Where are they now? An autism follow-up study.

AIM: To explore the stability of diagnosis and the relationship between behavioural, adaptive and developmental skills in early to middle childhood in children with autism spectrum disorder (ASD). METHODS: Fifty-four children recruited to the study were diagnosed with ASD before 42 months. Outcomes at follow-up after a mean interval of 64 months were measured using the Autism Diagnostic Observation Schedule, Vineland-II adaptive scale and Wechsler Intelligence Scale for Children and parental survey data. Scores before school were compared with follow-up data through descriptive, correlational and multiple regression analyses. RESULTS: ASD was confirmed in all children at follow-up (mean age 10 years). Fifty-eight percent of children were enrolled in a supported educational class or school and 42% were taking a psychotropic medication. Adaptive function improved significantly in 19% of children. Developmental and adaptive behavioural scores before school correlated with cognitive, behaviour and adaptive assessments at follow-up. CONCLUSION: At follow-up, the diagnosis was confirmed in all children. The children showed gains in their adaptive skills but and many required ongoing educational and behavioural support. Early developmental and adaptive assessments reliably predicted later educational support needs, cognitive and adaptive function and are a useful component of a diagnostic assessment.

Accurate assessment of functional abilities in pre-schoolers for diagnostic and funding purposes: A comparison of the Vineland-3 and the PEDI-CAT.

AIM: Assessment of functional abilities is an essential component in the diagnosis of neurodevelopmental disorders in young children. Functional abilities, assessed using the Pediatric Evaluation of Disability Inventory-Computer Adapted Test (PEDI-CAT), are used to determine eligibility for early intervention funded under the National Disability Insurance Scheme in Australia (NDIS). This study aims to compare the use of the PEDI-CAT with the Vineland-3, a comprehensive parent interview for the determination of support needs, diagnosis, and eligibility for funding. METHOD: Seventy-five preschool aged children referred for formal diagnosis were assessed with the Vineland-3, and subscale scores reviewed for clinical judgement. These children were also assessed on the PEDI-CAT speedy version and the results on the two tests compared. RESULTS: The PEDI-CAT was less sensitive than the Vineland-3 to the functional difficulties being experienced in this population of preschool aged children. The Vineland-3 had floor effects on some scales and deficits masked by skills in other areas in the same domain, but standard subscale scores allowed skills and areas needing support to be defined. Overall 25% of children clinically in need of support were not identified on the Pedi-cat compared to only 4% using Vineland Domain scores and 3% using Vineland-3 subscale scores. The PEDI-CAT also identified significantly lower levels of support required with only 32% of children found to need very substantial support compared to 40% of children on the Vineland Domain scores, and 59% using subscale scores. CONCLUSION: Based on the results of this study, the Vineland-3 comprehensive interview interpreted using subscale scores as well as domain scores is more sensitive than the PEDI-CAT in identifying young children in need of support as well as the areas and degree of support required.

Social disadvantage and developmental diagnosis in pre-schoolers.

AIM: To explore the association between social disadvantage and developmental diagnoses in pre-school children. METHODS: Between 2012 and 2015, 845 pre-school children were assessed by the Child Assessment Team at Campbelltown Hospital. A social worker interviewed 469 families and these children were eligible for inclusion in the study. Autism spectrum disorder (ASD) was confirmed in 290 children. Of those without ASD, 72 did not have global developmental delay (GDD) and were excluded from the study. The remaining 107 children with GDD were used as the comparison group. Social risk factors in the two groups were compared using χ 2 tests. Variables with statistical significance were then entered into a logistic regression. RESULTS: After logistic regression, children with ASD were more likely to be male (odds ratio (OR) 3.1, 95% CI 0.195-0.529; P < 0.001) and their parents were more likely to have a clinically significant stress score (OR 1.3, 95% CI 0.334-0.992; P = 0.047). Children with GDD were more likely to live in a disadvantaged suburb (OR 1.7, 95% CI 1.042-2.940; P = 0.034), more likely to have a sole parent (OR 1.8, 95% CI 1.062-3.082; P = 0.029) and much more likely to have had involvement with child protection services (OR 3.9, 95% CI 2.044-7.416; P < 0.001). CONCLUSIONS: Children with GDD without autism were more likely to be disadvantaged and to have had contact with child protection services than children with ASD. This has implications for the assessment, early intervention and support services for children with disabilities and their families.

Determinants of developmental progress in pre-schoolers referred for neuro-developmental diagnosis.

