Thursday, 22 January 2015

Experts and autism screening triage

Whilst hopefully using the word 'triage' in the right way in the title of this post, I want to briefly talk today about the paper by Terisa Gabrielsen and colleagues [1] (full-text version here) and their observation that when it came to "brief but highly focused observations", a group of psychologists (well, two of them) "with toddler and autism expertise" missed over a third of cases of children who required additional examination/screening for autism or autistic traits.

I am Meredith Vickers, and it is my
job to make sure you do yours.
Some media attention for this study can be found here alongside the quote: "medical professionals can't rely solely on their clinical judgment to detect autism risk." This is a slightly misleading quote given that autism is by definition a behavioural diagnosis with clinical judgement formed on the basis of presented behaviours (and developmental history) in the absence of any biological or genetic test. Perhaps more usefully it should have read that 'some' medical professionals can't rely solely on their clinical judgement to detect 'some' autism risk. Sorry to be so pedantic but it is an important point; that and realising that early detection/diagnosis of autism is still a work in progress.

Gabrielsen and colleagues focused on a small group of infants/children aged between 15-33 months who were screened and assessed to determine their membership of one of three group: autism, speech/language delay and asymptomatic controls. Expert raters were then invited to view video samples of the children and "asked for autism referral impressions based solely on individual 10-minute observations." Unsurprisingly, some children positioned in the autism group were missed, hence the headlines and comments like: "It's often not the pediatrician's fault that referrals are missed".

Another media quote from the study authors is also worthwhile highlighting: "Parents see their children at their very best and very worst... They're the experts for their children. They can be educated about signs and symptoms, and need to help their care providers by speaking up if there's a problem and being involved in referral decisions." I like the idea of passing power back to parents when it comes to autism screening. As per other posts on this blog about parental concerns (see here) and the pre-diagnostic journey (see here), parents are the experts on their own children and medical experts and others alike might perhaps take a little more notice of them when red flags are raised for example.

Oh and whilst we're on the subject of autism screening, remember, remember the work of Dennis Wall and colleagues (see here) on YouTube videos and lay raters among other things...

Music to close, and the exquisite sound of The Shires...


[1] Gabrielsen TP. et al. Identifying Autism in a Brief Observation. Pediatrics. 2015. January 12.

---------- Terisa P. Gabrielsen, Megan Farley, Leslie Speer, Michele Villalobos, Courtney N. Baker, & Judith Miller (2015). Identifying Autism in a Brief Observation Pediatrics : 10.1542/peds.2014-1428