Perseveration: tendency for an activity to recur even when there is no apparent stimulus and the activity has no obvious usefulness.
Memory score 12/20, other domains within normal limitsShowing non verbal memory impairment in early AD
45 y.o professionalPresented with depressionPoor verbal fluency was the only cognitive findingFather and uncle died of dementiaDx - Frontotemporal dementia
Librarian with AD who held it together for a long time because she was very bright and language was maintained for a long time. She was able to cover up her deficits well.Came to attention because she had a farm - daughters and friends noted she was neglecting the animals.Librarian with AD who held it together for a long time because she was very bright and language was maintained for a long time. She was able to cover up her deficits well.Came to attention because she had a farm - daughters and friends noted she was neglecting the animals.
THE ROLE OF SCREENING TOOLS IN INITIAL DIAGNOSIS NZPsS CONFERENCE August 2009 Marian Power Consultant Psychologist Australian Council for Educational Research
Features of Screening Tools Purpose – indicator for further investigation Response format Standardisation Administration time Scoring
Screeners Across the Lifespan Early Childhood – ADEC Childhood and Adolescence – CAPP Adults – APP Elderly – NUCOG
ADECAutism Detection in Early Childhood Purpose To screen for autistic tendencies in young children Candidates 12 months–3 years of age Administration 10–15 minutes Components Scoring sheet, Manual, Training DVD
ADEC Behaviours Nestling into caregiver Response to name Upset when line of blocks is disturbed Gaze switching (tiger or car) Eye contact in game Functional play (toy telephone or car) Reciprocity of a smile Pretend play
ADEC Behaviours Gaze monitoring – follows point Imitation Responds to verbal command Demonstrates use of words Anticipatory posture to be picked up Use of Gestures: wave/blow kiss Ability to switch to new task Response to everyday sounds
Scoring the ADEC A score of 0, 1, or 2 is assigned to the presence or absence of each of the 16 behaviours. The aggregate score is compared to normed cut-off scores that suggest: Low risk (no further action) Moderate risk (review child) High risk (further testing required) Very high risk (formal autism assessment strongly recommended)
Importance of Early Detection Prior to the ADEC, children with autistic disorders could not be easily identified until they were three or four years of age. This is a serious issue because research indicates children with autism are more responsive to early interventions before difficult behaviours become entrenched. Early diagnosis can lead to significantly better quality of life and developmental outcomes, with subsequent major savings in health care costs estimated to be between $4.5 and $7.2 million annually in Australia alone.
What happens when the ADEC suggests the presence of AD? Why do you need a diagnosis? services support intervention What next? Author argues that the core-deficit linked behaviours should be the target of intervention to minimise the emergence of traditional autistic behaviours. Dr Young has written SPECTRA, an intervention program http://shop.acer.edu.au/acer-shop/group/SPEC
Developed in Australia by Dr Shane Langsford (University of Western Australia), Professor Stephen Houghton and Dr Graham Douglas. Oriented to the DSM-IV-TR, PsychProfiler provides an accessible and affordable screener that can be used in the early identification of disorders prior to formal diagnosis.
Child and Adolescent PsychProfiler (CAPP) Candidates 2–17 years of age Administration 10–15 minutes per form Components 3 Screening Forms:
Scoring and Reporting Software – ‘unlimited’ reports
Scoring the PsychProfiler All items on the CAPP and APP require responses to be made on a six-point ordered scale pertaining to the perceived frequency of the behaviour: Never Rarely Sometimes Regularly Often Very Often
Scoring the PsychProfiler The summation of the items within each disorder produces a screening score for that disorder. If the screening score meets or exceeds the screening cut-off score, the individual is designated as a positive screen.
Free Trial Version of CAPP / APP is available from: www.acer.edu.au/psychprofiler/ (Limited to 5 reports each)
NUCOGNeuropsychiatry unit cognitive assessment tool
Brief neurocognitive screening tool
Assesses five major cognitive domains: attention, memory, language, executive and visuospatialfunctions
Used to screen for neurocognitive functioning, aid diagnosis and intervention
Authors Mark Walterfang Consultant Neuropsychiatrist, Royal Melbourne Hospital Dennis Velakoulis Director of Neuropsychiatry, Royal Melbourne Hospital
Features Global assessment, assesses domains of cognition (has breadth and depth) Sensitive to presence of illness and change Paper and pencil format; brief, portable and minimal materials required 15 minutes to administer, easy to perform Clear guidelines for administering and scoring Scores can be put online, made available on PDA Test can be administered by non-medical or non-clinical personnel Tool has strong reliability, validated against other instruments (e.g. MMSE)