Clinical Psychology

1. THE ROLE OF SCREENING TOOLS IN INITIAL DIAGNOSIS NZPsS CONFERENCE August 2009 Marian Power Consultant Psychologist Australian Council for Educational Research

2. Features of Screening Tools Purpose – indicator for further investigation Response format Standardisation Administration time Scoring

3. Screeners Across the Lifespan Early Childhood – ADEC Childhood and Adolescence – CAPP Adults – APP Elderly – NUCOG

4. ADECAutism Detection in Early Childhood Purpose To screen for autistic tendencies in young children Candidates 12 months–3 years of age Administration 10–15 minutes Components Scoring sheet, Manual, Training DVD

5. ADEC Behaviours Nestling into caregiver Response to name Upset when line of blocks is disturbed Gaze switching (tiger or car) Eye contact in game Functional play (toy telephone or car) Reciprocity of a smile Pretend play

6. ADEC Behaviours Gaze monitoring – follows point Imitation Responds to verbal command Demonstrates use of words Anticipatory posture to be picked up Use of Gestures: wave/blow kiss Ability to switch to new task Response to everyday sounds

7. Scoring the ADEC A score of 0, 1, or 2 is assigned to the presence or absence of each of the 16 behaviours. The aggregate score is compared to normed cut-off scores that suggest: Low risk (no further action) Moderate risk (review child) High risk (further testing required) Very high risk (formal autism assessment strongly recommended)

8. Importance of Early Detection Prior to the ADEC, children with autistic disorders could not be easily identified until they were three or four years of age. This is a serious issue because research indicates children with autism are more responsive to early interventions before difficult behaviours become entrenched. Early diagnosis can lead to significantly better quality of life and developmental outcomes, with subsequent major savings in health care costs estimated to be between $4.5 and $7.2 million annually in Australia alone.

9. What happens when the ADEC suggests the presence of AD? Why do you need a diagnosis? services support intervention What next? Author argues that the core-deficit linked behaviours should be the target of intervention to minimise the emergence of traditional autistic behaviours. Dr Young has written SPECTRA, an intervention program http://shop.acer.edu.au/acer-shop/group/SPEC

10. Developed in Australia by Dr Shane Langsford (University of Western Australia), Professor Stephen Houghton and Dr Graham Douglas. Oriented to the DSM-IV-TR, PsychProfiler provides an accessible and affordable screener that can be used in the early identification of disorders prior to formal diagnosis.

12. Parent – 111 items

13. Teacher – 91 itemsScreens for 20 disorders

15. Observer – 190 itemsScreens for 23 disorders

17. Obsessive-compulsive disorder

18. Panic disorder*

19. Post-traumatic stress disorder

20. Separation anxiety disorder^

21. Specific phobia*

22. Attention-deficit/hyperactivity disorder

23. Conduct disorder

24. Oppositional defiant disorder

25. Expressive language disorder

26. Motor and vocal tic disorder

27. Tourette’s disorder* Not included in CAPP ^ Not included in APP

29. Dysthymic disorder

30. Major depressive disorder*

31. Anorexia nervosa

32. Bulimia nervosa

33. Disorder of written expression

34. Antisocial personality disorder*

35. Asperger’s disorder

36. Autistic disorder

37. Mixed receptive-expressive language disorder

38. Mathematics disorder

39. Reading disorder* Not included in CAPP

41. Improved identification of disorders

42. Improved referral practices

43. Better assessment of outcomes

44. Improved accessibility to assessment services

45. A more objective and reliable tool

46. Increased efficiency of clinical practice

47. Assistance with Differential Diagnosis

49. Psychiatrists

50. General Practitioners

51. Paediatricians

52. Special Needs Teachers

53. Speech Pathologists

54. School Counsellors

55. Chiropractors

57. Direct input into softwareScoring and Reporting Software – ‘unlimited’ reports

58. Scoring the PsychProfiler All items on the CAPP and APP require responses to be made on a six-point ordered scale pertaining to the perceived frequency of the behaviour: Never Rarely Sometimes Regularly Often Very Often

59. Scoring the PsychProfiler The summation of the items within each disorder produces a screening score for that disorder. If the screening score meets or exceeds the screening cut-off score, the individual is designated as a positive screen.

60. Free Trial Version of CAPP / APP is available from: www.acer.edu.au/psychprofiler/ (Limited to 5 reports each)

62. Assesses five major cognitive domains: attention, memory, language, executive and visuospatialfunctions

64. Features Global assessment, assesses domains of cognition (has breadth and depth) Sensitive to presence of illness and change Paper and pencil format; brief, portable and minimal materials required 15 minutes to administer, easy to perform Clear guidelines for administering and scoring Scores can be put online, made available on PDA Test can be administered by non-medical or non-clinical personnel Tool has strong reliability, validated against other instruments (e.g. MMSE)

65. NUCOG Components Manual Interview Schedule Subject Completion Sheet

66. Multidimensionality Five domains of function (each score /20) Attention Memory Visuoconstructional Executive Language Multiple items in each domain

67. Sensitivity and Specificity: Dementia vs Non-dementia NUCOG 80 / 100 Sensitivity: 0.88 Specificity: 0.84 MMSE 24 / 27 Sensitivity: 0.72 / 0.86 Specificity: 0.92 / 0.78

68. Legend A Total – Attention B Total – Visuoconstructional C Total – Memory D Total – Executive E Total – Language

70. Global cognitive impairment

71. CT - vascular pathology

73. Memory problems

74. Dx early ADNUCOG = 77

76. FHx-FTD

78. Independent

79. ?depressed since divorce

80. ‘memory problems’

81. Sick leave, running farm

82. Driving