A Pilot Study to Enhance Psychologists’ Delivery of Feedback during the Autism Spectrum Disorder Diagnostic Evaluation

Background: Serving children with Autism Spectrum Disorder (ASD) is a significant public health concern (CDC, 2014). Although up to 44% of children with ASD receive a comprehensive evaluation before age 3, up to 25% of children with ASD do not receive any services (Bowker et al., 2011; CDC, 2014). Researchers have suggested that tailoring the diagnostic evaluation feedback can lead to reducing time to parent initiation of services (Mandell & Novak, 2005; Zuckerman et al., 2016). To date, only one study has examined a training to practice delivery of an ASD diagnosis and found it helped trainees increase flexibility, attentiveness, and responsivity to parents (Kawamura et al., 2016).

Objectives: To develop and pilot a toolkit to improve and individualize psychologists’ communication to families following an ASD diagnostic evaluation. Specific goals of this study are to: (a) examine psychologists’ perception of feasibility, usefulness, acceptability and appropriateness of a toolkit for feedback in a community based clinic using mixed-method data; and (b) examine the impact of the toolkit on psychologists’ perceptions and practice.

Methods: Seven psychologists at a regional children’s hospital were recruited to participate in a toolkit training, and complete a 4-item “confidence in tailoring feedback” prior to and following the training in addition to a feedback survey two-months post-training and a ten-month follow-up interview. All participating psychologists were female and the majority were Non-Hispanic White. Interview data were analyzed using a Rapid Assessment Process (RAP; Beebe, 2001); open-ended survey responses were coded using an open-coding process (Haine-Schlagel et al., 2013); and survey responses (on a Likert scale from 1-strongly disagree to 5-strongly agree) were analyzed using SPSS. In addition, parents served by participating psychologists before and after toolkit training were asked about psychologists’ use of key toolkit strategies.

Results: Psychologists responses to the feedback survey close-ended responses indicated: 1) very high training acceptability (M=4.70; SD=.39); 2) high toolkit feasibility (M=4.21; SD=.57)utility to increase parent readiness to act on recommendations (M=4.14; SD=.90), satisfaction (M=4.36; SD=.56); 5) appropriateness (M=4.50; SD=.50) and planned sustained use of the toolkit (M=4.43; SD=.54); and 3) moderate toolkit utility for tailoring evaluation feedback (M=3.89; SD=.48). Feedback survey open-ended responses indicated specific tools that were most useful.

For the second objective, only four providers completed the confidence items both before and after training and examination of the mean responses for each item indicate consistent trends in the expected direction (i.e., improved confidence after the training). Effect size estimates indicate that parents served after toolkit training reported that the psychologist was more likely to prioritize recommendations and provide clear guidelines for how to obtain the evaluation report than parents served before the training. Psychologist follow-up interview themes indicated sustained use of certain toolkit components but not always as intended.

Conclusions: Both quantitative and qualitative pilot data indicate that a toolkit to assist psychologists in tailoring their feedback and recommendations following an ASD evaluation is feasible, useful, acceptable, and appropriate and may impact psychologists’ perceptions about tailoring the evaluation feedback process as well their feedback delivery practices.