Assessment and Diagnostic Practices for Autism Spectrum Disorders: A Survey of Clinicians in Canada
Amber Yaholkoski, Janine M Newton Montgomery, Brenda Stoesz and Andrea Piotrowski
Timely assessment for Autism Spectrum Disorders (ASD) is essential for a comprehensive understanding of child functioning, advising diagnosis, and informing individualized treatment, but many children with milder symptoms of ASD are not diagnosed until they reach school age. American and Australian studies have identified disparities between best practice guidelines and actual clinical procedures for ASD assessment and diagnosis. At the time of this study, no research had been conducted examining school-aged ASD diagnostic practices in Canada. The primary objectives of this study were to understand clinicians’ knowledge and practices in screening and assessing ASD in school-aged children, compare clinicians’ reports of assessment practices to best practice guidelines, and identify assessment challenges. Eighty-six clinicians completed a web-based survey and reported that assessing comorbidities, organizing teams, and identifying ASD in children with milder symptomology were significant challenges. Findings also suggested disparities between reported practice and best practice guidelines in terms of processes implemented and inter-professional consultation practices. Overall, this study provides a snapshot of the current context of assessment and diagnosis for Canadian school-aged children. The findings may suggest training and policy implications, and barriers identified may inform Canadian-specific guidelines for school age children that may alleviate challenges in the diagnostic process.
A Personalized System of Instruction for Training Front-Line Staff: A Quality Improvement Project
Louis Busch, Gerry Bernicky, Valdeep Saini, Reghann Munno and David Lennox
The Personalized System of Instruction (PSI) is an evidence-based instructional approach that relies on written instruction, self-pacing, emphasis of concept mastery, and uses proctors (peers or supervisors who have previously mastered content) for evaluation, support and motivation. This study describes the result of a quality improvement project that used PSI methods to train 29 front-line staff employed in government-funded developmental sector group homes on knowledge of behavioural procedures. Following training, outcome measures included testing on staff knowledge of behavioural procedures, quality of staff-client rapport, and perceived level of staff stress. Training was correlated with increases in knowledge of behavioural procedures, but no significant change in quality of rapport or changes in staff-reported stress levels. Satisfaction surveys indicated that training was well received by front-line staff. We discuss the implications of PSI methods for training front-line staff and the feasibility of this instructional method in practical settings.
Quality of Life of Persons with Severe or Profound Intellectual and Developmental Disabilities Transitioning Into Community From a Complex Care Residence in Canada
Margherita Cameranesi, Shahin Shooshtari, Charmayne Dube and Lindsay McCombe
Over the last three decades, the construct of Quality of Life (QoL) has been advocated as an important indicator of the quality and effectiveness of social care practice and policy for persons with intellectual and developmental disabilities. As part of a larger multi-year evaluation study, this cross-sectional investigation describes the QoL of 59 persons with severe or profound intellectual and developmental disabilities who were living in the complex care residence, Health and Transition Services of St.Amant, in the City of Winnipeg, Canada, and were in transition to community homes. QoL data on the 59 individuals prior to their transition were collected mostly retrospectively by proxy administering the standardized tool San Martin Scale to St.Amant staff who were most knowledgeable of the life of the persons being assessed while residing in the complex care residence. Results are presented in a descriptive fashion by reporting on the QoL of our study population in the eight QoL dimensions assessed in the San Martin Scale. Importantly, an accurate assessment of the QoL of the 59 participants before their transition to community living serves as the baseline for their evaluation post-transition. Overall, our study population scored at the same level as, or above scores for the San Martin reference sample with intellectual and developmental disabilities in the QoL dimensions of Self-determination, Emotional Well-being, Physical Well-being, and Social Inclusion. Conversely, overall, our study population scored lower than the reference sample in the dimensions of Rights, Personal Development, Inter-personal Relations, and Material Well-being. We provide some recommendations for social care practice for persons with intellectual and developmental disabilities grounded in our findings.
Différentes perspectives sur l’utilisation des services offerts par les organismes communautaires en réponse aux besoins des mères présentant une déficience intellectuelle
Myriam Busson, Marjorie Aunos et Nathalie Poirier
Les mères présentant une déficience intellectuelle (DI) ont de nombreux besoins relativement à leur rôle parental qui ne sont pas tous directement liés à leurs limitations cognitives. Par exemple, elles peuvent être confrontées à l’isolement social, la pauvreté et la discrimination. Le soutien offert s’avère déterminant dans l’expression de leurs habiletés parentales. L’objectif de cette étude est d’explorer les besoins de ces mères liés à l’utilisation des organismes communautaires. Pour ce faire, des analyses quantitatives descriptives et qualitatives thématiques sont effectuées à partir des entrevues administrées auprès de huit mères présentant une DI, 10 intervenantes d’un centre de réadaptation en DI et 30 répondantes d’organismes communautaires. Les résultats indiquent que les mères et les intervenantes du centre de réadaptation ont une méconnaissance des ressources communautaires disponibles et que celles-ci sont conséquemment peu utilisées. Tous les participants de cette étude perçoivent positivement l'intégration des mères au sein des ressources communautaires, mais indiquent de nombreux besoins en termes de soutien et d'adaptations pour y arriver. Les résultats de cette étude permettent une meilleure compréhension des besoins et du soutien requis par les mères ayant une DI pour favoriser leur intégration au sein des ressources offertes dans la communauté.
Improving Upper Extremity Motor Control in Adults with Autism Spectrum Disorder and an Intellectual Disability Through Participation in an Adapted Physical Exercise Intervention
Stephen Bested, Kelly Carr, Chad Sutherland, Sean Horton and Nadia Azar
This study sought to quantify the impact of a 12-week adapted physical exercise (APEX) program on upper extremity motor control in 11 adults diagnosed with both autism spectrum disorder and an intellectual disability (ASD-ID). Motor planning and execution during an upper-limb reaching movement was assessed at baseline, mid-, and post-program. Overall, participants became more efficient at preparing and executing the task, needing fewer adjustments during the movement to achieve similar accuracy. Eight participants also improved their response programming. The multi-modal APEX program appears to be an effective intervention for improving upper extremity motor control in adults with ASD-ID. Improving motor skills may lead to increased participation in physical activity, greater independence, and improved quality of life for adults with ASD-ID
Assessing Discrimination Skills of Individuals With Developmental and Physical Disabilities Using Microswitches
Paul Rezutek, C. T. Yu and Leslie Thorne
The Assessment of Basic Learning Abilities (ABLA) measures the ability of a person with developmental disabilities to learn basic discrimination tasks. Its ease of use and strong psychometric properties make the ABLA a valuable tool for research and training. However, the ABLA requires a person to respond on each trial by grasping and placing an object into a container, which may not be possible for persons with limited hand function or arm movements. We modified the procedure by replacing the original response with switch-pressing to assess individuals who were not testable previously due to physical difficulties. Three females with developmental and physical disabilities participated. In Phase 1, all three participants demonstrated that their switch-pressing response was sensitive to positive reinforcement in an ABAB design. In Phase 2, baseline assessments showed that participants were unable to perform the ABLA 2-choice discrimination tasks. Switch pressing was introduced in a multiple-baseline design across four tasks and participants responded consistently on nearly all trials. Moreover, all participants performed the visual-position discrimination task at high accuracy using the switch-pressing response.