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Diagnostic classification models (DCMs) have recently become very popular both for research purposes and for real testing endeavors for student assessment. A plethora of DCM models give researchers and practitioners a wide range of options for student diagnosis and classification. One intriguing option that some DCM models offer is the possibility of examining the nature of the interactions among the attributes underlying a skill. Attributes in second/foreign language (L2) may interact with each other in a compensatory/non-compensatory manner. Subskill/attribute relationship has been studied using diagnostic classification models. The present study provides a mini review of the DCM studies on the attribute relationships in L2 reading, listening, and writing. The criteria based on which interaction between the attributes have been inferred are reviewed. The results showed that the majority of DCM studies have investigated reading comprehension and more studies are required on the productive skills of writing and speaking. Furthermore, suggestions for future studies are provided.

This article looks at how colonialism has contributed to the racialized history of Indigenous people by unethical diagnostic implementations of categories and classifications, while overlooking exceptionalities when assessing Indigenous people. By understanding how settler-colonial assessments and/or diagnostic tests have been developed and utilized on Indigenous peoples, the reader can grasp the severity of any misdiagnoses, which can contribute to mislabeling due to cultural factors that have not been included and are beyond the understanding of the often non-Indigenous evaluator. Having an assessment or diagnoses, though, is a method to obtain accommodations and specialized education. Yet, if the systems that were created do not accurately measure the responses of the Indigenous individual, then an injustice will occur, not only for a possible misdiagnosis, but also for a missed opportunity to offer help if required. The need to understand the total individual beyond a mere assessment can provide insightful information, which is crucial for the examinee and examiner. It can affect the life of the whole person being assessed, if done without the Indigenous information that has been omitted.

Multi-exceptional children often have deficits in auditory, visual, or sensory processing. As few psychologists have training in modalities, these deficits may be misdiagnosed as AD/HD, Nonverbal Learning Disorder, Autism, Dyslexia, or a host of personality disorders. This article describes the symptoms of these processing deficits and offers suggestions for therapeutic interventions. Conundrums in diagnosing the complex profiles of multi-exceptional children are addressed. Qualitative assessment is recommended as an alternative or adjunct to traditional assessment. The "Checklist for Recognizing Twice Exceptional Children" is included to help parents, teachers, and graduate students gain awareness of the many manifestations of multi-exceptionality. The author's experience as a clinician specializing in multi-exceptional children serves as the basis for the article.

Employment interviews can be challenging for autistic people. In addition to standard interview procedures often being inaccessible, features associated with autism (including atypical emotional expression, eye-contact, and gestures) may lead to negative first impressions. Research using vignettes and 'thin slices' of communication indicate that perceptions of an autistic individual can be improved when their autism diagnosis is disclosed. Here, we examined the impact of diagnostic disclosure on judgements of autistic adults undergoing an entire mock employment interview. A total of 119 participants (known as 'raters') watched a video of an autistic candidate's mock employment interview, after which they provided overall impressions of the candidate on factors such as confidence, motivation, and knowledgeability. Raters were either (1) unaware of the interviewee's diagnosis, (2) aware of their diagnosis, or (3) aware of their diagnosis and provided with information about autism. Results indicate that diagnostic disclosure improved perceptions of autistic candidates across all dimensions compared to when raters were unaware of their diagnosis. The provision of additional information about the diagnosis did not further improve ratings. The findings have important implications for employers and autistic people, who should consider the potential impact of diagnostic disclosure prior to interviewing for a role.

Little is currently known about the autism spectrum disorder (ASD)-related difficulties of females narrowly below the ASD diagnostic threshold and whether the disorder conceptualisation should be broadened to capture their presentations. We extracted fine-grained information from the assessment reports of 222 children who were either diagnosed with ASD (n = 156) or not diagnosed despite many ASD traits (n = 78). Females were less likely than males to meet Criterion B3 (restricted interests), and this was especially the case for subclinical (non-ASD) females. Non-ASD females lacked sufficient atypicality for diagnosis in several key domains, particularly Criterion A1 (social-emotional reciprocity). Evidence of sex/gender-specific restricted interests and stereotypical behaviours was found. Many behaviours differed in the extent to which they predicted the ASD diagnostic result for males and females, perhaps suggesting that sex/gender influences how ASD-related behaviours are perceived. We discuss these findings in the context of underdiagnosis of ASD in females and propose adjustments to assessment protocols.

