Browsing by Person "McCartney, Deborah"

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A national study to investigate the clinical use of standardised instruments in autism spectrum disorder assessment of children and adults in Scotland
(Elsevier, 2016-07-07) Rutherford, Marion; McKenzie, Karen; McClure, Iain; Forsyth, Kirsty; O'Hare, Anne; McCartney, Deborah; Finlayson, Ian R.; Scottish Government
Background: There are few large scale studies about the nature and extent of the actual use of standardised assessments for Autism Spectrum Disorder diagnosis in clinical practice. This study compares and contrasts practice in diagnostic services for both adults and children. Method: We conducted an analysis of retrospective case notes from 150 cases (70 adult, 80 children) assessed for Autism Spectrum Disorder by 16 diagnostic services. Results: We found differences between adult and child services in staff training and use of standardised assessment during diagnosis. All child services had staff trained in and regularly using standardised assessments. Most adult services had staff trained in using instruments but only half used them regularly. Administration of standardised ASD assessments was ten times more likely in children than in adults (OR = 10.1; CI = 4.24, 24.0). Child services selected the ADOS as the standardised tool and Adult services selected the DISCO, with very little overlap. Decisions to administer standardised tools were not based on case complexity but rather the same process was applied to all referrals within a service. The three recommended components of assessment (clinical history, clinical observation and contextual information) were included for the majority of cases, although clinical observation was more frequently used with children than with adults. Conclusions: Based on the findings, we suggest a need for a wider range of appropriate assessments for use with adults, particularly those with an intellectual disability and for further research into the reasons behind the choices clinicians make during the assessment process. For child services in Scotland, there is a need for more training in use of current diagnostic interviews. Clinicians did not vary tools used based on complexity, suggesting that this is a notion still to be clearly defined and operationalised in clinical decision making about the use of standardised assessments.
Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder
(SAGE Publishing, 2016-01-29) Rutherford, Marion; McKenzie, K.; Johnson, T.; Catchpole, C.; OHare, A.; McClure, I.; Forsyth, Kirsty; McCartney, Deborah; Murray, A.; Scottish Government
This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.
Implementation of a practice development model to reduce the wait for Autism Spectrum diagnosis in adults
(SpringerNature, 2018-03-03) Rutherford, Marion; Forsyth, Kirsty; McKenzie, K.; McClure, Iain; Murray, A.; McCartney, Deborah; Irvine, Lindesay; O'Hare, Anne
This study examined waiting times for diagnostic assessment of Autism Spectrum Disorder in 11 adult services, prior to and following the implementation of a 12 month change program. Methods to support change are reported and a multi-level modelling approach determined the effect of the change program on overall wait times. Results were statistically significant (b = − 0.25, t(136) = − 2.88, p = 0.005). The average time individuals waited for diagnosis across all services reduced from 149.4 days prior to the change program and 119.5 days after it, with an average reduction of 29.9 days overall. This innovative intervention provides a promising framework for service improvement to reduce the wait for diagnostic assessment of ASD in adults across the range of spectrum presentations.
Parent focused interventions for older children or adults with ASD and parent wellbeing outcomes: A systematic review with meta-analysis
(Elsevier, 2019-09-11) Rutherford, Marion; Singh Roy, Anusua; Rush, Robert; McCartney, Deborah; O'Hare, Anne; Forsyth, Kirsty
Background: There is a need for better evidence in relation to parent-focussed interventions for older children (over 7 years) and adults, which are recommended in clinical guidelines.
Quality of life outcomes for people with serious mental illness living in supported accommodation: Systematic review and meta-analysis
(Springer, 2020-05-24) Harrison, Michele; Singh Roy, Anusua; Hultqvist, Jenny; Pan, Ay-Woan; McCartney, Deborah; McGuire, Nicola; Irvine-Fitzpatrick, Linda; Forsyth, Kirsty
Purpose: To conduct a systematic review and meta-analysis of Quality of Life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation.
Why are they waiting? Exploring professional perspectives and developing solutions to delayed diagnosis of autism spectrum disorder in adults and children
(Elsevier, 2016-08-05) Rutherford, Marion; McKenzie, K.; Forsyth, Kirsty; McCartney, Deborah; O'Hare, Anne; Iain, McClure; Linda, Irvine; Scottish Government
Background: This paper reports on the development of child and adult Action Plans for Autism Spectrum Disorder to address the problem of delayed diagnosis and lengthy waiting times. Evidence used in the development of action plans was gathered from a sequential mixed methods study to further understand the reasons for the long waiting time and potential solutions. This is the first published investigation, from the perspective of diagnosing professional teams, of the reasons for delays, which also generates solutions. Methods: Ninety five clinicians from 8 child and 8 adult services attended 16 focus groups to explore clinicians' views on a) reducing the wait for diagnosis and b) providing a good quality diagnostic process with good adherence to clinical guidelines. During focus groups, quantitative data were fed back, used to frame discussions and facilitate solution focused action planning with each service. Sixteen local action plans were synthesised to create an ASD Action Plan for children and an ASD Action Plan for adults. Results: Key solutions are proposed to support the reduction of the wait for diagnostic assessment, through reducing non-attendance rates, reducing inappropriate referrals, developing efficient working and communication and improving the effectiveness of care pathways. These are presented in actions plans for use by clinical teams. Conclusion: The first step in addressing the clinical challenge of increased wait for diagnostic assessment of ASD is understanding the complex and multi-factorial reasons for delays. The action plans developed here through systematic enquiry and synthesis may provide clinical diagnostic teams with evidence based guidance on common challenges and solutions to guide future quality improvement programmes. Future research to evaluate whether using Action Plans leads to a reduction in waiting times would be of value.