JCPSLP Vol 22 No 1 2020

Participants The medical records of 20 children (5 females; 15 males) previously seen in the Developmental Paediatric Outpatient (DPOP) Clinic in 2015 or 2016 with suspected ASD were reviewed. These children were aged between 4;0 and 6;11 with normal intellectual functioning, as reported on a cognitive assessment. Data collection A customised data extraction form was developed in hardcopy and included the following categories: (a) whether the child was seen by a SLP prior to ASD diagnosis, (b) length of time from referral to SLP services, (c) whether a school observation was completed by the Tumbatin team prior to diagnosis, (d) length of time from initial referral to formal ASD diagnosis, and (e) reported diagnosis following the multidisciplinary team assessment. Data was independently extracted by the first author for each of the 20 children in the sample. Due to resourcing constraints at the time of extraction, data was not extracted by a second rater and thus inter-rater reliability measures were not conducted. In an effort to enhance the internal validity of the data extracted, the first author re-abstracted data from 20% of randomly selected files at a second time point, 6 months after initial extraction. Agreement of data extracted, between the two time points, was 100%. Descriptive statistics were used to describe patterns and trends noted in the data. Prospective cohort study Aim The prospective study aimed to explore how the inclusion of an SLP assessment and school observation would assist in a timely and accurate differential diagnosis of ASD. In addition, this information aimed to facilitate a possible future service delivery model whereby a medical evaluation and SLP assessment of functioning could expedite formal diagnosis and reduce the number of children waiting for multidisciplinary team assessments. Participants A convenience sample of 15 children (2 females, 13 males), aged between 4;0 and 6;11, was recruited following a medical evaluation in the DPOP Clinic. Only children with suspected ASD and average cognitive development, as informally reported by the paediatrician, were eligible for inclusion in this study. Parents of eligible children were given an information sheet by one of the authors or another member of the Tumbatin Clinic. Parents voluntarily agreed for their child and family to take part in the study and gave their written consent prior to participation. Participants were excluded if they had already received a diagnosis of ASD, specific language impairment, or if an intellectual disability was suspected. The speech-language pathology assessment was completed while participants were awaiting the multidisciplinary Tumbatin team assessment. Measures The speech-language pathology formal assessment was conducted at the Sydney Children’s Community Health Centre. All assessments were completed by the first author (KB). School observations were conducted at either the child’s preschool or school environment at a time arranged with education staff. Core language assessment To assess the participant’s overall core language ability, The Clinical Evaluation of Language Fundamentals, Preschool

(2nd ed.) (CELF-P2; Wiig, Secord, & Semel, 2004) was conducted with children aged 4;0 to 4;11 years and The Clinical Evaluation of Language Fundamentals (4th ed.) (CELF-4; Semel, Wiig, & Secord, 2003) was conducted with children aged 5;0 to 6;11 years. Narrative assessment The Expression, Reception and Recall of Narrative Instrument (ERRNI; Bishop, 2004) was used with all The Children’s Communication Checklist (2nd ed.) (CCC-2; Bishop, 2003), a parent questionnaire regarding their child’s social communication function, was given to parents of all 15 children to complete. All CCC-2 questionnaires were returned. School observation Informal observations of the participant’s social communication ability were made in the preschool or school environment. Information regarding participant’s nonverbal communication, initiation and response to direct and indirect communication attempts, play and shared enjoyment, reciprocity and their ability to maintain conversations about a range of topics was documented. Restricted and repetitive behaviours were noted and communicated to the team. School observations were recorded onto an informal recording sheet under the headings of ‘social communication’ and ‘restricted and repetitive behaviours’. Particular attention was given to the specific DSM 5 criteria for ASD (American Psychiatric Association, 2013). This information was then recorded into an Excel spreadsheet, recording “meets criteria” or “does not meet criteria” under the specific social communication DSM 5 criteria of “relationships”, “nonverbal communication” and “reciprocity”. The responses on the parent questionnaire were collated with the observations taken at school to form a complete picture of the participant’s social communication ability. On the basis of their clinical presentation during the medical evaluation with the second author (VS) and the assessment of functioning by the first author (KB), participants were grouped into one of three descriptive categories. Classification into each category was determined by consensus between the first (KB) and second author (VS). Group 1 (ASD) presented with a social communication disorder and restricted and repetitive behaviours consistent with a diagnosis of ASD. Group 2 (Behaviour) presented with behaviour difficulties not consistent with an ASD diagnosis. Group 3 (WNL) presented with no developmental concerns. This was not a formal diagnosis. Results Retrospective study A speech-language pathology assessment was completed prior to the ASD diagnostic assessment for 50% (n =10) of the 20 children included in the retrospective chart review. Of these children who were assessed by speech-language pathology, 40% (n = 4) saw a private speech-language pathologist, the remaining 60% (n = 6) were seen in the public system. The average waiting time for the children who were seen by public speech-language pathology was 6 months (SD 2.5). A preschool or school observation was completed by a member of the Tumbatin team for 45% (n = 9) of the 20 children. Following the full Tumbatin team participants to assess narrative skills. Social communication assessment

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology