensive monitoring tool for functional status among children with ASD. This scoping review mapped the utilization of adaptive behaviour assessment by an occupational therapist that directs future research and clinicians on potential future guidelines of adaptive behaviour evaluation for children with ASD.

Integrating evaluation data to enhance treatment planning for students with ASD

AbstractAccurate assessment across the various characteristics of autism spectrum disorder (ASD) and its comorbidities can help guide intervention planning. This introduction to the second issue of a double special issue on ASD assessment highlights assessment of various characteristics of and comorbidities with ASD to assist with treatment planning. For instance, anxiety and attention deficit hyperactivity disorder are two of the most common comorbidities with ASD. Educational, clinical, and medical interventions for individuals with ASD can vary based on the unique cognitive and additional mental health needs of the individual.

A Clinical Validity-Preserving Machine Learning Approach for Behavioral Assessment of Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neuropsychiatric disorder associated with critical challenges related to social, communication, and behavioral issues. Recent studies have proposed machine learning (ML) techniques for rapid and accurate assessment of ASD. However, the mismatch between the ML techniques and the clinical basis of ASD assessment reduces the effectiveness of ML-based assessment tools. The present study proposed an approach that utilized the potential of ML modeling and preserved the clinical relevance of the assessment instrument used. Experimental results of the empirical scoring algorithm and multiple ML models employed revealed the possibility of achieving a clinically valid ML-based ASD assessment tool. This study provides a roadmap for real-life implementation of ML-based ASD screening and diagnostic tools that comprise few behavioral features and maintain clinical relevance.

Prevalence of Autism Spectrum Disorder (ASD) in all Individuals Diagnosed with Down Syndrome (DS): A Systematic Review and Meta-analysis Protocol

Background: Traditionally, autism spectrum disorder in people with Down syndrome was believed to be uncommon. This misconception is rooted in the challenges that a dual diagnosis poses. In fact, evidence indicates that children with Down syndrome are at risk for autism spectrum disorder with a potentially higher prevalence than the typically developing population. The purpose of this review is to determine the reported prevalence rate of autism spectrum disorder in all individuals with Down syndrome in comparison to the prevalence rate of autism spectrum disorder in the typical population when specific diagnostic tools are used. Methods: A systematic review will be conducted of the prevalence and incidence data and perform a meta-analysis of these results. This study will consider all studies that reported on children and adults with an existing diagnosis of Down syndrome and diagnosed by the standardized assessments for autism spectrum disorder. The diagnoses made by team assessment (psychologist, psychiatrist & developmental pediatrician) will also be considered according to DSM-III, DSM-IV or DSM-V criteria for diagnosing autism spectrum disorder or if they use autism spectrum disorder screeners. Studies will be considered from all countries that have data reporting prevalence on this topic. The language restrictions will not be applied attempting to translate studies that are not in English. The five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL) will be searched. Two reviewers will conduct all screening and data extraction independently. The articles will be categorized according to key findings and a critical appraisal performed. Discussion: The results of this review will bring increased awareness of the presence of autism spectrum disorder in individuals with Down syndrome. In doing so, this may facilitate a recommendation for screening and diagnosis of autism spectrum disorder in all individuals with Down syndrome. Based on the research demonstrating the benefits of early identification and intervention on the outcomes of children with autism, we anticipate similar benefits in this population. This will guide the allocation of resources and direct future research.

The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours

PurposeDespite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.Design/methodology/approachThis is a conceptual paper that includes a case vignette.FindingsA DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.Research limitations/implicationsIt is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.Practical implicationsTreatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.Originality/valueThere are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.

Short report: Experiences of Caregivers Participating in a Telehealth Evaluation of Development for Infants (TEDI)

A growing literature supports the feasibility and validity of telehealth-based assessments for autism spectrum disorder (ASD). Better understanding families’ experiences is crucial for sustained use beyond the COVID-19 pandemic. This study qualitatively examines caregiver experiences with the Telehealth Evaluation of Development for Infants (TEDI) protocol to better understand benefits and challenges of telehealth-based evaluations. Caregivers (N = 32) completed an online survey following a telehealth-based evaluation with their 6–12 month-old infants. Open-ended text responses to queries about perceived benefits, challenges, and suggestions for future adaptations were coded. Most caregivers reported positive experiences with minor feedback relating to tailoring of individual needs. Responses suggest the TEDI is a feasible approach and provide guidance for components of successful telehealth evaluations more broadly.

