New ASD Clinical Research and Services at the Douglas Hospital
In the 1990’s, new tools for early diagnosis and treatment increased the interest in early intervention in ASD, and especially with the role of parents in coordinating and delivering treatment. During my tenure at the Centre Hospitalier Douglas, I came to focus much of my clinical and research work on children with autism.
In 1994, I led the creation of an intensive, bilingual, multidisciplinary treatment program (the Therapeutic Nursery) with the support of other clinicians at the hospital. We coached small groups of parents on how to work directly with their toddler or preschooler on early social, communication, and play skills. Over the course of the 6 hour/week, 14 week program, parents also participated in parent education and support groups, while their child completed other assessments and interventions.
Over a 5 year period, I provided psychological services and acted as the team leader for the program. I also conducted full diagnostic assessments (using the ADOS and ADI-R), as well as cognitive and adaptive behavior assessments on all participating children. This program helped to extend the hospital’s ASD diagnostic clinic to address the needs of younger children.
These new clinical services led to the development of a parallel program of research supported by the provincial government. I used emerging research indicating specific breakdowns in the early social, play, and imitation skills to explore the creation of an assessment protocol that would reliably differentiate autism from simple developmental delay in preschoolers (Doehring, Benaroya, Klaiman, & Scuccimarri, 1995; Doehring, Burack, & Benaroya, 1996; Doehring, Burack, Benaroya, Klaiman, Steinbach, & Wayland 1997; Doehring, Burack, Klaiman, Steinbach, & Benaroya, 1998). In the course of completing this research, I helped Peter Mundy to develop a detailed, written manual for the Early Social Communication Scales, the most frequently used measure of social communication in early research on autism (Mundy, Doehring, & Hogan, 2003).
At the Douglas Hospital, I also began to recognize the potential impact of broad policy decisions on day-to-day clinical work, and sought other leadership opportunities. I was subsequently elected by 35o allied health professionals (e.g., all clinicians employed by the hospital who were neither physicians nor nurses) as one of five representatives. I served as Vice President of this elected body (the Multidisciplinary Council) for four years, representing the interests of our 350 members to the hospital's executive committee for all clinical, research, and administrative concerns. In that capacity, I also served as the sole representative of these 350 staff as a full member of the hospital's Board of Director for two years. I also served as Director of the Department of Psychology for Child and Adolescent Services over a one year period. A majority of my clinical and administrative work as well as a number of papers (Doehring, 2001), presentations, (Doehring, 1997), and other works (Doehring, 1997) were completed in French, a second language acquired as a young adult.
Founded in 1881, the Douglas is a regional psychiatric hospital in Montreal affiliated with McGill University.
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Multidisciplinary teams magnify the reach and impact of individual professionals when they carefully draw on the strengths and role of each partner
The importance of multi- and transdisciplinary teamwork was emphasized throughout my training, but early in my career I realized teamwork is not something that "just happens". It requires an understanding and an appreciation for the unique contribution of each discipline, and a team structure that balances leadership and shared decision making.
In the case of ASD, this is complicated by the fact that different disciplines espouse different theories about ASD, rely on different techniques for assessment and treatment, and may play different roles in hospital-, school-, and university-based programs. As the elected representative of multiple disciplines to the Hospital's executive, I met regularly with department heads to capture their concerns. In every organization in which I have worked since, I have sought to clarify the role(s) of each discipline, educate professionals about the roles and contributions of their colleagues, and actively championed teaming.
The logo is adapted from Joaquim Alves Gaspar's drawing of Pedro Reinel's compass rose.
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My Presentations and Publications
With Cheryl Klaiman & Jake Burack (1997). The multifaceted nature of attention: Possible cognitive and social pathways to autism. European Congress of Psychology, Dublin, Ireland.
With Jake Burack, Cheryl Klaiman, Lisa Steinbach, & Sigmund Benaroya. (1998). Joint attention behavior in Autism: Developmental delay or developmental deviation? International Society for the Study of Behavioral Development, Berne, Switzerland.
With Jake Burack, Sigmund Benaroya, Cheryl Klaiman, Lisa Steinbach, & Lee Ann Wayland(1997). A developmental hierarchy of play skills in young children with developmental delays and developmental disorders. Society for Research in Child Development, Washington, DC.
With Jake Burack and Sigmund Benaroya(1996). Are joint attention, pretend play, play flexibility, and imitation counter-indicative of autism in young children? International Society for the Study of Behavioral Development, Quebec City, Canada.
With Sigmund Benaroya, Cheryl Klaiman, & Connie Scuccimarri, (1995). The role of social, play, imitation, and joint attention skills in the differential diagnosis of autism and developmental delay. Society for Research in Child Development, Indianapolis, IN
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