Dr. Julie Scorah, a distinguished neuropsychologist, has made significant contributions in the field of neurodevelopmental disorders. Since 2019, she has enriched the academic community as an Assistant Professor (Professional) in McGill University’s Department of Neurology and Neurosurgery, Faculty of Medicine and Health Sciences.
With over 18 years of clinical experience, Dr. Scorah has been a pivotal figure in neurodevelopmental assessment and diagnosis at renowned institutions like the McMaster Children’s Hospital, the Alberta Children’s Hospital, the Montreal Children’s Hospital, and The Neuro (Montreal Neurological Institute-Hospital). From 2019 to 2023, she served as the Associate Director of the Azrieli Centre for Autism Research (ACAR) Clinic located at The Neuro. She is currently a research member of ACAR and the collaborative research network, Transforming Autism Care Consortium (TACC). She is a co-investigator on the Quebec 1000 Families (Q1K) project, a Quebec-wide scientific collaboration across 6 institutions aiming to build a next-generation cohort to drive discovery in autism research. Her multifaceted experience spans across leading multidisciplinary teams for autism intervention in diverse settings and spearheading clinical research in assessment protocols and project development, including her role as a clinical site leader in various multi-site research initiatives.
What was your path into medicine and how has it evolved within academia?
At first, I was drawn by the allure of psychology without a specific focus in mind. Choosing to specialize in Autism Spectrum Disorder (ASD) didn’t occur intentionally during my graduate studies. Yet, I find myself deeply engaged and fulfilled in this particular field. I attribute my career trajectory to my innate curiosity and eagerness to explore new and intriguing concepts. This openness to learning and exploring has navigated me through various opportunities. My career has been enriched by working alongside incredibly talented individuals, which significantly influenced my path. It’s through these collaborations and networks that I found my way to McGill University, where I uniquely straddle the worlds of clinical practice and academic research. It’s quite rare to transition from clinical practice back into academia, and I am grateful for this unique blend in my career.
My journey has also been geographically diverse, allowing me to work in four different hospitals across three provinces. Each place has offered invaluable learning experiences and the chance to work with some of the most remarkable professionals in the field. I consider myself extremely fortunate to have had such a varied and enriching professional journey.
What are you focused on at McGill and The Neuro?
In my role at McGill and The Neuro, my involvement has varied among teaching, clinical practice, and research, adapting to the demands and opportunities of the moment. There have been phases in my career when I was fully engaged in clinical work, while at other times, my focus shifted to balancing clinical duties with research. Currently, I'm predominantly involved in research, but I'm actively working towards re-engaging more significantly in clinical practice.
The transition between these roles is not always straightforward. One significant challenge is the high demand for clinical services, which can limit the time available for research. However, I've been fortunate to maintain a presence in both areas. This dual involvement allows me to contribute valuable insights to each field, bridging the gap between clinical practice and research.
My role often involves mentoring and supervising students, ensuring that I remain connected to both clinical and research domains, regardless of my primary focus at any given time.
I believe that clinicians who are directly involved with patients bring essential perspectives to research. This model is more common in medicine but less so in allied health professions. Being actively involved in research is crucial for staying abreast of the latest developments in the field. It naturally leads to integrating new knowledge and findings into clinical practice. The main challenge is not the integration of knowledge per se but the accessibility to research opportunities for clinicians. Many clinicians find it difficult to stay updated with research advancements due to limited access.
How does your research at ACAR and TACC directly benefit patients?
My work at ACAR and TACC aims to narrow the historically long gap between research findings and clinical practice, which traditionally spanned about 15 to 20 years. Having professionals who are engaged both in research and clinical practice is crucial for this purpose. We can swiftly integrate new findings into clinical settings, ensuring that our practices are current and evidence based. This direct integration greatly benefits patients, as they receive care informed by the latest research developments.
Additionally, patients sometimes benefit directly from participating in research studies. The Quebec 1000 (Q1K) Families study provides access to resources not typically available in the publicly funded healthcare system. For example, participants can receive genetic testing like whole genome sequencing, which is currently not covered by standard healthcare insurance. This access allows patients to benefit from advanced technologies, more comprehensive data, and deeper assessments that go beyond what is usually available through public healthcare.