Research on how adults react to receiving an autism diagnosis is focused on the United States or the United Kingdom context even though cultural differences might have an impact on these experiences. Few interventions for autistic adults exist, and when they do, they are often described as inappropriate. Our study aimed to explore the experiences of French adults diagnosed with autism and the needs they identified following this diagnosis as well as to ask them directly what type of interventions they would have wanted. We conducted semi-structured interviews with 12 adults and identified three recurring themes: (1) reactions to the diagnosis, (2) relations with others and society, and (3) wants and needs. Results indicated that some experiences were congruent with existing Anglophone literature, while others were heavily influenced by the specific cultural context. Our participants also highlighted a number of unmet needs and offered suggestions for adequate interventions.

Post-diagnostic support for autistic adults in the United Kingdom is geographically inequitable and, in general, considered inadequate. This results in autistic adults facing unnecessary challenges and wide-ranging poor outcomes. A modified Delphi study sought to establish autistic adults' priorities for optimal provision of post-diagnostic support. The study was co-designed with 10 autistic adults across a series of three online workshops. Forty-three autistic adults, who had received their diagnosis in adulthood, completed a series of three online questionnaires through which 153 support priorities were identified. In a fourth questionnaire round, completed by 139 autistic adults, 24 priorities reached or exceeded a consensus threshold of 80% agreement that the item specified an important element of post-diagnostic support. Participants ranked "access to support where they live, training of professionals, support to process the impact of a late diagnosis, use of their preferred mode of contact and an individualised support plan" as their key priorities for post-diagnostic support. The whole priority list provides a clear and practical articulation of what autistic adults want from post-diagnostic support. This should be used by policymakers and service providers in the United Kingdom to ensure that post-diagnostic support for autistic adults is fit for purpose.

The timing of autism spectrum disorder detection in research and clinical practice is characterised by substantial heterogeneity ranging from infancy to school age. In this study, we examined the age of diagnosis and its associated individual and socio-familial factors in Chinese children diagnosed with autism spectrum disorder. A sample of 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen was investigated in 2021. We found a mean age of diagnosis of 31.4 ± 12.7 months and a median of 30.0 months. Although 71.7% of the children received their diagnosis between 25 and 36 months of age, and 13.3% were diagnosed early (?24 months), 15.1% did not have their symptoms detected until preschool or later years (>36 months). The diagnosis was likely delayed (>36 months) if the children were older, were less severe and presented with no intellectual impairment. The odds of delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than those with local household registrations. The study underscores the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection in addition to clinical factors, as the former are likely to affect the quality of life of many autism spectrum disorder children and their families.

Background: Cognitive rehabilitation is a complex and specialized area of practice, as it aims to support individuals with diverse neuropsychological profiles, personal characteristics, and intersectionalities in achieving meaningful, functional change in personally relevant aspects of their everyday lives. In many ways, cognitive rehabilitation is the epitome of a 'black box': it has complicated internal processes that are mysterious to users. We argue that this complex practice has suffered from a lack of specificity of clinical processes and treatment components, resulting in negative consequences for both providers and clients. Aim: To unpack the black box of cognitive rehabilitation by describing a unifying set of frameworks that can effectively direct clinical practice across clinical disciplines: the International Classification of Functioning, Disability, and Health (ICF), the Rehabilitation Treatment Specification System (RTSS), and the Planning, Implementation, and Evaluation framework (PIE). We present a clinical case that illustrates the application of the three frameworks. Conclusion: Implementation of these three integrated frameworks supports clinical reasoning, replication of treatments, and communication across disciplines with the ultimate impact of improving rehabilitation outcomes. The frameworks provide a structure for clinicians to clearly define both the "what" and the "how" of treatment, with a level of specificity to maximize both effectiveness and efficiency of intervention.

This article reports on the findings of a qualitative case study exploring the auditory skill "deficits" of a twice-exceptional male student who had multiple exceptionalities, including deficits in auditory processing skills, which contributed to learning issues and social connection difficulties in unique ways. Auditory skill deficits are an under-researched area in the field of gifted education, yet these are requisite skills necessary for learning in school. For this case study, auditory deficits were related to phonological processing, auditory sequential memory, lowered auditory recall abilities, and weaknesses in auditory analysis skills. The role that these auditory skill deficits played in the educational experiences of this young person is explored. Findings suggest that the presentation and impact of auditory processing deficits is very individual.

