Autism services in Canada and Neuropsychological evaluations

A review of:McLennan, J.D., Huculak, S., Sheehan, D. (2008). Brief Report: Pilot Investigation of Service Receipt by Young Children with Autistic Spectrum Disorders. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0535-5

This is a brief report published in the Journal of Autism and Developmental Disorders. The authors contacted over 1,100 families who had obtained services from specialized clinics for children with developmental disabilities. The centers were located in Alberta, Canada. Sixty four of these families reported having at least one child with ASD. The authors examined the different services that these families received and compared these with the recommended practice guidelines. The percentage of families receiving specific services were as follows: Speech and Language assessment (94%), Psychological Assessment (42%), Genetic Testing (31%), Speech and Language therapy (88%), occupational therapy (78%). The authors concluded that the rates of services received did not correspond with the recommended practice guidelines. The authors reported the post-diagnosis evaluation guidelines as proposed by the American Academy of Child and Adolescent Psychiatry, the National Research Council, the American Academy of Neurology, and the child Neurology Society:
1. Screening for lead, tuberous sclerosis, and Fragile X
2. Neuropsychological testing (audiological function, cognition, adaptive function, and expressive-receptive language)
3. Occupational and physical therapy assessment if needed.

My clinical practice is in pediatric neuropsychology. While working at a large hospital in Michigan conducting mostly neuropsychological evaluations for children with ASD, I assumed that most families received this service. However, once I left that setting and was exposed to clinics that do not have neuropsychological services, I realized that only a small portion of these families receive a full neuropsychological evaluation. The reasons for this vary, from limited access to trained neuropsychologists, unfamiliarity with the possible benefits of these evaluations, and sadly, limited insurance coverage in some States. In my experience, if families are informed about the nature and limitations of these evaluations, Neuropsychological evaluations are very useful in helping coordinate and determine interventions that are targeted to the pattern of strengths and weaknesses of each child, and monitor the progress of the child over time. But I also agree that some families do not find these evaluations as useful.

Here are the sources of the guidelines:

Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H. Jr., Dawson, G., et al. (2000). 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, 55(4), 468–479.

National Research Council (2001). Educating children with autism. Washington, DC: National Academy Press.

Volkmar, F., Cook, E. H. Jr., Pomeroy, J., Realmuto, G., & Tanguay, P. (1999). ractice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12 Suppl),
32S–54S.