Age-Based Diagnostic Tracks Are Effective in Interdisciplinary Team Evaluation for Autism Spectrum Disorder

Background: Diagnostic evaluations for autism spectrum disorder (ASD) follow a range of processes that can be lengthy and contribute to long wait times. At Seattle Children’s Autism Center (SCAC), we utilize an interdisciplinary team evaluation model with two providers of different disciplines after an initial neurodevelopmental intake. This model has high provider satisfaction, maintains consistency in ASD diagnostic rates, and results in significantly fewer billed hours than a traditional psychology-only evaluation (Gerdts, et al., 2018). SCAC provider feedback in working in teams has centered on two themes for improved processes: streamlining evaluations for younger children, and identifying different approaches for patients with clinically complex diagnostic profiles.

Objectives: We will explore the effectiveness of a single day team evaluation model for patients 5 years, foregoing the initial neurodevelopmental intake; and determine whether intake providers can reliably predict the length of time needed for evaluation of children 6+ (regular versus “complex”).

Methods: Two diagnostic tracks are being piloted: 1) Patients 5 years, who generally have less history and fewer records to review. Patients are sent directly to an interdisciplinary team evaluation involving an assessment of adaptive functioning, record review, and developmental/ASD-related history, as well as a direct assessment with feedback provided to families on the same day. For this track, outcome variable of interest is the ratio of incoming:outgoing referrals.

2) Patients 6+ years receive an initial clinical intake to obtain developmental history and collect records, and subsequent referral to an interdisciplinary team evaluation (Gerdts et al., 2018). In our pilot, intake providers indicated whether they anticipate the patient could participate in a regular team evaluation or whether the evaluation would need to be longer. Data from 27 patients 6+ years seen thus far in our pilot were tracked. Blind ratings from intake providers (n=10) were compared to evaluation outcomes from interdisciplinary teams (n=19 teams). Patients ranged in age from 6-18 years (Mean=10.55 years, 67% male).

Results: The ratio of incoming:outgoing referrals for children 5 years over the past 4 months has been decreasing despite an increase in the number of diagnostic referrals coming into SCAC (Figure 1: Aug=1.58, Sept=1.99, Oct=1.21, Nov=0.70). In the 6+ year track, there was 70.3% agreement between intake provider rating and ultimate team process. Mismatches were often when intake provider rated a patient as needing a lengthier evaluation, when teams were actually able to complete their evaluation in standard time. Patients with mismatched provider ratings were older than those with matched (13.1 years v 9.8 years).

Conclusions: Efficiency in evaluating children 5 years at SCAC has been improving since the pilot launch. Expediting young children is particularly important for accessing early intervention services. Referral for patients 6+ into two tracks based on clinical impressions at intake is 70% accurate. Further information and pilot data are necessary, but outcomes thus far suggest that specialized evaluations completed by appropriate providers (e.g., a psychiatrist/psychologist, developmental pediatrician/speech-language pathologist) could be helpful in optimizing clinical time and provider expertise. We plan to analyze full pilot data and efficiency data over time.