Assessment and Diagnostic Practices for School-Aged Children with Autism Spectrum Disorders: A Survey of Canadian Clinicians

Background: Timely assessment for Autism Spectrum Disorder (ASD) is essential to provide a comprehensive understanding of child functioning, advise diagnosis, and inform individualized treatment. Although early diagnosis is ideal, many children with ASD are not identified until school age. Information to guide early diagnostic practice is widely available; however, information specific to diagnosing ASD in school-aged populations is limited. Some evidence-based practice guidelines for school-aged ASD diagnosis have been developed, however, results from studies conducted outside of Canada suggest that disparities between these practice guidelines and clinical procedures exist. Various challenges to using these guidelines have also been identified. To date, no research has been conducted to examine school-aged ASD diagnostic practices in Canada.

Objectives: The primary objectives of this study were to: (a) understand clinicians’ knowledge, practices, and challenges encountered in screening, assessment, and diagnosis of ASD in Canadian school-aged children (i.e., ages 4-21 years); (b) compare Canadian clinicians’ reports of procedures and assessment tools used to existing practice guidelines; (c) identify training and professional development needs; and (d) determine whether policy changes may be required to alleviate challenges in the diagnostic process.

Methods: Clinicians (i.e., school and clinical psychologists, psychiatrists, and physicians) involved in diagnostic assessment of school-aged children suspected of having ASD were recruited via Canadian professional organizations to participate. A web-based survey (using Qualtrics Survey Software) was used to gather information about knowledge, practices, and challenges for screening, assessment, and diagnosis of ASD. The survey consisted of four sections to gather information about: (1) referral, screening, and assessment processes; (2) tools used for screening, assessing, and diagnosing ASD; (3) broad assessment approaches for ASD diagnosis; (4) and participant demographics.

Results: Findings suggest both similarities and differences in perceived knowledge and expertise for ASD diagnosis, processes implemented, inter-professional consultation practices, and frequencies in using specific tools across professional groups and across Canada. Clinicians indicated that assessing comorbidities, difficulties organizing assessment teams, identifying ASD in higher functioning individuals, and lack of training/knowledge specific to ASD assessment are significant challenges. Although clinicians’ responses indicated that they are generally aware of and follow evidence-based practice guidelines, in some cases, procedures differed from specific practice guidelines. This may reflect context specific constraints (e.g., access to specific tools and/or other professionals for consultation) rather than an awareness or unwillingness to follow recommended practice.

Conclusions: This study provides a picture of the current Canadian context for school-aged ASD assessment and diagnosis. Specifically, the findings contribute to an understanding of the extent to which Canadian clinicians conduct assessments in accordance with evidence-based practice guidelines for ASD diagnosis, and highlights reasons why they may be unable to adhere to some recommendations. This information may be used to inform the development of additional training opportunities, and highlight where funding and policy changes are required to alleviate challenges in the diagnostic process to increase access to timely, accurate identification.