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Improved access to diagnosis services in Scotland.

Why is there a need for improved diagnostic services?

The latest statistics for schools in Scotland compendium (Dec. 2010) indicates that 1:104 Scottish children are currently diagnosed with ASD, although head teachers and teachers have reported the figure to be higher due to a short fall in diagnositic services. There is a further 1:30 children known to have a speech and communication condition, or social, emotional and behavioural problems, with the strong likelihood that some of these children in fact present with ASD. In total, 1 child in 24 is affected with related developmental and behavioural problems. At the moment, there are no indications of any reduction in the number of affected children. It is generally accepted that the rise in diagnosis is due to a combination of genetic susceptibility and exposure to environment triggers. However no causal agents have yet been identified.

These figures are matched by others conducted elsewhere in the UK. The current UK rate is 1 in 66 children aged 5-11. Evidence of geographical disparity is dramatically illustrated by the recorded rate of ASD in the Orkney Islands. The audit of services for people with ASD identified 91 children with ASD resident in Orkney NHS catchment area, making this the highest rate of autism in Scotland and in the UK, with 1 child in 44 being affected.

The majority of studies suggest a typical male:female diagnostic ratio of 3-4:1, with very few of the girls diagnosed being of the high functioning type. Yet recent publications suggest that women and girls are particularly under-diagnosed because of the relative subtlety of their presentation. This is an observation we have also made with an increasing number of young adult women coming forward seeking help in understanding the nature of their social and developmental difficulties. These young women have essentially fallen through the net of the diagnosis service, because their presentation is not typical of that of high functioning autism in boys. Commonly these women have been diagnosed with an eating disorder when the core of their difficulties is in fact ASD.

Early intensive behavioural interventions have helped many ASD children to acquire the core skills they are lacking and enable them to integrate successfully into the mainstream school system. The lifetime cost of autism has been estimated to exceed £2.4 million per individual.

Based on the above findings Scotland faces a lifetime care bill of between £40.2bn (Scottish figures) and £175bn (if the English prevalence is accepted as a more accurate figure for Scotland).

‘The age of autism’ presents an enormous challenge and ATT-Training is at the forefront of organisations trying to find ways of improving the life and prospects for people with autism.

The diagnosis training we provide includes the standardised assessments used for making an autism diagnosis, namely, Autism Diagnostic Observation Schedule (ADOS), and Autism Diagnostic Interview Revised (ADI-R). The course is delivered over 8 days in total, split into two 2 sessions. The blocks will be run 1 month apart. The first session will teach all required knowledge for professionals to practice in delivering and scoring across all assessments. The second session will review the work conducted by each participant in the interim period, from video recordings and by discussing any issues encountered. There will be further practice opportunities in the second training session. After completion of 8 days training, the participants will be invited to administer two ADOS modules and 1 ADI-R interview and rate some video materials. The course organiser will then review the video materials and scores returned, upon which a course qualification can be obtained. Participants will be invited to meet twice yearly as consensus rating groups in order to ensure a consistency in the ratings.

Requirement

Typical applicants will have a background in psychology, psychiatry, paediatrics, nursing, speech therapy or similar, and will be currently employed in that capacity either as a clinician, part of a clinical team or part of a research team. Qualifications and employment information must be provided on the course application form. Participants must have access to an ADOS Kit (Hogrefe product code 5580001) for completing the pre-course and post-course assignments and be in a position to video record their sessions for evaluation.