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17-11-2022 | Original Paper

Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis

Auteurs: Cheryl Klaiman, Stormi White, Shana Richardson, Emma McQueen, Hasse Walum, Christa Aoki, Christopher Smith, Mendy Minjarez, Raphael Bernier, Ernest Pedapati, Somer Bishop, Whitney Ence, Allison Wainer, Jennifer Moriuchi, Sew-Wah Tay, Yiming Deng, Warren Jones, Scott Gillespie, Ami Klin

Gepubliceerd in: Journal of Autism and Developmental Disorders | Uitgave 2/2024

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Abstract

Differential diagnosis of young children with suspected autism spectrum disorder (ASD) is challenging, and clinician uncertainty about a child’s diagnosis may contribute to misdiagnosis and subsequent delays in access to early treatment. The current study was designed to replicate and expand a recent report in this Journal (McDonnell et al. in J Autism Dev Disord 49:1391–1401, https://​doi.​org/​10.​1080/​15374416.​2020.​1823850, 2019), in which only 60% of diagnoses were made with complete certainty by clinicians evaluating 478 toddlers and preschool children referred for possible ASD to specialized clinics. In this study, secondary analyses were performed on diagnostic, demographic and clinical data for 496 16–30-month-old children who were consecutive referrals to a 6-site clinical trial executed by specialized centers with experienced clinicians following best-practice procedures for the diagnosis of ASD. Overall, 70.2% of diagnoses were made with complete certainty. The most important factor associated with clinician uncertainty was mid-level autism-related symptomatology. Mid-level verbal age equivalents were also associated with clinician uncertainty, but measures of symptomatology were stronger predictors. None of the socio-demographic variables, including sex of the child, was significantly associated with clinician certainty. Close to one third of early diagnoses of ASD are made with a degree of uncertainty. The delineation of specific ranges on the ADOS-2 most likely to result in clinician uncertainty identified in this study may provide an opportunity to reduce random subjectivity in diagnostic decision-making via calibration of young-child diagnostic thresholds based on later-age longitudinal diagnostic outcome data, and via standardization of decision-making in regard to clinical scenarios frequently encountered by clinicians.
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Metagegevens
Titel
Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
Auteurs
Cheryl Klaiman
Stormi White
Shana Richardson
Emma McQueen
Hasse Walum
Christa Aoki
Christopher Smith
Mendy Minjarez
Raphael Bernier
Ernest Pedapati
Somer Bishop
Whitney Ence
Allison Wainer
Jennifer Moriuchi
Sew-Wah Tay
Yiming Deng
Warren Jones
Scott Gillespie
Ami Klin
Publicatiedatum
17-11-2022
Uitgeverij
Springer US
Gepubliceerd in
Journal of Autism and Developmental Disorders / Uitgave 2/2024
Print ISSN: 0162-3257
Elektronisch ISSN: 1573-3432
DOI
https://doi.org/10.1007/s10803-022-05812-8