PhD/PsyD ADOS-2 “Final Results” determined by individuals not present during administration?

[pediatric_psydoc]

Has anyone ever heard of speech therapists administering the ADOS-2, coding it, and providing the codes to someone else (in this case, a neurodevelopmental pediatrician or NP) for them to “have the final say” on whether the results support an ASD diagnosis when the NDV pediatrician was not present during the administration? I am seeing this happen at a top AMC, and to me it seems off because the person giving the “final say” did not observe firsthand any of the behaviors on which the coding is based. Autism is not my area of expertise so I wanted to hear from others about this practice. Thanks!

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[mypointlesspov]

I just did ADOS-2 training the other week and they literally told us not to do this because ADOS-2 interpretation relies so heavily on live observation.

 

[WisNeuro]

Haven't seen it, but having seen speech therapists practice grossly out of their scope for some time now, I am not surprised.

 

[Sanman]

Top AMC or not, everything is healthcare is becoming about the bottom line. Finding a way to increase billables surprises me not at all. One wonders what the pediatrician is also billing for that likely never happened as well. You would have to be an idiot to sign it with no financial incentive.

 

[borne_before]

In my state, I've even seen dirty applied behavioral analysts give it. Hell, during a fellowship in grad school, I saw a human development phd student give one for a developmental pediatrician.

Theres an autism start up in my state that has psychometrists doing everything, then a psych writes the report up and never actually contexts or observes the kiddo. The goal is to streamline treatment.

Here is my attempt at steelmanning this practice: 9 times out 10, when I give an ADOS-2, it's not to provide a clearer diagnostic picture. It's because some insurances really like to have ADOS-2 before they will pay for ABA. It's probs okay in that context.

But in 20 years, autism will be a dogfeces diagnosis that doesn't actually mean anything either way.

 

[cara susanna]

In my state, I've even seen dirty applied behavioral analysts give it. Hell, during a fellowship in grad school, I saw a human development phd student give one for a developmental pediatrician.

Theres an autism start up in my state that has psychometrists doing everything, then a psych writes the report up and never actually contexts or observes the kiddo. The goal is to streamline treatment.

Here is my attempt at steelmanning this practice: 9 times out 10, when I give an ADOS-2, it's not to provide a clearer diagnostic picture. It's because some insurances really like to have ADOS-2 before they will pay for ABA. It's probs okay in that context.

But in 20 years, autism will be a dogfeces diagnosis that doesn't actually mean anything either way.

Can you elaborate on that last comment more?

 

[borne_before]

Can you elaborate on that last comment more?

It's become a catch all diagnosis for any weird kid. No one cares about criterion E or differential diagnosis. Parenting practices leading to highly rigid behavior. Poor differential diagnosis. Wholesale acceptance of autism as a personality feature/identity. Financial incentives tied to autism diagnosis, therapy, etc. The autism narrative fallacy.

 

[Sanman]

Can you elaborate on that last comment more?

It's become a catch all diagnosis for any weird kid. No one cares about criterion E or differential diagnosis. Parenting practices leading to highly rigid behavior. Poor differential diagnosis. Wholesale acceptance of autism as a personality feature/identity. Financial incentives tied to autism diagnosis, therapy, etc. The autism narrative fallacy.

Interesting opinion piece I read on the topic:

There's no autism epidemic. But there is an autism diagnosis epidemic

 

[clausewitz2]

It's become a catch all diagnosis for any weird kid. No one cares about criterion E or differential diagnosis. Parenting practices leading to highly rigid behavior. Poor differential diagnosis. Wholesale acceptance of autism as a personality feature/identity. Financial incentives tied to autism diagnosis, therapy, etc. The autism narrative fallacy.

I'm sure you have bucket loads of terrible referral anecdotes but the most egregious one I've seen is someone sending a five year old for autism evaluation because "he doesn't like to make eye contact when he's in trouble."

Y'know, not wanting to look someone in the eye when they're scolding you used to be considered the normative response

 

[smalltownpsych]

It's become a catch all diagnosis for any weird kid. No one cares about criterion E or differential diagnosis. Parenting practices leading to highly rigid behavior. Poor differential diagnosis. Wholesale acceptance of autism as a personality feature/identity. Financial incentives tied to autism diagnosis, therapy, etc. The autism narrative fallacy.

The any weird kid part is what I have seen dramatically increase over the last few years. I tend to talk with my patients about the difference between being different and a bit more sensitive to sensory stimuli and/or anxious and having marked social and communication deficits that cause an impairment in functioning. If they aren’t autistic, they tend to get it.