How mental health disorders such as obsessive compulsive disorder (OCD) manifest in high ability youth has received little empirical attention, and differentiating OCD from other diagnoses like autism spectrum disorder (ASD) can be challenging. The purpose of this study was to examine clinical profiles among OCD, ASD, or no diagnosis for those of high ability and not high ability. Results indicated those with high ability only tended to obtain higher ability and achievement scores than those with a co-occurring disability. Youth in the high ability/OCD and high ability/ASD groups had lower working memory and processing speed scores than the high ability alone group, but also had frequent comorbid attention-deficit hyperactivity disorder diagnoses. The high ability/OCD and high ability/ASD groups were the most divergent on the anxiety and atypicality Behavioral and Emotional Screening System (BASC) subtests, but an anxiety disorder was often comorbid with OCD.

In the United States, HIV disproportionately affects people 13-45 years old, people of color, people in the south, and men who have sex with men. Given the growing number of postsecondary students within these demographic groups, this presents an equity issue and raises concerns for how higher education researchers and practitioners choose to engage problems of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in U.S. college contexts. Using a content analysis methodology and Endarkened Feminist Epistemological lens, we examined a decade of HIV/AIDS-related research published in 113 higher education journals. Our findings suggest a generally limited focus on HIV/AIDS in college contexts and overrepresentation of quantitative methods in available scholarships. Furthermore, despite widening HIV/AIDS diagnosis gaps, researchers rarely nuanced identity and most often focused on individual choices rather than systemic structures.

Autism is heterogeneous at many levels, including clinical symptoms and etiology. A key strategy in studying heterogeneous conditions is having large enough sample sizes to stratify into smaller groups that are more homogeneous. SPARK and Simons Searchlight are large and growing research cohorts of individuals with autism in the United States and individuals with genetically defined neurodevelopmental conditions around the world, respectively. They both provide freely available phenotypic and genotypic data with the ability to re-contact participants through the research match program. Deep dives into each gene in Searchlight provide comprehensive natural history data to understand the differing clinical courses to inform proper clinical care, and work toward treatment for each condition. Moreover, pilots of genetically based newborn screening programs for neurogenetic disorders can provide opportunities for equitable and early diagnosis to try to improve outcomes with earlier interventions.

It was recently reported that learning one is autistic earlier in life is associated with greater quality of life and well-being in university students. In a pre-registered extension of this work, we addressed several limitations of this study by: (1) recruiting a larger sample of more diverse ages and education levels; (2) distinguishing between learning about and receiving an autism diagnosis; (3) accounting for additional confounding variables; and (4) studying different quality of life dimensions. Autistic adults (N = 300) reported when they first learned they were autistic, as well as when they actually received an autism diagnosis, and provided detailed socio-demographic information. Participants also completed measures of their autistic traits, as well as well-being and quality of life across multiple domains. In contrast to recent research, we found the age participants first learned they were autistic did not significantly and uniquely predict their quality of life and well-being. Rather, having more autistic traits was the strongest predictor of poorer quality of life and well-being, while other socio-demographic factors were also relevant. We discuss the implications of these findings for understanding and improving outcomes in autistic adults and call for higher quality open science on this important topic.

Autism evaluation processes are often fragmented and lead to delays in accurate identification and services. These inefficient processes also lead to substantial burden on families when navigating the autism diagnostic odyssey that often requires information-sharing across providers and settings. Collaboration across schools, clinical settings, and communities can facilitate equitable and efficient access to autism evaluation services. Children and families from minoritized and marginalized backgrounds are particularly positioned to benefit from school-clinic collaboration. This paper: (1) highlights the current state of autism identification and systems inefficiencies and inequities along racial/ethnic/socioeconomic lines; (2) compares the processes, benefits, and challenges between educational identification and clinical diagnosis of autism; (3) describes how school-clinic collaboration processes can address these systems inefficiencies and inequities; (4) presents examples of models that use school-clinic collaboration; and (5) offers specific recommendations for providers.