MiRNAs and isomiRs: Serum-Based Biomarkers for the Development of Intellectual Disability and Autism Spectrum Disorder in Tuberous Sclerosis Complex.

Tuberous sclerosis complex (TSC) is a rare multi-system genetic disorder characterized by a high incidence of epilepsy and neuropsychiatric manifestations known as tuberous-sclerosis-associated neuropsychiatric disorders (TANDs), including autism spectrum disorder (ASD) and intellectual disability (ID). MicroRNAs (miRNAs) are small regulatory non-coding RNAs that regulate the expression of more than 60% of all protein-coding genes in humans and have been reported to be dysregulated in several diseases, including TSC. In the current study, RNA sequencing analysis was performed to define the miRNA and isoform (isomiR) expression patterns in serum. A Receiver Operating Characteristic (ROC) curve analysis was used to identify circulating molecular biomarkers, miRNAs, and isomiRs, able to discriminate the development of neuropsychiatric comorbidity, either ASD, ID, or ASD + ID, in patients with TSC. Part of our bioinformatics predictions was verified with RT-qPCR performed on RNA isolated from patients’ serum. Our results support the notion that circulating miRNAs and isomiRs have the potential to aid standard clinical testing in the early risk assessment of ASD and ID development in TSC patients.

Identifying Rare Genetic Variants of Immune Mediators as Risk Factors for Autism Spectrum Disorder.

Autism spectrum disorder (ASD) affects more than 1% of children, and there is no viable pharmacotherapeutic agent to treat the core symptoms of ASD. Studies have shown that children with ASD show changes in their levels of immune response molecules. Our previous studies have shown that ASD is more common in children with folate receptor autoantibodies. We also found that children with ASD have abnormal gut immune function, which was characterized by a significant increase in the content of immunoglobulin A and an increase in gut-microbiota-associated epitope diversity. These studies suggest that the immune mechanism plays an important role in the occurrence of ASD. The present study aims to systematically assess gene mutations in immune mediators in patients with ASD. We collected genetic samples from 72 children with ASD (2–12 years old) and 107 healthy controls without ASD (20–78 years old). We used our previously-designed immune gene panel, which can capture cytokine and receptor genes, the coding regions of MHC genes, and genes of innate immunity. Target region sequencing (500×) and bioinformatics analytical methods were used to identify variants in immune response genes associated with patients with ASD. A total of 4 rare variants were found to be associated with ASD, including HLA-B: p.A93G, HLA-DQB1: p.S229N, LILRB2: p.R322H, and LILRB2: c.956-4C>T. These variants were present in 44.44% (32/72) of the ASD patients and were detected in 3.74% (4/107) of the healthy controls. We expect these genetic variants will serve as new targets for the clinical genetic assessment of ASD, and our findings suggest that immune abnormalities in children with ASD may have a genetic basis.

Clinicians’ Experience of Remote Assessment of Autism Spectrum Disorder Within the Barnet CAMHS Service

