Use of a Severity Scale In Clinical Practice

Background: There are few, if any, practical tools to measure clinical severity in children with autism spectrum disorder.  A simple measure of autism severity can aid in following children over time, and may also help to better segment a large clinic population.  It may also aid in a better understanding of which children progress more, and why.

Objectives: To test the use of a simple measure of severity in a large clinical practice, and to analyze the findings, specifically severity distribution, and changes in severity over time.

Methods: As part of work assessing clinical effectiveness, a simple measure of autism severity was developed based on consensus of autism specialists, including physicians, psychologists, speech pathologists and nurse practitioners.  The measure is comprised three domains, communication, cognition, and behavior.  Each domain has a 1 to 5 likert scale of degree of impairment (1 being most impaired, 5 being least).  The panel of autism specialists defined each level of impairment on the likert scale.  The severity scale was loaded into the electronic medical record, and two autism clinicians (DDBP physician, and autism specific nurse practitioner) completed the severity scale on follow-up patients in clinic who had been previously diagnosed with autism.  Autism clinicians also assigned a diagnosis of autism, or autism spectrum disorder (including PDD-NOS and Asperger Syndrome), after the completion of a 45 minute  in clinic follow-up assessment.  The severity scale was completed based on the clinical impression of the autism clinician.

All severity scale measures will be collected by CHMC clinical effectiveness data staff.  Specifically, overall severity distribution, as well as severity changes in children who have multiple measures completed will be analyzed. 

Results: At the time of presentation, results will include total number of children on whom severity scales have been completed (currently estimated at approximately 900), overall distribution of severity, and patterns of severity change over time in patients with more than one measure completed.  This information may be used to adapt the current severity scale.  Completion of severity scale took 1 minute or less on average.

Conclusions: Simple, clinician completed measures of severity can yield important information about an overall population, change over time, and ultimately, factors that may predict rates of progress, and possibly outcome, in children with ASD.