Marian Power -The Role of Screening Tools in Initial Diagnosis


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  • 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.
  • Marian Power -The Role of Screening Tools in Initial Diagnosis

    1. 1. THE ROLE OF SCREENING TOOLS IN INITIAL DIAGNOSIS<br />NZPsS CONFERENCE <br />August 2009<br />Marian Power<br />Consultant Psychologist<br />Australian Council for Educational Research<br />
    2. 2. Features of Screening Tools<br />Purpose – indicator for further investigation <br />Response format<br />Standardisation<br />Administration time<br />Scoring<br />
    3. 3. Screeners Across the Lifespan<br />Early Childhood – ADEC<br />Childhood and Adolescence – CAPP<br />Adults – APP<br />Elderly – NUCOG<br />
    4. 4. ADECAutism Detection in Early Childhood<br />Purpose<br />To screen for autistic tendencies in young children<br />Candidates<br />12 months–3 years of age<br />Administration<br />10–15 minutes<br />Components<br />Scoring sheet, Manual, Training DVD<br />
    5. 5. ADEC Behaviours<br />Nestling into caregiver <br />Response to name <br />Upset when line of blocks is disturbed<br />Gaze switching (tiger or car)<br />Eye contact in game <br />Functional play (toy telephone or car) <br />Reciprocity of a smile <br />Pretend play <br />
    6. 6. ADEC Behaviours<br />Gaze monitoring – follows point <br />Imitation <br />Responds to verbal command<br />Demonstrates use of words <br />Anticipatory posture to be picked up<br />Use of Gestures: wave/blow kiss <br />Ability to switch to new task<br />Response to everyday sounds<br />
    7. 7. Scoring the ADEC<br />A score of 0, 1, or 2 is assigned to the presence or absence of each of the 16 behaviours.<br />The aggregate score is compared to normed cut-off scores that suggest:<br />Low risk (no further action)<br />Moderate risk (review child)<br />High risk (further testing required)<br />Very high risk (formal autism assessment strongly recommended)<br />
    8. 8. Importance of Early Detection<br />Prior to the ADEC, children with autistic disorders could not be easily identified until they were three or four years of age. <br />This is a serious issue because research indicates children with autism are more responsive to early interventions before difficult behaviours become entrenched. <br />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.<br />
    9. 9. What happens when the ADEC suggests the presence of AD?<br />Why do you need a diagnosis?<br />services<br />support<br />intervention<br />What next?<br />Author argues that the core-deficit linked behaviours should be the target of intervention to minimise the emergence of traditional autistic behaviours. <br />Dr Young has written SPECTRA, an intervention program<br /><br />
    10. 10. Developed in Australia by Dr Shane Langsford (University of Western Australia), Professor Stephen Houghton and Dr Graham Douglas.<br />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.<br />
    11. 11. Child and Adolescent PsychProfiler (CAPP) <br />Candidates<br />2–17 years of age<br />Administration<br />10–15 minutes per form <br />Components<br />3 Screening Forms:<br /><ul><li>Self – 111 items
    12. 12. Parent – 111 items
    13. 13. Teacher – 91 items</li></ul>Screens for<br />20 disorders<br />
    14. 14. Adult PsychProfiler (APP) <br />Candidates<br />18+ years of age<br />Administration<br />25 minutes per form <br />Components<br />2 Screening Forms:<br /><ul><li>Self – 190 items
    15. 15. Observer – 190 items</li></ul>Screens for<br />23 disorders<br />
    16. 16. Screens for:<br /><ul><li>Generalised anxiety disorder
    17. 17. Obsessive-compulsive disorder
    18. 18. Panic disorder*
    19. 19. Post-traumatic stress disorder
    20. 20. Separation anxiety disorder^
    21. 21. Specific phobia*
    22. 22. Attention-deficit/hyperactivity disorder
    23. 23. Conduct disorder
    24. 24. Oppositional defiant disorder
    25. 25. Expressive language disorder
    26. 26. Motor and vocal tic disorder
    27. 27. Tourette’s disorder</li></ul>* Not included in CAPP<br />^ Not included in APP<br />
    28. 28. Screens for:<br /><ul><li>Phonological disorder
    29. 29. Dysthymic disorder
    30. 30. Major depressive disorder*
    31. 31. Anorexia nervosa
