Improving early identification of autism and developmental delay
New Nepean Hospital research has highlighted the importance of detailed referral information in supporting earlier identification and triage for children with autism spectrum disorder (ASD) and global developmental delay.
The study, published in the Journal of Paediatrics and Child Health, examined referral concerns documented for children assessed at the Nepean Hospital Child Development Clinic and how these concerns related to subsequent diagnoses.
Clinical Associate Professor Dr Habib Bhurawala, Head of Paediatrics at Nepean Hospital and senior co-author of the study, says the findings may help improve access and prioritisation for children requiring specialist assessment.
“Demand for developmental assessment services has increased significantly in recent years, particularly for autism and related developmental conditions,” says Dr Bhurawala.
“Our study found that speech delay was the strongest predictor of an eventual autism diagnosis, while behavioural and motor concerns were more closely associated with global developmental delay and ADHD.”
The research reviewed children assessed at the Nepean Hospital Child Development Clinic between 2015 and 2019. Among the 161 children included in the study, speech delay and social interaction concerns were the most commonly documented referral issues.
Dr Alison Poulton, Senior Paediatrician at Nepean Hospital, Clinical Academic with The University of Sydney Nepean Clinical School, and senior co-author of the study, says the quality of referral information can play an important role in triage and early intervention planning.
“Detailed symptom-based referral information can help clinicians identify children who may benefit from earlier multidisciplinary assessment and support,” says Dr Poulton.
“The findings also highlight the important role of allied health professionals, particularly speech pathologists, in recognising developmental concerns early.”
The study found that while some referral concerns were strongly associated with later diagnoses, others lacked diagnostic specificity. In particular, observer impressions of abnormal sensory behaviour, repetitive behaviour, motor mannerisms, or fixated interests showed no predictive value. This indicates that in the absence of more substantial developmental concerns, these symptoms alone do not justify a multidisciplinary developmental assessment.
The research also reflects the growing focus within Nepean Blue Mountains Local Health District on using real-world clinical data to improve patient care, service planning, and access to specialist services.
“Our aim is to undertake research that has practical relevance to clinicians, families, and health services,” says Dr Bhurawala.
“By better understanding referral patterns and diagnostic outcomes, we can help support earlier identification and contribute to more effective care pathways for children.”
The project was a collaboration between clinicians and researchers from Nepean Hospital, Nepean Blue Mountains Local Health District, The University of Sydney, and The University of Notre Dame Australia.
The full study, Predictive Value of Referral Concerns for Autism Spectrum Disorder and Global Developmental Delay: A Retrospective Audit of a Tertiary Paediatric Developmental Service, is available online in the Journal of Paediatrics and Child Health.