Speak Out February 2019

Association news

National Guideline Assessment and Diagnosis of Autism Spectrum Disorders in Australia

Recommendations for the assessment process The assessment should include a comprehensive needs assessment and a diagnostic evaluation. Comprehensive needs assessment At the initial identification of possible ASD features, the comprehensive needs assessment should include a medical examination relevant to neurodevelopmental disorders, and an assessment of function. The comprehensive needs assessment may or may not support the provision of a diagnostic evaluation. Speech pathologists are listed as one of the professions whose information and observations can be used to support the comprehensive needs assessment and diagnostic evaluation. Speech pathologists have been identified as one of the professions able to undertake an assessment of functioning as part of the comprehensive needs assessment. Recommendations regarding the assessment of functioning are on pp28-32. The relevant information in the report is outlined on pp12 to 21 of the PDF version of the guideline. Diagnostic evaluation The diagnostic evaluation may be provided by a single clinician where high diagnostic confidence can be achieved. Single clinician diagnosis can be provided by selected medical practitioners or selected psychologists (recommendations 37 to 40, pp37-38). Where a single clinician is unable to provide a high level of diagnostic confidence based on their assessment, a consensus team diagnostic evaluation is recommended. This may be in the case where the presentation is more subtle or complex. Speech pathologists are included among the professions that are identified to be part of the consensus team diagnostic evaluation. Recommendations 47-50 are about the diagnostic consensus team and those about the process of information collection by the Consensus Team are numbers 52-56. Initiating a referral The guideline seems to assume that primary health care providers will provide the first point of contact for community members who have “health concerns” (6.1, p25). GPs are identified as the most likely primary health care provider to offer primary health care, but allied health practitioners are also listed. The guideline provides recommendations regarding the professional training that primary health providers should have to enable them to support a referral for an ASD Assessment (Recommendation 17, p25) as well as for information collection, decision making, and outcomes, including information to include in a referral. The role of the NDIS Early Childhood Early Intervention Partner (as a potential referrer) is unclear.

THE NATIONAL GUIDELINE aims to support improved diagnostic practices and consistency nationally, and ensure that future diagnostic assessments are in keeping with best practice guidelines. The guideline is evidence-based and aims to support equitable and accessible processes for diagnosis of Autism Spectrum Disorder. Within the guidelines are seventy recommendations for Diagnostic Assessment of Autism Spectrum Disorder in Australia and weblinks are provided to relevant resources. Members are encouraged to read the full document at www. autismcrc.com.au/knowledge-centre/resource/national- guideline Speech Pathology Australia’s role Our thanks are extended to Robyn Stephen who was SPA representative on the steering committee for the project, and who was unstinting in the contribution of her considerable time, knowledge and expertise on behalf of the profession. The process and opportunity to provide input and feedback during the development of the guidelines is outlined under feedback and revision, on page 6. SPA provided feedback which influenced the information included in 12.2 Intellectual and/or Communicative Capacity (pp54-56). This section promotes the importance of differentiating between difficulties with verbal communication and intellectual disability, the role and value of providing Augmentative and Alternative Communication (AAC) options, and the involvement of speech pathologists with experience in AAC, “to identify resources and supports that will facilitate the ability of individuals to participate communicatively, including to reflect their thoughts and feelings, indicate their preferences and choices, and make decisions.” There have been concerns from members over the past several months that speech pathologists were no longer recognised as able to contribute to diagnosis of ASD, particularly by the NDIS. This is not the case. The guidelines clearly identify speech pathologists as appropriate members of the Consensus Diagnostic Team. Social interaction and/or communication domains are identified as domains which may be included in an assessment to address areas of uncertainty in the diagnostic decision (Table 7, p44). SPA feedback included concerns from members regarding the appropriateness and reliability of diagnosis based on a single diagnostician’s findings. We would encourage members to share any experiences with SPA, where they feel there are adverse impacts for people with ASD arising from single clinician diagnosis. To be clear, though representation on the steering committee enabled the Association to see and provide feedback on the various iterations of the draft guidelines, the Association was not given the opportunity to officially endorse the final National Guideline.

Cathy Olsson National Advisor Disability

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February 2019 www.speechpathologyaustralia.org.au

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