ACQ_Vol_11_no_3_2009

Mental health

Clinical insights The Autism Diagnostic Observation Schedule-Generic (ADOS-G):

A clinical referral pathway for young people suspected of pervasive developmental disorders at a mental health clinic Nickolina Aloizos

Speech and language disorders often overlap with social, emotional and behavioural disorders in childhood. For young people who present to a mental health clinic with these conditions it is not always clear whether a diagnosis of a communication disorder, a pervasive type of developmental disorder and/ or a mental health disorder should be given. The issue of correct diagnosis is critical, as precision in the classification and subtypes carries implication for outcome and response to treatment (Mahoney et al., 1998). This paper outlines a systematic approach to critically appraising the evidence and participating in the decision-making and assessment and intervention process for speech pathologists Child and Youth Mental Health Services (CYMHS) are a component of Queensland Health’s Mental Health Program. It targets service delivery to children and young people aged 0–18 years, whose emotional, social or behavioural disorders are severe and complex, or at risk of becoming so, and whose needs cannot be met by other services. All clients entering CYMHS are given a diagnosis following bio- psychosocial assessment. The diagnostic classification system used is the International Classification of Diseases, Tenth Revision (ICD-10: World Health Organization, 1992). Within the mental health team, the speech pathologist has primary responsibility for the diagnosis and remediation of communication impairment. Research literature is consistent in finding that communication disorders are a pervasive feature of mental health conditions (Cantwell & Baker, 1991; Gualtieri, Koriath, & Bourgondien, 1983). The speech pathologists’ area of expertise in mental health is specialist knowledge of the reciprocal relationship between communication, bio-psychosocial development, psychopathology and the impact of adverse psychosocial contexts. Specialist speech pathology practice requires a capacity to effectively evaluate communication competence, to analyse the impact of communication vulnerability in the context of psychosocial adversity and then to select working in mental health services. Mental health services for young people

management responses relevant to the communication needs of the client. Pervasive developmental disorders Pervasive developmental disorders (PDD) are a group of disorders characterised by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities in all situations (ICD-10: World Health Organization, 1992). Although PDD is the overarching ICD-10 category, some services (e.g., Queensland Department of Education) have adopted autism spectrum disorder (ASD) for those conditions that are referred to in the literature as either PDD or autistic spectrum disorders (ASD). These include autistic disorder, Asperger’s disorder, childhood disintegrative disorder, Rett’s syndrome, and PDD not otherwise specified. ASD is a specific diagnosis with a variety of communication characteristics and social interactions central to the recognition of the condition (see Whitehouse, this issue, for further information on the differential diagnosis of ASD). Although speech pathologists do not diagnose PDD (or ASD), they are often the first professionals to come into contact with a young child with ASD (Wetherby, Prizant, & Hutchinson, 1998), and can assist with the diagnosis and can provide communication and behaviour interventions. The co-occurrence of several disorders in the same individual is not uncommon in the mental health field (Giddan & Milling, 1999). However, the importance of distinguishing ASD from a mental health disorder becomes crucial because of the detrimental effects on parents and young people through inappropriate diagnoses and treatment recommendations and delays in inappropriate intervention (Sikora, Harley, McCoy, Gerrard-Morris, & Dill, 2008). PDD and mental health disorders There has been a significant increase in the number of cases diagnosed with PDD and this has been associated with corresponding decreases in the use of other diagnostic categories (Shattuck, 2006, p. 1028). However, typical features of PDD can also be present in other mental health disorders (i.e., communication, socialisation and repetitive/ restricted behaviours) (Goin-Kochel, Mackintosh, & Meyers, 2006). Diagnostic procedures for PDD may also be complicated by the confounding factors of behaviour, childhood schizophrenia, psychosis, anxiety, mood, and attention disorders (Giddan & Milling, 1999; Sikora et al., 2008). At CYMHS services in Queensland, an established referral pathway exists to assist clinicians in making a

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing