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28-11-2018 | Original Paper

When Are We Sure? Predictors of Clinician Certainty in the Diagnosis of Autism Spectrum Disorder

Auteurs: Christina G. McDonnell, Catherine C. Bradley, Stephen M. Kanne, Clara Lajonchere, Zachary Warren, Laura A. Carpenter

Gepubliceerd in: Journal of Autism and Developmental Disorders | Uitgave 4/2019

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Abstract

Differential diagnosis of autism spectrum disorder (ASD) is challenging, and uncertainty regarding a child’s diagnosis may result in under-identification or prolonged diagnostic pathways. The current study examined diagnostic certainty, or how sure clinicians were that their diagnosis was accurate, among 478 toddler and preschool-aged children referred for possible ASD to academic medical specialty clinics. Overall, 60 percent of diagnoses were made with complete certainty. Clinicians were more certain when positively identifying ASD than ruling it out. Children presenting with a moderate (vs high or low) level of observable ASD symptoms were less likely to have a certain diagnosis. Further, clinicians rated less diagnostic certainty for older children, those with public insurance, and those with higher IQ and adaptive behavior abilities.
Voetnoten
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We also examined whether ADOS calibrated severity (comparison) scores related to diagnostic certainty. Severity scores were computed for social affect and restricted, repetitive behaviors using the child’s age, module, and algorithm used (Hus et al. 2014; Esler et al. 2015). The social affect (r = 0.308, p < 0.001) and restricted, repetitive behavior (r = 0.315, p < 0.001) scores both correlated positively with diagnostic certainty. Both comparison scores were also significant predictors of diagnostic certainty when entered in place of the ADOS-2 classifications (autism, spectrum, non-spectrum) in the full logistic regression model. The overall results of the logistic regression model were unchanged regardless of whether we used the ADOS-2 classifications or the comparison scores. Therefore, substantive results are presented using the ADOS-2 classifications to be consistent with the level of analysis at which clinicians would use the ADOS-2.
 
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Metagegevens
Titel
When Are We Sure? Predictors of Clinician Certainty in the Diagnosis of Autism Spectrum Disorder
Auteurs
Christina G. McDonnell
Catherine C. Bradley
Stephen M. Kanne
Clara Lajonchere
Zachary Warren
Laura A. Carpenter
Publicatiedatum
28-11-2018
Uitgeverij
Springer US
Gepubliceerd in
Journal of Autism and Developmental Disorders / Uitgave 4/2019
Print ISSN: 0162-3257
Elektronisch ISSN: 1573-3432
DOI
https://doi.org/10.1007/s10803-018-3831-3