Forty years of referrals and outcomes to a UK Child Development Centre (CDC): Has demand plateaued?

Williams, A N; Mold, B; Kilbey, LM; Naganna, P.

doi:10.1111/cch.12552

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…For example, recommendations to engage families in service design, and to produce a needs-based holistic assessment and report are mirrored internationally. 69 70 The seven PTs are echoed overall, for example in New Zealand recommendations, 71 while international research also supports individual PTs, including improving knowledge and skills of referrers, 72 improving information gathering to inform appropriateness of referral, 54 and upskilling the diagnostic workforce. 73 74 These are also echoed in recommendations from NHS England published after completion of the RRR.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…It is unclear what the outcome was for the remainder of the referrals. 17 The CHAT 7 is a short parent report questionnaire combined with a health professional observation. The CHAT was tested prospectively in 18-month-old toddlers from the general population, with a diagnostic follow-up of those who scored above the cut-point to allow estimation of both sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism

Allison

Matthews

Ruta

et al. 2021

bmjpo

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ObjectiveThis is a prospective population screening study for autism in toddlers aged 18–30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4.DesignObservational study.SettingLuton, Bedfordshire and Cambridgeshire in the UK.Participants13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18–30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4.InterventionsA stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT.Main outcome measuresConsensus diagnostic outcome at phase 1 and phase 2.ResultsAt phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2.ConclusionsThe Q-CHAT can be used at 18–30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4–5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.

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“…1 Kevin Borg, 1 Daniel Camilleri, 1 Janice Mifsud, 2 Tania Borg. 1 Aims Looked after children (LAC) generally come from disadvantaged backgrounds and often have greater health needs than age-matched peers. The looked after children healthcare service (LACHS) was established in Malta in 2021.…”

Section: Health Characteristics Of Looked After Children In Residenti...mentioning

confidence: 99%

“…On a published background of CDC data from 1974 onwards, there is evidence on increasing diagnosis of ASD over the last 2 decades (1) .This has remained unchanged in terms of upward trend in the number of ASD diagnosis from 2019 to 2020 despite COVID-19 pandemic (figure 2).…”

mentioning

confidence: 99%

646 Health characteristics of looked after children in residential and community homes in Malta

Borg¹,

Camilleri²,

Mifsud³

et al. 2022

British Association for Community Child Health

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Forty years of referrals and outcomes to a UK Child Development Centre (CDC): Has demand plateaued?

Cited by 5 publications

References 19 publications

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

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

Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism

646 Health characteristics of looked after children in residential and community homes in Malta

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