Skip to main content
Top
Published in: Molecular Autism 1/2018

Open Access 01-12-2018 | Research

Practice patterns and determinants of wait time for autism spectrum disorder diagnosis in Canada

Published in: Molecular Autism | Issue 1/2018

Login to get access

Abstract

Background

Inefficient diagnostic practices for autism spectrum disorder (ASD) may contribute to longer wait times, delaying access to intervention. The objectives were to describe the diagnostic practices of Canadian pediatricians and to identify determinants of longer wait time for ASD diagnosis.

Methods

An online survey was conducted through the Canadian Paediatric Society’s developmental pediatrics, community pediatrics, and mental health sections. Participants were asked for demographic information, whether they diagnosed ASD, and elements of their diagnostic assessment. A multiple linear regression of total wait time (time from referral to communication of the diagnosis to the family) as a function of practice characteristics was conducted.

Results

A total of 90 participants completed the survey, of whom 57 diagnosed ASD in their practices (63.3%). Respondents reported varied use of multi-disciplinary teams, with 53% reporting participation in a team. No two identically composed teams were reported. Respondents also had varied use of diagnostic tools, with 21% reporting no use of tools. The median reported total wait for ASD diagnosis time was 7 months (interquartile range 4–12 months). Longer time spent on assessment was the only variable that remained significantly associated with longer wait time in multiple regression (p = 0.002). Use of diagnostic tools did not significantly affect wait time.