Objective: The increasing rate of depression among university students is a cause of great concern worldwide. With the recent growth in computer vision technology, eye movement features are proving beneficial in the assessment of depression owing to their non-invasiveness. Our objective was to determine the presence of depression through emotional elicitation by studying blink patterns in a student population. Method: The blink data of 50 university students (26 males, 24 females) from different regions of the country within the age group of 21-26 years were collected using an experimental setup. Results: Statistical tests on blink data revealed that blink rate changes with changes in emotion from joy to sadness or vice versa, irrespective of one's depression status. Another explanation is that the blink rates of the healthy and depressed groups differed significantly during sad emotional states. The tests also indicated a half-closed eye state as a possible symptom of depression. Conclusions: These findings suggest that the prevalence of mental health problems can be detected at an early stage by designing simple non-invasive procedures, such as blink pattern analysis driven by technology and expert advice, which will help prevent the further development of such illnesses.

The present study examined whether learning disabilities (LD) in reading and/or math (i.e., reading disability [RD], math disability [MD], and RD+MD) co-occur with other diagnoses. The data comprised a clinical sample (n = 430) with LD identified in childhood and a sample of matched controls (n = 2,140). Their medical diagnoses (according to the "International Classification of Diseases" nosology) until adulthood (20-39 years) were analyzed. The co-occurrence of LD with neurodevelopmental disorders was considered a homotypic comorbidity, and co-occurrence with disorders or diseases from the other diagnostic categories (i.e., mental and behavioral disorders, diseases of the nervous system, injuries, other medical or physical diagnoses) was considered a heterotypic comorbidity. Both homotypic and heterotypic comorbidity were more common in the LD group. Co-occurring neurodevelopmental disorders were the most prominent comorbid disorders, but mental and behavioral disorders, diseases of the nervous system, and injuries were also pronounced in the LD group. Accumulation of diagnoses across the diagnostic categories was more common in the LD group. No differences were found among the RD, MD, and RD+MD subgroups. The findings are relevant from the theoretical perspective, as well as for clinical and educational practice, as they provide understanding regarding individual distress and guiding for the planning of support.

Background: As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)-learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services. Aims: (1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant-Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross-cultural comparison between the EP adaptation and the original US version. Methods & Procedures: A total of 611 EP-learning children (ages 6-24 months) were assessed on the CSBS DP Infant-Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test-retest reliability), and cross-cultural comparison between the EP and the original version were explored. Outcomes & Results: Internal consistency ranged from good to excellent and the test-retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found. Conclusions & Implications: These findings showed that the EP CSBS DP Infant-Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP-learning children, which can be particularly relevant for decision-making in clinical practice.

Background and Aims: Epidemiological studies have provided invaluable insight into the origin and impact of low language skills in childhood and adolescence. However, changing terminology and diagnostic guidelines have contributed to variable estimations of the prevalence of developmental language difficulties. The aim of this review was to profile the extent and variability of low language prevalence estimates through a systematic review of epidemiological literature. Methods: A systematic review of the empirical research (August 2022) was undertaken to identify studies that aimed to estimate the prevalence of low language skills in children (<18 years). A total of 19 studies published between 1980-2022 met inclusion criteria for review. Results: Studies reported prevalence estimates of low language skills in children between 1 and 16 years. Estimated rates varied from 0.4% to 25.2%. More stable estimations were observed in studies of children aged 5 years and older and those that applied updated diagnostic criteria to performance on standardised assessments of receptive and expressive language. Conclusions and Implications: The estimated prevalence of low language skills in childhood varies considerably in the literature. Application of updated diagnostic criteria, including the assessment of functional impact, is critical to inform advocacy efforts and govern social, health and educational policies.