AIM: To determine factors associated with change in developmental progress in pre-schoolers referred to a developmental clinic. METHODS: Of 360 pre-schoolers referred to a Child Assessment clinic for neuro-developmental diagnosis before 3.6 years, 190 (53%) were reassessed prior to school entry and recruited to this study. They were assessed with the Bayley Scales of Infant and Toddler Development (3rd edn) before 3.5 years and the Griffiths Mental Development Scales before school entry. The influence of medical and environmental variables on improvement or deterioration in scores (±0.5 SD) was examined using logistic regression. RESULTS: Consistent scores were present in 51.6% of children, and associated with environmental variables. Children with stable scores were more likely to live in a suburb of social advantage (OR = 3.2; 95%CI = 1.37-7.64, P = 0.008) or to come from families dependent on welfare or public housing (OR=4.8; 95%CI = 2.19-10.49, P < 0.001). Improvement was seen in 18.1% of children; they were more likely to have commenced therapy after the first assessment (OR = 2.4; 95%CI = 1.05-5.58, P = 0.038). Deterioration of scores was seen in 30% of children. Children with a mild delay on initial assessment were less likely to deteriorate (OR = 2.9; 95%CI = 1.16-7.04, P = 0.022), while lower scores were more likely in children with neuro-motor disabilities (OR = 10.8; 95%CI = 2.64-44.58, P < 0.001), and chromosomal variations of both known and unknown significance (OR = 4.4; 95%CI = 1.54-12.76, P = 0.006). CONCLUSIONS: Socio-economic advantage and disadvantage are associated with stable scores, but introducing intervention is associated with improved scores. Deterioration is most likely in children with chromosomal variations or neuro-motor disabilities, and regular reassessment of these children is recommended.

Families referred to a Child Assessment Team: the Campbelltown experience.

AIM: To study the socio-demographic and psychosocial risk factors of families presenting with their children for a diagnostic developmental assessment. METHODS: Socio-demographic details of children who had a multidisciplinary developmental assessment with the Child Assessment Team at Campbelltown Hospital between January 2009 and December 2010 were collated and compared with census data. RESULTS: In 2009 and 2010, 277 families were seen by the Child Assessment Team. A detailed socio-demographic profile was available for 251 (91%) families. Parents seen in the clinic were more likely to be younger, single, born overseas, have less post-school education, identify as Aboriginal and/or live in public housing compared with the district rates. CONCLUSIONS: Families presenting to the developmental clinic have more socio-economic disadvantage compared with the referring district. This has implications for service delivery and clinical presentation, and highlights the importance of the social worker's role in a developmental diagnostic team.

Developmental and behavioural characteristics of children enrolled in a child protection pre-school.

AIM: The study aims to describe the developmental and behavioural difficulties in pre-school children who have experienced maltreatment and/or neglect METHODS: A retrospective medical file audit of all children assessed at the Cottage Family Care Centre, a child protection pre-school, between April 2004 and June 2010. Demographic characteristics, parent and teacher reports, and clinical and developmental assessment results were collated and analysed. RESULTS: The average age of the 55 children assessed was 36.3 months (ranging from 14 to 55.3 months). Fifty-five per cent were male and 65% were from disadvantaged families. A significant developmental delay in at least one domain and or a significant behavioural problem was identified in 91% of assessments. Overall (or global) delay was found in 38% and this was significantly more likely in girls (P = 0.03). Emotional and/or behavioural difficulties were reported in 85% of children. Internalising problem behaviours were more common than externalising problems. A diagnosis of an autism spectrum disorder was made in four children. In the six review assessments, regression was identified in three children. CONCLUSIONS: Children who have experienced maltreatment and/or neglect may present with developmental delays and behavioural problems. Language delays and internalising problems are characteristic. There are many features in common with primary developmental disorders. The presence of fearfulness and hypervigilance may provide a clue to diagnosis.

The use of the Bayley Scales of Infant and Toddler Development III with clinical populations: a preliminary exploration.

In response to concerns that the Bayley Scales of Infant and Toddler Development III (BSIDIII) underestimate delay in clinical populations, this study explores developmental quotient scores as an alternative to composite scores for these children. One hundred and twenty-two children aged ≤42 months, referred for diagnosis of developmental disability from January 2007 to May 2010, were assessed, and their composite and developmental quotient scores on each scale were compared. Composite scores identified only 22% (cognitive), 27% (motor), and 47.5% (language) of children as having a developmental disability. Developmental quotient scores were significantly lower than composite scores, giving rates of developmental disability of 56.6% (cognitive), 48.4% (motor), and 74.6% (language) and more closely matching both clinical impressions of delay and the proportions of those children who were also delayed on standardized tests of adaptive function.

Adaptive function in preschoolers in relation to developmental delay and diagnosis of autism spectrum disorders: insights from a clinical sample.

This study aims to explore the relationship between developmental ability, autism and adaptive skills in preschoolers. Adaptive function was assessed in 152 preschoolers with autism, with and without developmental delay, and without autism, with and without developmental delay. Their overall adaptive function, measured by the general adaptive composite on the Adaptive Behaviour Assessment System, was closely correlated to developmental ability as measured by the general quotient on the Griffith Mental Development Scales. Children with autism performed significantly less well on both scales. Domain scores discriminated between children with and without autism, with poorer performance on both the social and practical domain scores for children with autism, even when controlling for the effects of development. Children with average development, both with and without autism, had lower adaptive skills than expected for their developmental level. The importance of considering domain scores as well as the general adaptive composite when determining support needs is emphasised.