This work updates clinical practices with cutting-edge findings and offers patients unique opportunities to access advanced medical resources and assessments. These efforts help advance quality of care for patients, potentially setting a precedent for future standards in healthcare.
What specific areas of research are captivating for you right now?
The aspect of my research that excites me the most revolves around the themes of equity, access and the reduction of barriers.
As I reflect on the various projects I've been involved in, most of which I joined through collaborations, I realize the common thread is our focus on enhancing inclusion, access, and fostering equity. This theme resonates deeply with me and is a driving force behind my endeavors.
As a clinician, one of the most challenging aspects I've faced is witnessing patients who possess immense potential but are hindered by lack of access to necessary services at critical times. The limitations might be due to geographical constraints, language barriers, or other societal and systemic issues. This has been a consistent source of frustration in my clinical practice — seeing patients who could significantly benefit and improve if only they had access to the right resources and support.
My research interest is firmly anchored in exploring and developing strategies to increase equity and access to services, especially for those who have been traditionally underrepresented and underserved.
My goal is to address these barriers, creating a healthcare environment where every individual could receive the care they need, tailored to their unique circumstances. This focus on equitable access and reducing barriers is a professional interest and a personal passion, driving my work towards meaningful and impactful outcomes.
How do you see the state of services evolving over the next decade?
Looking ahead to the next decade, I anticipate a significant evolution in the state of services, particularly influenced by the growing inclusion and recognition of neurodivergent voices. There's a noticeable shift happening that includes the perspectives and experiences of neurodivergent individuals in research and policymaking.
The involvement of neurodivergent people in directing research efforts and shaping policies is expected to lead to services that more effectively improve their daily lives and align with their actual needs and experiences. By having a say in where research funding is allocated and what policies are developed, neurodivergent individuals are helping to create more accommodating and adaptive environments. This shift is about improving direct services and about reducing everyday barriers.
Another hopeful outcome of this evolution is a decrease in secondary mental health issues like anxiety and depression. By focusing on creating environments that are more inclusive and adaptive, quality of life for neurodivergent individuals can be improved and the root causes of these secondary issues can be addressed. This shift towards more inclusive and responsive services is a promising development.
What excites you about the ECHO-Autism series?
I'm deeply passionate about the ECHO-Autism project, and it's an honor to have been instrumental in introducing it to Quebec. The ECHO model uses technology to leverage telehealth platforms and connects specialists with community practitioners.
Traditionally, ECHO was designed to bridge the gap between specialists in urban centers and healthcare providers in rural communities who might not have easy access to specialized knowledge.
In healthcare, professionals often receive mentorship and training during their residency and internships, but continuous learning becomes challenging once they begin practicing independently. Conferences or courses don’t always provide the depth required for treating specific cases.
ECHO thrives on case-based discussions presented by participants. These cases are anonymous for confidentiality, allowing practitioners to discuss real patient scenarios and receive tailored advice and recommendations from a panel of experts. Participants gain insights into their own cases, and learn from diverse cases shared by others, broadening their knowledge and preparing them for future encounters.
ECHO is accessible. Participation is usually offered at no cost to the participant, removing financial barriers and opening doors. This makes ECHO an exceptional resource for continued professional development, enabling healthcare providers to offer the best possible care to their patients.
How do you envision the growth of clinical capacity related to autism and other mental health conditions in the Canadian healthcare system?
The key to addressing the challenge of limited practitioner supply and the increasing demand for healthcare services, particularly post-pandemic, lies in emphasizing training and education. This approach is at the heart of the ECHO model, which aims to reduce barriers to care by enhancing clinical capacity.
The reality is that many neurodivergent individuals are already receiving care for various co-occurring conditions like sleep disorders, mental health issues, gastrointestinal problems and epilepsy. However, practitioners often feel uncertain about treating these patients due to their neurodevelopmental conditions, such as autism, which might require specialized knowledge.
Our goal with ECHO is to empower existing practitioners. We want to convey that neurodivergent patients don't always need to be referred to specialty centers. Instead, they can receive effective treatment from their existing care providers, with the support of additional consultation and guidance. By doing so, we can reduce the need for referrals and the stress of moving patients from one clinic to another. Patients can continue with their existing healthcare providers, who, with the right training and support, can address a broader range of their healthcare needs.
