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C59. Introducing the Ritvo Autism Asperger Diagnostic Screening Tool – Revised in a Residential Substance Use Disorder Treatment Facility

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  • Cost: Free
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Learner category:

  • Expert Level

Learning objectives:

  • The purpose of this quantitative quasi-experimental
    project was to compare the prevalence or rate of patients
    identified with comorbid ASD/SUD after implementation
    of a validated ASD screening tool to the prevalence or rate
    of patients identified with no screening tool among adult
    patients admitted to a dual-diagnosis residential SUD
    treatment program in the western region of the United
    States within a four week period. The independent variable
    was the use of the RAADS-R and the dependent variable
    was the number or rate of patients screened positive by
    scoring 65 or higher on the RAADS-R, which is consistent
    with a diagnosis of ASD, or a prior diagnosis of ASD (Ritvo
    et al., 2016).
  • A second part of this quality improvement project was to
    show changes in staff confidence levels in diagnosis and
    individualized ASD interventions after provider education.
    An online video education was provided on the DSM-5
    ASD diagnostic criteria and adaptive ASD interventions,
    and was intended to improve the effectiveness of
    increasing referrals for further ASD diagnostic work-up
    and providing interventions consistent with ASD/SUD
    comorbidity in order to possibly enhance treatment
    retention. Staff confidence levels were analyzed in a pre and post-                                                                                                                                                                              type of survey measure using the TCS-ID


Undiagnosed autism spectrum disorder (ASD) in residential
substance use disorder (SUD) programs can lead to premature
departure and increased morbidity and mortality and could
be prevented using quality improvement measures. Available
literature lacks sufficient evidence on the impact of screening tool
implementation combined with staff education in increase of ASD
diagnoses. The purpose of this quantitative, quasi-experimental
quality improvement project was to investigate whether
implementing the Ritvo Autism Asperger Diagnostic Scale – Revised
(RAADS-R) tool with staff education increased the rate and number
of ASD diagnoses pre- and post-implementation compared with
prior practice where no validated tool or education were used. Staff
pre- and post-ASD knowledge, experience, and comfort levels were
analyzed using the Therapist Confidence Scale – Intellectual Disability
(TCS-ID). The theory of diffusion of innovation framed this project by
introduction of the RAADS-R and results (innovation) to generate
a new practice of utilizing the tool (diffusion). Participants included
all patients 18 years or older admitted to an adult residential dualdiiagnosis                                                                                                                                                                   SUD treatment facility in western California. Total data
analysis time period was 12 months pre-implementation and four
weeks post-implementation. A total of five ASD diagnoses occurred—
zero pre-implementation and five post-implementation. The total
percentage of ASD diagnoses increased significantly from 0% to 16.1%
post-implementation (p <.00001). A paired-samples t test comparing
pre- and post-education staff confidence levels in treating ASD
revealed significant changes across time (p = .012). Patients identified
were referred for further diagnostics and individualized treatment
plans. Additional investigation with a longer intervention period is


Deborah Bowman
DNP, PhD, CARN-AP, NP MindTherapy Clinic

MindTherapy Clinic, California, USA
Dr. Bowman is a board certified addiction nurse practitioner
specializing in co-occurring disorders at the MindTherapy Clinic,
a psychiatric outpatient clinic as well as the Alta Mira and Living
at Reflections residential substance use disorder facilities in
Marin County, California. She is EMDR certified and provides
substance detoxification as well as multiple forms of MAT to include
buprenorphine (sublingual, subcutaneous and implanted) and
ketamine-assisted psychotherapy. Dr. Bowman has worked in
substance use disorder for thirty years and graduated from the
University of Michigan, Michigan State University and Grand Canyon
University and is a veteran of the United States Marine Corps.

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Deborah Bowman
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