Community paediatrics in transition.
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Australia↗
Biomedical subjects
Catherine Skellern
Publications and source records attributed to Catherine Skellern.
From complexity to category: responding to diagnostic uncertainties of autistic spectrum disorders.
OBJECTIVE: Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland. METHODS: Using anonymous self-report, all Queensland child psychiatrists and paediatricians who see paediatric patients with development/behavioural problems were surveyed and asked whether they had ever specified an ASD diagnosis in the presence of diagnostic uncertainty. Using logistic regression, elicited responses to the diagnostic uncertainty questions were related to other clinical- and practice-related characteristics. RESULTS: Overall, 58% of surveyed psychiatrists and paediatricians indicated that, in the face of diagnostic uncertainty, they had erred on the side of providing an ASD diagnosis for educational ascertainment and 36% of clinicians had provided an autism diagnosis for Carer's Allowance when Centrelink diagnostic specifications had not been met. CONCLUSION: In the absence of definitive biological markers, ASD remains a behavioural diagnosis that is often complex and uncertain. In response to systems that demand a categorical diagnostic response, specialists are providing ASD diagnoses, even when uncertain. The motivation for this practice appears to be a clinical risk/benefit analysis of what will achieve the best outcomes for children. It is likely that these practices will continue unless systems change eligibility to funding based on functional impairment rather than medical diagnostic categories.
Autistic Disorder↗
Diagnosis of autistic spectrum disorders in Queensland: variations in practice.
OBJECTIVE: For both paediatricians and child psychiatrists, referrals to assess possible autistic spectrum disorders (ASD) are increasing. This study examines current practices of medical specialists in the assessment of these disorders. METHODS: An anonymous, self-report questionnaire was sent to all Queensland paediatricians and child psychiatrists. The survey elicited frequencies of consultation for ASD, diagnostic method, advice provided and perceived adequacy of training for this work. RESULTS: Responses were received from 79 (85%) eligible paediatricians and 26 (58%) eligible child psychiatrists. For one-third of all clinicians, new consultations for possible ASD occurred as often as 2-3 times per week. Most specialists approached the clinical diagnosis of ASD by considering history from different sources and professional assessments. Paediatricians (86%) were more likely than child psychiatrists (62%) to request genetic studies for children with severe autism (P = 0.01). Both general paediatricians and developmental paediatricians perceived level of training for possible ASD consultations was significantly worse than child psychiatrists (P < 0.001 and P = 0.02, respectively), but no difference was found between paediatric groups (P = 0.27). Perceived adequacy of specialist training was not associated with length of experience in clinical practice. CONCLUSION: Medical practice in Queensland around diagnosis of ASD is characterized by considerable variability. There is still a long way to go if we are to achieve consistency around medical issues of organic diagnosis and practices impacting on health as well as consideration of differential developmental diagnoses. The finding that recently trained paediatricians felt just as unprepared for this work as their older colleagues suggests that the graduate training response to this 'new morbidity' has not been adequate.
Autistic Disorder↗
Role of the tertiary child protection paediatrician: expert and advocate.
AIM: The role of the child protection paediatrician is varied. This study examines perceptions of how tertiary child protection (tCP) paediatricians view their multifaceted roles, perceived adequacy of length of pre-FRACP training and how this relates to confidence and satisfaction in their roles. METHODS: An anonymous self-report survey was distributed to child protection paediatricians working in tertiary hospitals across New Zealand and Australia. The survey addressed the adequacy of training and confidence within the diverse roles encountered within child protection work. It also identified perceptions of stress and satisfaction. RESULTS: Responses were received from 32 out of 45 of eligible tCP paediatricians (72%). The majority (71.8%) had entered directly into a tCP unit in their first consultant position. Two-thirds (65.7%) of tCP paediatricians received less than 4 months of pre-FRACP child protection training while a third received no training at all. Generally tCP paediatricians perceived their training in all domains of child protection to be inadequate although their current confidence levels in all roles are high. They expressed most concerns within their role as forensic expert. CONCLUSION: Despite receiving little or no training pre-FRACP in child protection, this group of tCP paediatricians function in their specialised roles in tCP and feel confident in fulfilling the dimensions of forensic expert and child advocate. As the field of medical child protection continues to evolve, it is important for training to keep pace with expectations of the varied roles of the paediatric specialist in child protection.
Child↗