Browsing by Person "McKenzie, Karen"

Now showing 1 - 4 of 4

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.
Factors influencing waiting times for diagnosis of Autism Spectrum Disorder in children and adults
(Elsevier, 2015-08-26) McKenzie, Karen; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Rutherford, Marion; Murray, Aja; Irvine, Linda
Aims: To identify the main factors predicting delays in diagnosis for Autism Spectrum Disorder (ASD) at three stages in the diagnostic process: wait for first appointment; assessment duration, and total wait for diagnosis. Method: Data were gathered from 150 case notes (80 child and 70 adult cases) from 16 diagnosing services across Scotland. Results: Having more information pre-assessment was associated with a reduced duration of the diagnostic process for children. This relationship was partially mediated by a reduction in the number of contacts required for diagnosis. In adults, having more factors associated with ASD (increased risk) reduced the wait time from referral to first appointment, but increased the overall duration of the diagnostic process. The latter relationship was partially mediated by an increase in the number of contacts required for diagnosis. Conclusion: Within children's services, increasing the amount of relevant information available pre-assessment is likely to reduce total duration of the assessment process by reducing number of contacts required. Having a high risk of ASD as an adult appears to result in being seen more quickly following referral, but also to increase the number of contacts needed and assessment duration. As a result, it increases and total duration overall. 2015 Elsevier Ltd.
The relation between practice that is consistent with NICE guideline 142 recommendations and waiting times within Autism Spectrum Disorder diagnostic services
(Elsevier, 2016-03-09) McKenzie, Karen; Rutherford, Marion; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Murray, Aja L.; Irvine, Linda
Background This study explores the extent to which recommendations from the National Institute of Health and Care Excellence (NICE) 142 guidelines, section 9.2 (relating to identification, assessment and diagnosis) reflected existing routine clinical practice in Autism Spectrum Disorder (ASD) diagnosing services in Scotland; and whether there was a significant relation between routine practice which more closely reflected these recommendations and waiting times. Method A cross-sectional, retrospective case note analysis of recently diagnosed adults, in eight ASD services across Scotland. Results The study found that the existing practice of the participating services was consistent with 14 (maximum number) of the included recommendations in at least half of cases analysed (range 37-70 cases) and was not related to increased total waiting time for diagnosis. Conclusion The results, based only on the included recommendations, suggest that the section 9.2 recommendations can be integrated into clinical practice in Scotland with relative ease and that it is unlikely to have a negative impact on waiting times.
The relationship between waiting times and 'adherence' to the Scottish Intercollegiate Guidelines Network 98 guideline in autism spectrum disorder diagnostic services in Scotland
(SAGE, 2015-06-01) McKenzie, Karen; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Rutherford, Marion; Murray, Aja; Irvine, Linda; The Scottish Government
The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence)to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits.