Cost of assessing a child for possible autism spectrum disorder? An observational study of current practice in child development centres in the UK

Galliver, Mark; Gowling, Emma; Farr, William; Gain, Aaron; Male, Ian

doi:10.1136/bmjpo-2017-000052

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…The project seems to be very cost-effective with estimated costs per family of around £1000. This compares to an estimated average cost of £850 of assessing and diagnosing a child with ASD in the UK (Galliver et al 2017). However further research is warranted on this issue as noted below.…”

Section: Discussionmentioning

confidence: 93%

The Impact of a Brief Home-Based Intervention on Families with a Child with Autism Spectrum Disorder

Mullan¹,

Boyd²,

McConkey

2020

J Dev Phys Disabil

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A brief intervention is described and evaluated that aimed to build and strengthen relationships for families of children diagnosed with ASD aged 12 and under. A particular focus was on socially disadvantaged parents. Parents were offered around five home visits which took place on weekdays during working hours; each lasting around 90 min. They were given individualised practical tools and support to manage their children’s behaviours alongside providing a listening ear to parents’ concerns. In all, 456 children and 427 families participated over a four-year period with a take-up rate of 87% of all referrals. The drop-out rate was low (4.5%) as was the proportion of missed and cancelled appointments. Parents’ satisfaction ratings were high and most found the number of sessions provided was ‘just right’. Children improved in their personal care, had less difficulty with change, showed less anger and had fewer meltdowns. Parents reported being less stressed, not feeling so down and managing their child better. The evaluations suggested that a brief home-based intervention is a viable and effective means of providing personalized, post-diagnostic support to parents at periodic intervals, although socially disadvantaged families may require additional assistance beyond managing their child’s ASD. The project also highlighted broader issues that impede effective support for families.

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Section: Discussionmentioning

confidence: 93%

The Impact of a Brief Home-Based Intervention on Families with a Child with Autism Spectrum Disorder

Mullan¹,

Boyd²,

McConkey

2020

J Dev Phys Disabil

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“…Next, the robustness of our DANN was further tested using varying k-fold cross validation. A classification model that is not robust may appear to perform very differently with different k. Figure 4 shows plots of the accuracy, sensitivity, precision, F-score, and specificity of the proposed DANN over k-fold cross validation strategies (k � [6,7,8,9,10]). Using one-way ANOVA, the proposed DANN exhibited no significantly different performance across varying k-fold experiments (p � 0.082), indicating the robustness of the proposed multichannel DANN model.…”

Section: Robustness Of Multichannel Dann On Varying Data Splitmentioning

confidence: 99%

“…Currently, behavior-based test is the standard clinical method for diagnosing ASD [9]. However, the diagnostic process for ASD is not only time consuming but also costly [10]. is results in a tremendous financial burden for patients' families.…”

Section: Introductionmentioning

confidence: 99%

“…Comparison of random forest (RF), support vector machine (SVM), multichannel deep neural network (DNN), and multichannel deep attention neural network (DANN) classifiers trained using 10-fold cross validation on the entire dataset. Performance of multichannel DANN over varying data split schemes with k-fold cross validation strategies (k �[6,7,8,9,10]). Mean and standard deviation are displayed.…”

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confidence: 99%

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Multichannel Deep Attention Neural Networks for the Classification of Autism Spectrum Disorder Using Neuroimaging and Personal Characteristic Data

et al. 2020

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Autism spectrum disorder (ASD) is a developmental disorder that impacts more than 1.6% of children aged 8 across the United States. It is characterized by impairments in social interaction and communication, as well as by a restricted repertoire of activity and interests. The current standardized clinical diagnosis of ASD remains to be a subjective diagnosis, mainly relying on behavior-based tests. However, the diagnostic process for ASD is not only time consuming, but also costly, causing a tremendous financial burden for patients’ families. Therefore, automated diagnosis approaches have been an attractive solution for earlier identification of ASD. In this work, we set to develop a deep learning model for automated diagnosis of ASD. Specifically, a multichannel deep attention neural network (DANN) was proposed by integrating multiple layers of neural networks, attention mechanism, and feature fusion to capture the interrelationships in multimodality data. We evaluated the proposed multichannel DANN model on the Autism Brain Imaging Data Exchange (ABIDE) repository with 809 subjects (408 ASD patients and 401 typical development controls). Our model achieved a state-of-the-art accuracy of 0.732 on ASD classification by integrating three scales of brain functional connectomes and personal characteristic data, outperforming multiple peer machine learning models in a k-fold cross validation experiment. Additional k-fold and leave-one-site-out cross validation were conducted to test the generalizability and robustness of the proposed multichannel DANN model. The results show promise for deep learning models to aid the future automated clinical diagnosis of ASD.

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“…13 This suggests demand for diagnostic services has outstripped capacity, exacerbated by recent increases in demand. 15 Additionally, assessment is time consuming and costly; Galliver et al, 16 found assessments took a mean of 13 hours of professional time, costing £800 per child/young person. Our recent study of 500 children's diagnostic journeys estimated 15 hours, costing around £950 per child.…”

Section: Introductionmentioning

confidence: 99%

Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review

et al. 2020

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IntroductionThe National Health Service (NHS) Long-Term Plan (2019) acknowledges that children and young people with suspected autism wait too long for diagnostic assessment and sets out to reduce waiting times. However, diagnostic pathways vary with limited evidence on what model works best, for whom and in what circumstances. The National Autism Plan for Children (2003) recommended that assessment should be completed within 13 weeks but referral to diagnosis can take as long as 799 days.This Rapid Realist Review (RRR) is the first work package in a national programme of research: a Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD). We explore how particular approaches may deliver high-quality and timely autism diagnostic services for children with possible autism; high quality is defined as compliant with National Institute for Heath and Care Excellence (2011) guidelines, and timely as a pathway lasting no more than one calendar year, based on previous work.Methods and analysisRRR is a well-established approach to synthesising evidence within a compressed timeframe to identify models of service delivery leading to desired outcomes. RRR works backwards from intended outcomes, identified by NICE guidelines and the NHS England Long-Term Plan. The focus is a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within a particular set of parameters (Autism and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group consists of policymakers, content experts and knowledge users with a wide range of experience to supplement, tailor and expedite the process. The RRR is consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and includes identifying the research question, searching for information, quality appraisal, data extraction, synthesising the evidence, validation of findings with experts and dissemination.Ethics and disseminationEthical approval not required. Findings will inform the wider RE-ASCeD evaluation and be reported to NHS England.Trial registration numberNCT04422483. This protocol relates to Pre-results.

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Cost of assessing a child for possible autism spectrum disorder? An observational study of current practice in child development centres in the UK

Cited by 18 publications

References 20 publications

The Impact of a Brief Home-Based Intervention on Families with a Child with Autism Spectrum Disorder

The Impact of a Brief Home-Based Intervention on Families with a Child with Autism Spectrum Disorder

Multichannel Deep Attention Neural Networks for the Classification of Autism Spectrum Disorder Using Neuroimaging and Personal Characteristic Data

Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review

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