Aims1. To evaluate clinicians’ experiences of the newly implemented remote ASD assessment process (due to COVID-19), including the long-term sustainability and potential standardisation of this approach; 2. To establish areas for improvement in this process and make further recommendations.MethodsMembers of the Neurodevelopmental MDT completed an online survey, whereby feedback was collected regarding the use of the Child Observation of Social Communication (COSC), which had been adapted for online use from the standardised Autism Diagnostic Observation (ADOS) Schedule by a senior Psychologist[.Participants also responded to questions on other assessment domains, including the Developmental, Dimensional and Diagnostic interview, feedback and formulation meetings. Questions included their comfort with performing the assessment, theirs views on the quality of care provided and any difficulties they faced. Survey data were collected on two occasions: between November and December 2020 and between July and August 2021.ResultsPositive Experiences63% of respondents in November-December 2020 reported that COSC was a good alternative whilst standardised ADOS was unavailable. This increased to 100% in July-August 2021. Quality of care delivered by COSC was rated to be the same as ADOS in 70% of participants November-December 2020; 25% felt quality of care delivered by COSC was better than ADOS in July-August 2021. 73% of participants reported they would continue to use the remote assessment in the November-December 2020 survey. This increased to 88% in July-August 2021. 33% of the clinicians were very comfortable with administering the COSC in July-August 2021, 56% were somewhat comfortable.Negative Experiences27% of the clinicians reported being somewhat uncomfortable with administering the COSC assessment in November-December 2020; 11% remained somewhat uncomfortable in July-August 2021. 30% of the participants rated the quality of care delivered by COSC worse than ADOS in November-December 2020. 37.5% rated this to be worse in July-August 2021. 77% of the respondents had technical or organisational difficulties, which could result in missing non-verbal cues during the assessment.ConclusionClinicians’ experiences improved over time and with practice (34% had delivered over 10 COSC assessments in July-Aug 2021). A hybrid model may increase the quality of care of the approach, as well as careful selection of cases which would be suitable for an online assessment. There is scope for the continued use of the remote ASD pathway, taking into account patient and clinician preferences, however patient feedback will be necessary as a next step in this evaluation.

Introductory editorial to the special issue: Assessment and diagnosis of autism spectrum disorder (ASD) and related clinical decision making in neuropsychological practice

Introductory editorial to the special issue: Assessment and diagnosis of autism spectrum disorder (ASD) and related clinical decision making in neuropsychological practice

Parents' satisfaction with a Canadian pilot clinic to reduce waiting lists for the assessment and diagnosis of autism spectrum disorder and intellectual disability in young children.

A large body of evidence suggest that parents of young children with autism spectrum disorder or intellectual disability experience low levels of satisfaction with the diagnostic evaluation process. This study sought to document parents' satisfaction with the services of a pilot clinic implemented in Québec, Canada. Two-hundred fifty-nine (259) parents were recruited following their child's diagnosis. A mixed methods approach was used to investigate parents' satisfaction globally and with specific aspects of the assessment process. Parents expressed overall high satisfaction with the assessment process. Parental satisfaction with specific aspects of the assessment process was negatively related to paternal stress, fathers' unemployment and household income and positively related to maternal stress. This pilot clinic could meet parents' needs at this crucial moment in their care and services trajectory. The factors associated with satisfaction in the present study may inform future improvements to its services.

Collaborative approaches to autism spectrum disorder assessment

AbstractWith the rising prevalence rates of autism spectrum disorder (ASD), school and clinical psychologists must be abreast of the current research on assessment to determine diagnosis or educational eligibility. This is the first of a double special issue focusing on assessment of individuals with ASD. Within the school setting, collaboration is at the core of special education eligibility assessment. This introduction highlights the role of collaboration in the assessment process. Collaborative approaches help school psychologists determine the best assessment plan, understand the diversity, equity, and inclusive needs of children with ASD, and can assist in determining if alternative methods (i.e., telehealth) are appropriate.

Coaching While Waiting for Autism Spectrum Disorder Assessment: A Pilot Feasibility Study for a Randomized Controlled Trial on Occupational Performance Coaching and Service Navigation

AimTo determine whether short-phase Occupational Performance Coaching combined with service navigation support is feasible for families waiting for autism assessment.MethodA pilot feasibility study was conducted using a blinded randomization procedure that allocated participants to one of three trial arms: (1) face-to-face coaching, (2) videoconference coaching, and (3) usual care. Outcomes included a retention aim of 70–80%, goal attainment and secondary standardised measures of adaptive behaviour, social skills, parenting stress, service access and family quality of life.ResultsCaregivers and children (n = 16, child mean age of 3 years 7 months) were recruited following referral for an autism assessment. Retention was 75%, with change scores in performance and satisfaction of selected goals higher in the intervention groups than the usual care group.InterpretationFindings support progression to a future randomized controlled trial assessing intervention efficacy.