    32. 32. Bulimia nervosa
    33. 33. Disorder of written expression
    34. 34. Antisocial personality disorder*
    35. 35. Asperger’s disorder
    36. 36. Autistic disorder
    37. 37. Mixed receptive-expressive language disorder
    38. 38. Mathematics disorder
    39. 39. Reading disorder</li></ul>* Not included in CAPP<br />
    40. 40. Benefits of the PsychProfiler include:<br /><ul><li>Increased early identification and intervention
    41. 41. Improved identification of disorders
    42. 42. Improved referral practices
    43. 43. Better assessment of outcomes
    44. 44. Improved accessibility to assessment services
    45. 45. A more objective and reliable tool
    46. 46. Increased efficiency of clinical practice
    47. 47. Assistance with Differential Diagnosis
    48. 48. Improved communication of sensitive issues</li></li></ul><li>Currently used by:<br /><ul><li>Psychologists
    49. 49. Psychiatrists
    50. 50. General Practitioners
    51. 51. Paediatricians
    52. 52. Special Needs Teachers
    53. 53. Speech Pathologists
    54. 54. School Counsellors
    55. 55. Chiropractors
    56. 56. Mental Health Nurses </li></li></ul><li>USER OPTIONS<br />Gathering Data<br /><ul><li>Paper-and-pencil Forms; or
    57. 57. Direct input into software</li></ul>Scoring and Reporting<br />Software – ‘unlimited’ reports<br />
    58. 58. Scoring the PsychProfiler<br />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:<br />Never <br />Rarely<br />Sometimes<br />Regularly<br />Often<br />Very Often<br />
    59. 59. Scoring the PsychProfiler<br />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.<br />
    60. 60. Free Trial Version<br />of CAPP / APP is available from: <br /><br />(Limited to 5 reports each)<br />
    61. 61. NUCOGNeuropsychiatry unit cognitive assessment tool<br /><ul><li>Brief neurocognitive screening tool
    62. 62. Assesses five major cognitive domains: attention, memory, language, executive and visuospatialfunctions
    63. 63. Used to screen for neurocognitive functioning, aid diagnosis and intervention</li></li></ul><li>Authors<br />Mark Walterfang <br /> Consultant Neuropsychiatrist, Royal Melbourne Hospital <br />Dennis Velakoulis <br /> Director of Neuropsychiatry, Royal Melbourne Hospital<br />
    64. 64. Features<br />Global assessment, assesses domains of cognition (has breadth and depth)<br />Sensitive to presence of illness and change<br />Paper and pencil format; brief, portable and minimal materials required<br />15 minutes to administer, easy to perform<br />Clear guidelines for administering and scoring<br />Scores can be put online, made available on PDA<br />Test can be administered by non-medical or non-clinical personnel<br />Tool has strong reliability, validated against other instruments (e.g. MMSE)<br />
    65. 65. NUCOG Components<br />Manual<br />Interview Schedule<br />Subject Completion Sheet<br />
    66. 66. Multidimensionality<br />Five domains of function (each score /20) <br />Attention<br />Memory<br />Visuoconstructional<br />Executive<br />Language<br />Multiple items in each domain<br />
    67. 67. Sensitivity and Specificity: Dementia vs Non-dementia<br />NUCOG 80 / 100<br />Sensitivity: 0.88<br />Specificity: 0.84<br />MMSE 24 / 27<br />Sensitivity: 0.72 / 0.86<br />Specificity: 0.92 / 0.78<br />
    68. 68. Legend<br />A Total – Attention<br />B Total – Visuoconstructional<br />C Total – Memory<br />D Total – Executive<br />E Total – Language<br />
    69. 69. Case 1<br /><ul><li>81-year-old
    70. 70. Global cognitive impairment
    71. 71. CT - vascular pathology
    72. 72. Perseveration</li></li></ul><li>Case 2<br /><ul><li>61-year-old man
    73. 73. Memory problems
    74. 74. Dx early AD</li></ul>NUCOG = 77<br />
    75. 75. NUCOG = 82.5<br />MMSE = 30<br />Case 3<br /><ul><li>45-year-old man
    76. 76. FHx-FTD
    77. 77. ‘Depression’</li></li></ul><li>Case 4<br /><ul><li>55-year-old female professional
    78. 78. Independent
    79. 79. ?depressed since divorce
    80. 80. ‘memory problems’
    81. 81. Sick leave, running farm
    82. 82. Driving
    83. 83. Dx – Alzheimers disease</li></li></ul><li>Marian Power<br />CONSULTANT PSYCHOLOGIST<br />Phone+61 3 9277 5411<br /><br /><br />Australian Council for Educational Research<br />