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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.
  • Transcript

    • 1. THE ROLE OF SCREENING TOOLS IN INITIAL DIAGNOSIS
      NZPsS CONFERENCE
      August 2009
      Marian Power
      Consultant Psychologist
      Australian Council for Educational Research
    • 2. Features of Screening Tools
      Purpose – indicator for further investigation
      Response format
      Standardisation
      Administration time
      Scoring
    • 3. Screeners Across the Lifespan
      Early Childhood – ADEC
      Childhood and Adolescence – CAPP
      Adults – APP
      Elderly – NUCOG
    • 4. 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
    • 5. 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
    • 6. 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
    • 7. 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)
    • 8. 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.
    • 9. 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
    • 10. 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.
    • 11. Child and Adolescent PsychProfiler (CAPP)
      Candidates
      2–17 years of age
      Administration
      10–15 minutes per form
      Components
      3 Screening Forms:
      • Self – 111 items
      • 12. Parent – 111 items
      • 13. Teacher – 91 items
      Screens for
      20 disorders
    • 14. Adult PsychProfiler (APP)
      Candidates
      18+ years of age
      Administration
      25 minutes per form
      Components
      2 Screening Forms:
      • Self – 190 items
      • 15. Observer – 190 items
      Screens for
      23 disorders
    • 16. Screens for:
      • Generalised anxiety disorder
      • 17. Obsessive-compulsive disorder
      • 18. Panic disorder*
      • 19. Post-traumatic stress disorder
      • 20. Separation anxiety disorder^
      • 21. Specific phobia*
      • 22. Attention-deficit/hyperactivity disorder
      • 23. Conduct disorder
      • 24. Oppositional defiant disorder
      • 25. Expressive language disorder
      • 26. Motor and vocal tic disorder
      • 27. Tourette’s disorder
      * Not included in CAPP
      ^ Not included in APP
    • 28. Screens for:
      • Phonological disorder
      • 29. Dysthymic disorder
      • 30. Major depressive disorder*
      • 31. Anorexia nervosa
      • 32. Bulimia nervosa
      • 33. Disorder of written expression
      • 34. Antisocial personality disorder*
      • 35. Asperger’s disorder
      • 36. Autistic disorder
      • 37. Mixed receptive-expressive language disorder
      • 38. Mathematics disorder
      • 39. Reading disorder
      * Not included in CAPP
    • 40. Benefits of the PsychProfiler include:
      • Increased early identification and intervention
      • 41. Improved identification of disorders
      • 42. Improved referral practices
      • 43. Better assessment of outcomes
      • 44. Improved accessibility to assessment services
      • 45. A more objective and reliable tool
      • 46. Increased efficiency of clinical practice
      • 47. Assistance with Differential Diagnosis
      • 48. Improved communication of sensitive issues
    • Currently used by:
    • USER OPTIONS
      Gathering Data
      • Paper-and-pencil Forms; or
      • 57. Direct input into software
      Scoring and Reporting
      Software – ‘unlimited’ reports
    • 58. 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
    • 59. 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.
    • 60. Free Trial Version
      of CAPP / APP is available from:
      www.acer.edu.au/psychprofiler/
      (Limited to 5 reports each)
    • 61. NUCOGNeuropsychiatry unit cognitive assessment tool
      • Brief neurocognitive screening tool
      • 62. Assesses five major cognitive domains: attention, memory, language, executive and visuospatialfunctions
      • 63. 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
    • 64. 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)
    • 65. NUCOG Components
      Manual
      Interview Schedule
      Subject Completion Sheet
    • 66. Multidimensionality
      Five domains of function (each score /20)
      Attention
      Memory
      Visuoconstructional
      Executive
      Language
      Multiple items in each domain
    • 67. Sensitivity and Specificity: Dementia vs Non-dementia
      NUCOG 80 / 100
      Sensitivity: 0.88
      Specificity: 0.84
      MMSE 24 / 27
      Sensitivity: 0.72 / 0.86
      Specificity: 0.92 / 0.78
    • 68. Legend
      A Total – Attention
      B Total – Visuoconstructional
      C Total – Memory
      D Total – Executive
      E Total – Language
    • 69. Case 1
      • 81-year-old
      • 70. Global cognitive impairment
      • 71. CT - vascular pathology
      • 72. Perseveration
    • Case 2
      • 61-year-old man
      • 73. Memory problems
      • 74. Dx early AD
      NUCOG = 77
    • 75. NUCOG = 82.5
      MMSE = 30
      Case 3
    • Case 4
      • 55-year-old female professional
      • 78. Independent
      • 79. ?depressed since divorce
      • 80. ‘memory problems’
      • 81. Sick leave, running farm
      • 82. Driving
      • 83. Dx – Alzheimers disease
    • Marian Power
      CONSULTANT PSYCHOLOGIST
      Phone+61 3 9277 5411
      Emailpower@acer.edu.au
      www.acerpsychology.com.au
      Australian Council for Educational Research