Objective measurement of vocalizations in the assessment of autism spectrum disorder symptoms in preschool age children.

Assessment of autism spectrum disorder (ASD) relies on expert clinician observation and judgment, but objective measurement tools have the potential to provide additional information on ASD symptom severity. Diagnostic evaluations for ASD typically include the autism diagnostic observation schedule (ADOS-2), a semi-structured assessment composed of a series of social presses. The current study examined associations between concurrent objective features of child vocalizations during the ADOS-2 and examiner-rated autism symptom severity. The sample included 66 children (49 male; M=40 months, SD=10.58) evaluated in a university-based clinic, 61 of whom received an ASD diagnosis. Research reliable administration of the ADOS-2 provided social affect (SA) and restricted and repetitive behavior (RRB) calibrated severity scores (CSS). Audio was recorded from examiner-worn eyeglasses during the ADOS-2 and child and adult speech were differentiated with LENA SP Hub. PRAAT was used to ascertain acoustic features of the audio signal, specifically the mean fundamental vocal frequency (F0) of LENA-identified child speech-like vocalizations (those with phonemic content), child cry vocalizations, and adult speech. Sphinx-4 was employed to estimate child and adult phonological features indexed by the average consonant and vowel count per vocalization. More than a quarter of the variance in ADOS-2 RRB CSS was predicted by the combination of child phoneme count per vocalization and child vocalization F0. Findings indicate that both acoustic and phonological features of child vocalizations are associated with expert clinician ratings of autism symptom severity. LAY SUMMARY: Determination of the severity of autism spectrum disorder is based in part on expert (but subjective) clinician observations during the ADOS-2. Two characteristics of child vocalizations-a smaller number of speech-like sounds per vocalization and higher pitched vocalizations (including cries)-were associated with greater autism symptom severity. The results suggest that objectively ascertained characteristics of children's vocalizations capture variance in children's restricted and repetitive behaviors that are reflected in clinician severity indices.

Diagnostic evaluation of patients referred by family physicians with the suspicion of autism spectrum disorder

Current evidence shows that early interventions in children with autism spectrum disorder (ASD) are more efficient and associated with better long-term outcomes. This also highlights the need for early recognition of children with ASD symptoms by family physicians and referral to child psychiatrists. This study aimed to evaluate how family physicians’ knowledge about ASD is reflected in clinical practice by making a diagnostic evaluation of the cases referred with suspected ASD. The study included 149 cases that family physicians referred to child psychiatrists regarding the assessment for ASD. Diagnostic evaluation of the subjects was carried out using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) were used in the evaluation process. Denver II developmental screening inventory was used to evaluate all subjects under six. The mean age of all participants was 39.1 (±13.2) months, and in ASD cases, it was 34.6 (±7.8) months. Of all referred cases, 72,5% were diagnosed according to the DSM-5 criteria. The most common diagnoses were global developmental delay (28.9%), language disorder (15.4%), ASD (15.4%), and attention deficit hyperactivity disorder (8.7%), respectively. The most common reason for referral specified on the consultation note was delayed speech, with a rate of 87.2%. In addition, 148 (99.3%) of the symptoms noted on the referral note were clustered within the DSM-5 ASD A criteria and 19 (12.8%) within the ASD B criteria. Developmental delay was more prominent in cases with ASD when compared to those with global developmental delay and language disorder. The most common diagnosis was a global developmental delay in referred cases, and only some of the symptoms seen in ASD from the referral notes of family physicians stood out as the reason for referral. These results underline the necessity of continuing ASD training for family physicians.

