The Effect of a Brief Training Intervention on Teacher and Parent Referral Accuracy for Youth on the Autism Spectrum

Author

Kristen Elizabeth Boog, Southern Illinois University CarbondaleFollow

Date of Award

8-1-2022

Degree Name

Doctor of Philosophy

Department

Psychology

First Advisor

Fehr, Karla

Abstract

As the prevalence of autism spectrum disorder (ASD) rises, the demand for services also increases. For individuals on the autism spectrum to access most of these services, a formal diagnosis is necessary. An accurate diagnosis also informs the type of services a child receives and whether that treatment will appropriately address their symptoms. Unfortunately, there is a shortage of professionals trained to recognize the signs of ASD and perform ASD diagnostic assessments. Thus, waitlists for diagnostic assessments can be months to years long. The problem of too few trained professionals is compounded by inappropriate referrals (i.e., children referred for ASD evaluations who do not exhibit signs of ASD). When children are referred to an inappropriate service, waitlists can be unnecessarily lengthened. Long waitlists can delay access to services with limited availability for children who would benefit from them by creating a bottleneck effect. Additionally, it may delay access to services for the incorrectly referred child who waits for inappropriate services (e.g., behavior therapy for ASD) rather than being directed to more appropriate services with potentially shorter waiting times (e.g., Cognitive-Behavioral Therapy for social anxiety). Children are typically referred for ASD-specific diagnostic assessments after failing a screening measure. However, existing screening measures have high rates of false positives. Further, given the misconceptions surrounding ASD, children may be referred based on symptoms that are incorrectly assumed to be symptoms of ASD (e.g., inattention, hyperactivity). Many children receive another diagnosis before being diagnosed with ASD, while other families are told their child does not have ASD before ultimately receiving an ASD diagnosis, suggesting that many referral sources and diagnosticians (e.g., pediatricians) lack proper knowledge of the symptom patterns seen in children on the autism spectrum. Adults who have frequent contact with children (e.g., teachers, parents) are ideally situated to identify signs of ASD as they see children over long periods of time and in a variety of situations. However, research shows that these individuals may lack knowledge and have misconceptions about ASD and the corresponding patterns of behavior and symptoms. Thus, for them to serve as effective early identifiers and accurate referral sources, they will need training in the presentation and diagnostic criteria of ASD. The present study examined whether a brief and specific training increased parents’ and teachers’ knowledge of ASD and their ability to accurately identify children in need of referrals for ASD diagnostic services. Sixty-four parents of children ages 4 to 12 years and 24 teachers and teachers’ aides (referred to collectively as teachers) of pre-k through 5th grade were recruited through social media. Participants were primarily women (81.3% of parents, 83.3% of teachers) and White (81.3% of parents, 75.0% of teachers). All participants completed a demographics questionnaire and baseline measures of ASD knowledge and referral accuracy (assessed using hypothetical case examples). Participants were randomly assigned to view either a 5-minute video about ASD or a short brochure. Both training materials included the same information and wording. After the brief training intervention, post-training ASD knowledge and referral accuracy were assessed. Parents and teachers did not significantly differ in their baseline ASD knowledge nor their baseline referral accuracy. Additionally, there was not a significant increase in ASD knowledge from baseline to post-training for the sample. ASD knowledge was correlated with referral accuracy at baseline and post-training. The gender of the hypothetical case examples did not influence participants’ referral decisions. The majority of the sample had adequate baseline knowledge of ASD. Additionally, referral accuracy was also high at baseline. Therefore, it is possible that the training materials reviewed by the participants did not present information that was new to them. It is unclear if the degree of knowledge and referral accuracy in the present sample is reflective of the general population without replication. Future studies should examine ASD knowledge and referral accuracy in larger and more diverse samples. Additionally, the effect of the training in a sample with inadequate knowledge should also be studied.