The agreement between the referrer, practitioner and research diagnosis of autistic spectrum conditions among children attending child and adolescent mental health services

Abstract

We aimed to explore the levels of agreement about the diagnoses of Autistic Spectrum Conditions between the referrer, CAMHS practitioner and a research diagnosis, as well as the stability of the practitioner’s diagnosis over time in a secondary analysis of data from 302 children attending two Child and Adolescent Mental Health Services over two years. Kappa coefficient was used to assess the agreement between the referrer and research diagnosis. Kendall’s tau b coefficient was used to assess the agreement between the practitioner and the research diagnosis assigned using the Development and Well-Being Assessment, as well as the agreement between the referrer’s indication of presenting problems and the practitioner diagnosis. Diagnostic stability was explored in children with and without a research diagnosis of Autistic Spectrum Condition. There was a moderate level of agreement between the referrer and research diagnosis (Kappa = 0.51) and between practitioner’s and research diagnosis (Kendall’s tau = 0.60) at baseline, which reduced over the subsequent two years. Agreement between the referrer and practitioner’s diagnosis at baseline was fair (Kendall’s tau = 0.36).The greatest diagnostic instability occurred among children who practitioners considered to have possible Autistic Spectrum Conditions but who did not meet research diagnostic criteria. Further studies could explore the approaches used by practitioners to reach diagnoses and the impact these may have on diagnostic stability in Autistic Spectrum Conditions. Standardised assessment using a clinically rated diagnostic framework has a potential role as an adjunct to standard clinical care and might be particularly useful where practitioners are uncertain.

Informative value of referral letters from general practice for child and adolescent mental healthcare

“…Our findings are in line with the broader medical literature, research in various medical specialties suggests that RLs yield some useful information but improvements are necessary. The predictive values we found are similar to the two studies on RLs concerning autism spectrum disorders [ 14 ] and non-obsessive–compulsive anxiety disorders [ 15 ]. To the best of our knowledge no other studies have been published on the value of RLs in predicting the full range of common diagnostic categories.…”

“…Several studies across various fields of medicine have analysed the information content of RLs, but little is known concerning the average RL for children and adolescents accessing mental health services [ 14 , 15 ]. RLs to psychiatric services could potentially guide institutions as regards the urgency of registration or even which subspecialty may be appropriate (e.g., emotional disorders).…”

Approaches to improve mental health care for autistic children and young people: a systematic review and meta-analysis

“…Reaven et al, 2015; J. Reaven, Blakeley-Smith, Leuthe, Moody, & Hepburn, 2012; Sofronoff, Silva, & Beaumont, 2017; Solish et al, 2020; Swain, Murphy, Hassenfeldt, Lorenzi, & Scarpa, 2019; Wise et al, 2019), two papers compared different samples before and after implementation of a new care pathway (Cervantes et al, 2019; Kuriakose et al, 2018), seven were surveys (Cooper, Loades, & Russell, 2018; Fisher, van Diest, Leoni, & Spain, 2023; Ford et al, 2019; Hollocks et al, 2019; Jones, Gangadharan, Brigham, Smith, & Shankar Background, 2021; Pickard et al, 2020; Stadnick, Brookman-Frazee, Nguyen Williams, Cerda, & Akshoomoff, 2015), and two were qualitative (Petty, Bergenheim, Mahoney, & Chamberlain, 2021; Spain et al, 2017). There were multiple papers that were from the same trials (Cervantes et al, 2019; Keefer et al, 2017; Kuriakose et al, 2018; Pickard et al, 2020; J.…”

“…Ten papers explored service-level strategies applied to improve mental health care for autistic people across a service. These papers explored initiatives to improve the detection of autism (Ford et al, 2019; Hollocks et al, 2019; Stadnick et al, 2015), strategies for improving clinicians’ skills and knowledge of autism (Cervantes et al, 2019; Dreiling et al, 2022; Helverschou et al, 2021; Kuriakose et al, 2018), and general adaptations to standard practice concerning the way mental health services are organised for autistic people (Jones et al, 2021; Petty et al, 2021; Spain et al, 2017).…”

“…Overall, moderate certainty evidence suggested that some screening tools may be helpful in detection of autism in mental health services (Table S10). The Development and Well-being Assessment (DAWBA) was found to have moderate agreement with practitioner diagnosis of autism in child and adolescent mental health services (CAMHS), suggesting it may be useful to aid the diagnostic process (Ford et al, 2019). Conversely, the Social Communication Questionnaire (SCQ) was found to not be an effective autism screening tool in CAMHS (Hollocks et al, 2019).…”