3 results
Comparison of an online adaptation of the Autism Diagnostic Observation Schedule-2 with its in-person version in an adult autism diagnostic service
- Charlotte E. Blackmore, Alexandra Nolan, Vladimira Stoencheva, Natalie Greenwood, Natasha Liu-Thwaites, Stefanos Maltezos, Grainne M. McAlonan
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- Journal:
- BJPsych Open / Volume 9 / Issue 2 / March 2023
- Published online by Cambridge University Press:
- 06 March 2023, e51
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Background
Restrictions on in-person assessments during the COVID-19 pandemic were a challenge for an adult autism diagnostic service receiving over 600 referrals annually. The service sought to adapt the Autism Diagnostic Observation Schedule (ADOS-2) for online administration.
AimsTo investigate whether an online adaptation of the ADOS-2 performed comparably to the in-person ADOS-2. To obtain qualitative feedback from patients and clinicians regarding experiences of the online alternative.
MethodOnline ADOS-2 assessments were completed for 163 referred individuals. A matched-comparison group comprised 198 individuals seen for an in-person ADOS-2 assessment prior to COVID-19 restrictions. A two-way analysis of variance (ANOVA) was run to explore any effect of assessment type (online or in-person ADOS-2) and gender on total ADOS score. Qualitative feedback was collected from 46 patients and 8 clinicians involved in diagnostic decision-making after the online ADOS-2 assessment.
ResultsA two-way ANOVA found no significant effect of assessment type or gender and no assessment type × gender interaction effect on total ADOS score. Qualitative feedback suggested that only 27% of patients would have preferred an in-person assessment. Nearly all clinicians reported gains from offering an online alternative.
ConclusionsThis is the first study to examine an online adaptation of ADOS-2 within an adult autism diagnostic service. It performed comparably to the in-person ADOS-2, making it a viable alternative when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, we encourage further work to determine whether online assessment approaches generalise to other services to increase options for patients and efficiencies for service delivery.
How Does an Observational Assessment Adapted for Online Delivery Perform Compared to an In-Person Assessment? Learning From the National Autism Service for Adults
- Charlotte Blackmore, Alexandra Nolan, Vladimira Stoencheva, Natalie Greenwood, Natasha Liu-Thwaites, Stefanos Maltezos, Grainne McAlonan
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S63-S64
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Aims
The National Autism Service for Adults receives over 600 referrals annually and with an extensive waitlist, COVID-19 restrictions on in-person assessments were a challenge for service delivery. We aimed to adapt the Autism Diagnostic Observation Schedule (ADOS) for online delivery and investigate whether it is comparable to the in-person ADOS in predicting Autism Spectrum Disorder (ASD) diagnostic outcome. We also aimed to obtain qualitative feedback from service users and clinicians regarding experiences of the online ADOS.
MethodsA working group of staff who administer ADOS and representatives from psychiatry, psychology and management reached consensus that an online version of ADOS module 4 was feasible based on experience that a lot information required for coding is obtained verbally and some tasks were adaptable for online delivery. After the pilot, it was agreed all algorithm items could be coded except ‘unusual eye-contact’. Subsequently, 163 service users attended an online ADOS between August 2020 and February 2021. A matched-comparison group consisted of 198 service users seen for an in-person ADOS between May 2014 and February 2020. Algorithm scores were recorded and ASD diagnosis was made by a trained clinician. Qualitative feedback regarding the online ADOS was collected from 46 service users and 11 clinicians.
ResultsThe working group agreed the online and in-person ADOS were closely matched regarding administration and coding. Mean scores for service users who received an ASD diagnosis were comparable for the online and in-person ADOS groups (7 and 8 respectively). This was also shown for those who were not diagnosed with ASD (3 and 4 respectively). A two-sample t-test showed no significant difference in total scores between the online and in-person ADOS (p = 0.38). Qualitative feedback suggested good service user and clinician satisfaction; only 27% of service users indicated they would have preferred an in-person assessment; 88% of clinicians reported there were gains from offering an online alternative. Although the online and in-person ADOS perform similarly, clinicians reported relying more on qualitative reports over scores from the online version to inform diagnostic decision.
ConclusionTo our knowledge, this is the first study to examine using an online ADOS within an adult diagnostic service. Due to its comparable performance, the online-ADOS is a viable alternative option for service delivery when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, the applicability of online assessments could generalise to other services and have an impact beyond the pandemic.
Brain Development in Children With Early Onset Liver Disease
- Megan Earl, Charlotte Blackmore, Jemma Day, Marianne Samyn, Anil Dhawan, Grainne McAlonan
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S3-S4
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Aims
Biliary Atresia (BA) is a progressive inflammatory liver disease and the most frequent indication for pediatric liver transplant. There is a strong association between BA in adulthood and reduced cognitive abilities, however, data on neurodevelopmental outcomes at an early age are scarce, with small participant numbers. Hence, the neurodevelopmental difficulties in BA are poorly understood in childhood even though the brain development and maturation occur in parallel with the time-course of BA. This study aimed to characterize the cognitive and behavioral phenotype within BA infants from the age of 14 months to 4 years and investigate the extent to which this group deviates from children of typical development.
Methods42 infants with BA that were diagnosed and treated at Kings College Hospital were recruited into this study. These infants ranged from 14 months to 4 years (mean age = 3 Years, 1 month). Out of the 42 infants, 19 had received a liver transplant, 22 were stable on their native liver, and 1 was on the transplant waiting list. 36 Mullens Scale of Early Learning assessments and 42 Vineland Adaptive Behavior Scale Interviews were collected. 42 typically developing infants (TD) were also recruited into the study, matched for age and gender to the BA population. First, we compared the whole group with BA to TD; then we compared children with BA on their native liver to those with a transplant.
ResultsAcross the cohort with BA, infants scored significantly lower on the Vineland Summary T-Score compared to age-matched TD control children (t(82) = −5.05, p < .001) and across all domains of the Vineland. They also scored significantly lower than TD children on the Mullens Development Assessment (t(66) = −6.52, p < .001), and this was also across all domains. BA children on their native liver scored lower on both instruments than children who had received a liver transplant, however, this difference did not reach significance.
ConclusionIndividuals with Biliary Atresia, regardless of their transplant status, show lower levels of development across all aspects, suggesting a global delay. These findings suggest that all of these young children remain at significant risk for neurodevelopmental difficulties. These findings emphasize that special attention to neurodevelopment needs to be given as part of a holistic approach to care in a serious life-long illness. Work is ongoing to understand the trajectory of brain maturation in these children to ensure neurodevelopmental needs are addressed alongside physical health.