Conclusion

Canadian ASD diagnostic practices vary widely and wait times for these assessments are substantial—7 months from referral to receipt of diagnosis. Time spent on the assessment is a significant determinant of wait time, highlighting the need for efficient assessment practices.
Appendix
Available only for authorised users
Literature
1.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Association; 2013.CrossRef American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Association; 2013.CrossRef
2.
go back to reference Centre for Disease Control National Center on Birth Defects and Developmental Disabilities. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63:1–21. Centre for Disease Control National Center on Birth Defects and Developmental Disabilities. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63:1–21.
3.
go back to reference Siklos S, Kerns KA. Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Res Dev Disabil. 2007;28(1):9–22.CrossRefPubMed Siklos S, Kerns KA. Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Res Dev Disabil. 2007;28(1):9–22.CrossRefPubMed
4.
go back to reference Dua V. Standards and guidelines for the assessment and diagnosis of young children with autism spectrum disorder in British Columbia. An evidence-based report prepared for the British Columbia Ministry of Health Planning. 2003. Dua V. Standards and guidelines for the assessment and diagnosis of young children with autism spectrum disorder in British Columbia. An evidence-based report prepared for the British Columbia Ministry of Health Planning. 2003.
5.
go back to reference The Miriam Foundation. Canadian Best Practice Guidelines. Screening, assessment and diagnosis of autism spectrum disorders in young children; 2008. The Miriam Foundation. Canadian Best Practice Guidelines. Screening, assessment and diagnosis of autism spectrum disorders in young children; 2008.
6.
go back to reference National Collaborating Centre for Women’s and Children’s Health. Autism: recognition, referral and diagnosis of children and young people on the autism spectrum. London: RCOG Press; 2011. National Collaborating Centre for Women’s and Children’s Health. Autism: recognition, referral and diagnosis of children and young people on the autism spectrum. London: RCOG Press; 2011.
7.
go back to reference Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH Jr, Dawson G, et al. Practice parameter: screening and diagnosis of autism: report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000;55(4):468–79.CrossRefPubMed Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH Jr, Dawson G, et al. Practice parameter: screening and diagnosis of autism: report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000;55(4):468–79.CrossRefPubMed
8.
go back to reference Johnson CP, Myers SM. American Academy of Pediatrics Council on children with disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183–215.CrossRefPubMed Johnson CP, Myers SM. American Academy of Pediatrics Council on children with disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183–215.CrossRefPubMed
9.
go back to reference Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(2):237–57.CrossRefPubMed Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(2):237–57.CrossRefPubMed
10.
go back to reference Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Dev Psychopathol. 2008;20(3):775–803.CrossRefPubMed Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Dev Psychopathol. 2008;20(3):775–803.CrossRefPubMed
11.
go back to reference Perry A, Cummings A, Dunn Geier J, Freeman N, Hughes S, Managhan T, et al. Predictors of outcome for children receiving intensive behavioral intervention in a large, community-based program. Res Autism Spectr Disord. 2011;5:592–603.CrossRef Perry A, Cummings A, Dunn Geier J, Freeman N, Hughes S, Managhan T, et al. Predictors of outcome for children receiving intensive behavioral intervention in a large, community-based program. Res Autism Spectr Disord. 2011;5:592–603.CrossRef
12.
go back to reference Ouellette-Kuntz HM, Coo H, Lam M, Yu CT, Breitenbach MM, Hennessey PE, et al. Age at diagnosis of autism spectrum disorders in four regions of Canada. Can J Public Health. 2009;100(4):268–73.PubMed Ouellette-Kuntz HM, Coo H, Lam M, Yu CT, Breitenbach MM, Hennessey PE, et al. Age at diagnosis of autism spectrum disorders in four regions of Canada. Can J Public Health. 2009;100(4):268–73.PubMed
13.
go back to reference Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116(6):1480–6.CrossRefPubMedPubMedCentral Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116(6):1480–6.CrossRefPubMedPubMedCentral
14.
go back to reference Valicenti-McDermott M, Hottinger K, Seijo R, Shulman L. Age at diagnosis of autism spectrum disorders. J Pediatr. 2012;161(3):554–6.CrossRefPubMed Valicenti-McDermott M, Hottinger K, Seijo R, Shulman L. Age at diagnosis of autism spectrum disorders. J Pediatr. 2012;161(3):554–6.CrossRefPubMed
15.
go back to reference Frenette P, Dodds L, MacPherson K, Flowerdew G, Hennen B, Bryson S. Factors affecting the age at diagnosis of autism spectrum disorders in Nova Scotia, Canada. Autism. 2013;17(2):184–95.CrossRefPubMed Frenette P, Dodds L, MacPherson K, Flowerdew G, Hennen B, Bryson S. Factors affecting the age at diagnosis of autism spectrum disorders in Nova Scotia, Canada. Autism. 2013;17(2):184–95.CrossRefPubMed
16.
go back to reference Fountain C, King MD, Bearman PS. Age of diagnosis for autism: individual and community factors across 10 birth cohorts. J Epidemiol Community Health. 2011;65(6):503–10.CrossRefPubMed Fountain C, King MD, Bearman PS. Age of diagnosis for autism: individual and community factors across 10 birth cohorts. J Epidemiol Community Health. 2011;65(6):503–10.CrossRefPubMed
17.
go back to reference Wiggins LD, Baio J, Rice C. Examination of the time between first evaluation and first autism spectrum diagnosis in a population-based sample. J Dev Behav Pediatr. 2006;27(2 Suppl):S79–87.CrossRefPubMed Wiggins LD, Baio J, Rice C. Examination of the time between first evaluation and first autism spectrum diagnosis in a population-based sample. J Dev Behav Pediatr. 2006;27(2 Suppl):S79–87.CrossRefPubMed
18.
go back to reference McKenzie K, Forsyth K, O'Hare A, McClure I, Rutherford M, Murray A, et al. Factors influencing waiting times for diagnosis of autism Spectrum disorder in children and adults. Res Dev Disabil. 2015;45(46):300–6.CrossRefPubMed McKenzie K, Forsyth K, O'Hare A, McClure I, Rutherford M, Murray A, et al. Factors influencing waiting times for diagnosis of autism Spectrum disorder in children and adults. Res Dev Disabil. 2015;45(46):300–6.CrossRefPubMed
20.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
23.
go back to reference Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc. 1983;78(3838):605–10.CrossRef Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc. 1983;78(3838):605–10.CrossRef
24.
go back to reference Anagnostou E, Zwaigenbaum L, Szatmari P, Fombonne E, Fernandez BA, Woodbury-Smith M, et al. Autism spectrum disorder: advances in evidence-based practice. Can Med Assoc J. 2014;186(7):509–19.CrossRef Anagnostou E, Zwaigenbaum L, Szatmari P, Fombonne E, Fernandez BA, Woodbury-Smith M, et al. Autism spectrum disorder: advances in evidence-based practice. Can Med Assoc J. 2014;186(7):509–19.CrossRef
25.
go back to reference Preece P, Mott J. Multidisciplinary assessment at a child development centre: do we conform to recommended standards? child: care. Health Dev. 2006;32(5):559–63.CrossRef Preece P, Mott J. Multidisciplinary assessment at a child development centre: do we conform to recommended standards? child: care. Health Dev. 2006;32(5):559–63.CrossRef
26.
go back to reference Moh TA, Magiati I. Factors associated with parental stress and satisfaction during the process of diagnosis of children with autism spectrum disorders. Res Autism Spectr Disord. 2012;6(1):293–303.CrossRef Moh TA, Magiati I. Factors associated with parental stress and satisfaction during the process of diagnosis of children with autism spectrum disorders. Res Autism Spectr Disord. 2012;6(1):293–303.CrossRef
27.
go back to reference Howlin P, Moore A. Diagnosis in autism: a survey of over 1200 patients in the UK. Autism. 1997;1(2):135–62.CrossRef Howlin P, Moore A. Diagnosis in autism: a survey of over 1200 patients in the UK. Autism. 1997;1(2):135–62.CrossRef
28.
go back to reference Goin-Kochel RP, Mackintosh VH, Myers BJ. How many doctors does it take to make an autism spectrum diagnosis? Autism. 2006;10(5):439–51.CrossRefPubMed Goin-Kochel RP, Mackintosh VH, Myers BJ. How many doctors does it take to make an autism spectrum diagnosis? Autism. 2006;10(5):439–51.CrossRefPubMed
29.
go back to reference Penner M, King GK, Hartman L, Anagnostou E, Shouldice M, Moore Hepburn C. Community general pediatricians’ perspectives on providing autism diagnoses in Ontario, Canada: a qualitative study. J Dev Behav Pediatr. 2017;38:593–602.CrossRefPubMedPubMedCentral Penner M, King GK, Hartman L, Anagnostou E, Shouldice M, Moore Hepburn C. Community general pediatricians’ perspectives on providing autism diagnoses in Ontario, Canada: a qualitative study. J Dev Behav Pediatr. 2017;38:593–602.CrossRefPubMedPubMedCentral
30.
go back to reference Robins D, Fein D, Barton M. Modified Checklist for Autism in Toddlers. 2009. Robins D, Fein D, Barton M. Modified Checklist for Autism in Toddlers. 2009.
31.
go back to reference The College of Family Physicians of Canada, Canadian Medical Assocation, The Royal College of Physicians and Surgeons of Canada. National Physician Survey. 2010. The College of Family Physicians of Canada, Canadian Medical Assocation, The Royal College of Physicians and Surgeons of Canada. National Physician Survey. 2010.
Metadata
Title
Practice patterns and determinants of wait time for autism spectrum disorder diagnosis in Canada
Publication date
01-12-2018
Published in
Molecular Autism / Issue 1/2018
Electronic ISSN: 2040-2392
DOI
https://doi.org/10.1186/s13229-018-0201-0

Other articles of this Issue 1/2018

Molecular Autism 1/2018 Go to the issue