Integration of physical health and sensory processing assessment for children with autism spectrum disorder in schools

AbstractIndividuals with autism spectrum disorder (ASD) often undergo various assessments and evaluations as part of the diagnostic process, identification and classification for special education eligibility, and continued progress monitoring for skill growth. Such evaluations may include cognitive, social and emotional, behavioral, and speech evaluations, among other skill and ability assessments. One other area for assessment that clinicians may consider examining when working on evaluations for individuals with ASD includes the integration of assessments capturing physical and sensory needs. Physical health identifiers that may be included in such evaluations cover physical exercise, sleep, diet and food sensitivities, and elimination. Additionally, sensory evaluations may consider auditory, olfactory, taste, tactile, vestibular, and proprioceptive sensory abilities and needs. This practitioner‐focused chapter includes a brief review of each of the aforementioned physical and sensory abilities and their connection to ASD. Further, implications for practitioners in their assessment of ASD are explored with practical tips and recommendations for providers to use for their future assessments for ASD.

The effect of different service models on quality of care in the assessment of autism spectrum disorder in children: study protocol for a multi-centre randomised controlled trial

BackgroundThere is significant variability in clinical pathways available in the diagnostic assessment of ASD, including the order and timing of allied health assessments in relation to paediatrician consultations. Allied health professionals in first-contact models are increasingly used to improve the timeliness of healthcare access, whilst complementing medical specialty workforce shortages. Anecdotally, the implementation of allied health first-contact models in paediatrics has improved waitlists and timely access to healthcare. However, no rigorous studies have been conducted to evaluate the outcomes of these models. This study aims to determine the impacts of an allied health first-contact model on health service use and costs and patient quality of life and satisfaction.MethodsAn open, semi-blinded, multi-centre randomised controlled trial in paediatric outpatient clinics at two Australian metropolitan public hospitals. 56 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for assessment of ASD: (1) allied health first-contact or (2) medical first-contact model. Cost outcomes will be collected from both health service and family perspectives. Caregiver-reported outcome measures include: Pediatric Quality of Life Inventory (PedsQL), the EuroQOL Five Dimension Youth Version (EQ-5D-Y), the Autism Family Experience Questionnaire (AFEQ) and Measure of Processes of Care.DiscussionEvidence of improvements in service and consumer centric outcomes will help inform the development and implementation of high-value, evidenced based models of care for the assessment of ASD in children. The findings from this study are expected to contribute to the evidence base around the costs and consequences of allied health first contact models for the assessment of children with ASD in the Australian setting. Findings of this study may help to inform the allocation of health care resources while maintaining, or potentially improving, patient and family quality of life and experience of care. These findings may be useful in informing the wider adoption of these models in Australia and internationally, particularly in healthcare settings where medical specialist shortages exist.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12621001433897. Registered: 25th October, 2021.

Appraising the need for audiological assessment before autism spectrum disorder referral.

Mandatory audiological testing before autism spectrum disorder (ASD) assessment is common practice. Hearing impairment (HI) in the general paediatric population is estimated at 3%; however, hearing impairment prevalence among children with ASD is poorly established. Our objective was to determine which children referred for ASD assessment require preliminary audiological assessment. Retrospective chart review of children (n=4,173; 0 to 19 years) referred to British Columbia's Autism Assessment Network (2010 to 2014). We analyzed HI rate, risk factors, and timing of HI diagnosis relative to ASD referral. ASD was diagnosed in 53.4%. HI rates among ASD referrals was 3.3% and not significantly higher in children with ASD (ASD+; 3.5%) versus No-ASD (3.0%). No significant differences in HI severity or type were found, but more ASD+ females (5.5%) than ASD+ males (3.1%) had HI (P<0.05). Six HI risk factors were significant (problems with intellect, language, vision/eye, ear, genetic abnormalities, and prematurity) and HI was associated with more risk factors (P<0.01). Only 12 children (8.9%) were diagnosed with HI after ASD referral; all males 6 years or younger and only one had no risk factors. ASD+ children with HI were older at ASD referral than No-ASD (P<0.05). Children with ASD have similar hearing impairment rates to those without ASD. HI may delay referral for ASD assessment. As most children were diagnosed with HI before ASD referral or had at least one risk factor, we suggest that routine testing for HI among ASD referrals should only be required for children with risk factors.