The focus should be on expanding training opportunities so that more healthcare professionals feel confident and capable of treating patients with neurodevelopmental conditions. By doing this, we can lessen the reliance on specialists like myself. In fact, my ideal scenario would be to render my own specialization less necessary by ensuring that a wide range of healthcare providers possess the skills and knowledge to treat neurodivergent patients effectively. This approach would significantly improve the healthcare system's capacity to meet the growing demands in the context of autism and other neurodevelopmental conditions.
Are you able to share any memorable patient stories in terms of impact creation?
What stands out are the instances where patients come to us with a specific concern, like a query about Autism Spectrum Disorder, and through our evaluation process, we uncover additional, often overlooked aspects of their health.
Our approach is meticulous, focusing not just on the immediate concern but on the patient's overall development. In several cases, this thorough examination has led to the discovery of coexisting conditions, ranging from gastrointestinal issues to dental problems, and even epilepsy. These additional diagnoses often emerge from our referrals for further investigations, prompted by the realization that no one had yet taken a comprehensive look at the patient's overall condition.
This is particularly significant for many individuals on the autism spectrum, who may struggle with communication. Sometimes, their behavior is the only indicator of internal symptoms or pain. By closely observing these behaviors and delving deeper into their causes, we've been able to identify underlying medical issues. For example, what might initially appear as challenging or dysregulated behavior could, upon careful examination and history-taking, be a sign of physical discomfort or pain. It’s in these moments, where we uncover the root cause of a behavior through diligent investigation, that the true impact of our work becomes evident.
These experiences epitomize the essence and success of our patient-centered approach. It's in these discoveries and subsequent treatments that I find the most fulfillment, knowing that our comprehensive evaluation has made a significant difference in our patients' lives.
How is the learning that you acquire from patient interactions incorporated into clinical flows and to the research you are conducting?
I often feel that I learn more from my patients than they do from me. This patient-centric learning has been pivotal as I transitioned from primarily working in pediatrics to also treating adults.
What I've found most effective in adapting to this new patient group is adopting a collaborative approach. Many of these adults, particularly those who weren't diagnosed in childhood, are highly verbal and have been able to articulate their developmental experiences and how they perceive the world. This direct communication has been instrumental in enhancing my understanding, diagnostic skills, and overall evaluation of adult patients.
This experiential learning from adult patients has enriched my expertise. It has allowed me to recognize patterns and apply this newfound understanding to other patients. My method revolves around attentive listening and keen observation. By truly hearing what my patients express about their experiences and observations, I gain invaluable insights that inform both my clinical practice and research.
This approach ensures that the patient remains at the core of everything I do. It's not just about applying theoretical knowledge but also about continuously learning from the unique experiences and perspectives of each patient. This patient-centered approach helps me to evolve as a healthcare provider and researcher, ensuring that my work is continually informed by the real-life experiences of those I serve.
Who are the people who you find to be particularly inspiring in the healthcare field?
I draw inspiration from many outstanding researchers and clinicians. Notable figures like Dr. Mayada Elsabbagh and Dr. Evdokia Anagnostou are among those I have had the honor to learn from, collaborate with and admire greatly. Their work and contributions are indeed inspiring and have significantly impacted the field.
I also believe the real heroes of care are those professionals who are on the front lines, tirelessly going above and beyond for their patients every day. This includes nurses, general practitioners, community pediatricians, speech-language pathologists, and many others who are directly involved in patient care. Their dedication and commitment to caring for people, often in challenging circumstances, are truly commendable.
I see many of these heroes among the participants of our ECHO series. These individuals seek out learning opportunities with a genuine curiosity and a strong desire to improve their patient care. They often work with limited resources, a lack of available services, and sometimes a gap in necessary knowledge or expertise. Yet, their determination to find ways to help their patients is unwavering.
For me, these frontline workers are the embodiment of "heroes of care." They exemplify the essence of healthcare – working in community offices, doing their utmost with the resources they have, and consistently putting their patients' needs first. Their everyday efforts and contributions are what truly make a difference in the lives of countless individuals and communities.
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