Background: The detection and description of language impairments in neurodegenerative diseases like Alzheimer's Disease (AD) play an important role in research, clinical diagnosis and intervention. Various methodological protocols have been implemented for the assessment of morphosyntactic abilities in AD; narrative discourse elicitation tasks and structured experimental tasks for production, offline and online structured experimental tasks for comprehension. Very few studies implement and compare different methodological protocols; thus, little is known about the advantages and disadvantages of each methodology. Aims: To discuss and compare the main behavioral methodological approaches and tasks that have been used in psycholinguistic research to assess different aspects of morphosyntactic production and comprehension in individuals with AD at the word and sentence levels. Methods: A narrative review was conducted through searches in the scientific databases Google Scholar, Scopus, Science Direct, MITCogNet, PubMed. Only studies written in English, that reported quantitative data and were published in peer-reviewed journals were considered with respect to their methodological protocol. Moreover, we considered studies that reported research on all stages of the disease and we included only studies that also reported results of a healthy control group. Studies that implemented standardized assessment tools were not considered in this review. Outcomes & Results: The main narrative discourse elicitation tasks implemented for the assessment of morphosyntactic production include interviews, picture-description and story narration, whereas the main structured experimental tasks include sentence completion, constrained sentence production, sentence repetition and naming. Morphosyntactic comprehension in AD has been assessed with the use of structured experimental tasks, both offline (sentence-picture matching, grammaticality judgment) and online (cross-modal naming, speeded sentence acceptability judgment, auditory moving window, word detection, reading). For each task we considered studies that reported results from different morphosyntactic structures and phenomena in as many different languages as possible. Conclusions & Implications: Our review revealed strengths and weaknesses of these methods but also directions for future research. Narrative discourse elicitation tasks as well as structured experimental tasks have been used in a variety of languages, and have uncovered preserved morphosyntactic production but also deficits in people with AD. A combination of narrative discourse elicitation and structured production tasks for the assessment of the same morphosyntactic structure has been rarely used. Regarding comprehension, offline tasks have been implemented in various languages, whereas online tasks have been mainly used in English. Offline and online experimental paradigms have often produced contradictory results even within the same study. The discrepancy between the two paradigms has been attributed to the different working memory demands they impose to the comprehender or to the different parsing processes they tap. Strengths and shortcomings of each methodology are summarized in the paper, and comparisons between different tasks are attempted when this is possible. Thus, the paper may serve as a methodological guide for the study of morphosyntax in AD and possibly in other neurodegenerative diseases.

Background: Recent evidence suggests that speech substantially changes in ageing. As a complex neurophysiological process, it can accurately reflect changes in the motor and cognitive systems underpinning human speech. Since healthy ageing is not always easily discriminable from early stages of dementia based on cognitive and behavioural hallmarks, speech is explored as a preclinical biomarker of pathological itineraries in old age. A greater and more specific impairment of neuromuscular activation, as well as a specific cognitive and linguistic impairment in dementia, unchain discriminating changes in speech. Yet, there is no consensus on such discriminatory speech parameters, neither on how they should be elicited and assessed. Aims: To provide a state-of-the-art on speech parameters that allow for early discrimination between healthy and pathological ageing; the aetiology of these parameters; the effect of the type of experimental stimuli on speech elicitation and the predictive power of different speech parameters; and the most promising methods for speech analysis and their clinical implications. Methods & Procedures: A scoping review methodology is used in accordance with the PRISMA model. Following a systematic search of PubMed, PsycINFO and CINAHL, 24 studies are included and analysed in the review. Main Contribution: The results of this review yield three key questions for the clinical assessment of speech in ageing. First, acoustic and temporal parameters are more sensitive to changes in pathological ageing and, of these two, temporal variables are more affected by cognitive impairment. Second, different types of stimuli can trigger speech parameters with different degree of accuracy for the discrimination of clinical groups. Tasks with higher cognitive load are more precise in eliciting higher levels of accuracy. Finally, automatic speech analysis for the discrimination of healthy and pathological ageing should be improved for both research and clinical practice. Conclusions & Implications: Speech analysis is a promising non-invasive tool for the preclinical screening of healthy and pathological ageing. The main current challenges of speech analysis in ageing are the automatization of its clinical assessment and the consideration of the speaker's cognitive background during evaluation.

Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.

An autism spectrum condition is considered a lifelong condition. Affected individuals typically experience poorer psychosocial outcomes compared to non-autistic individuals. However, in Southeast Asian countries such as Malaysia, research about autism spectrum conditions beyond the early childhood context is scarce, and therefore, the prevalence and psychosocial outcomes of young adults with autism spectrum conditions remain largely unknown. This study aims to explore self-reported autistic traits among university students in Malaysia, and their relation to emotion regulation, stress, self-efficacy and quality of life. Data from 2732 students revealed that 0.3% of the students reported having an autism spectrum condition diagnosis, while 2.5% reported that they suspected having an autism spectrum condition, but did not obtain a formal diagnosis. This indicates that an estimated 2.8% of students might have a diagnosed or suspected autism spectrum condition. These two categories of students were found to have poorer self-efficacy, higher perceived stress and poorer quality of life, as compared to their peers. However, these students were not significantly different from their peers in emotion regulation. Overall, the findings pointed to negative psychosocial outcomes associated with autism spectrum condition and culture-specific associations between autistic traits and psychosocial outcomes.

Sensory processing abilities are highly variable within and across people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD). This study examined the transdiagnostic nature of sensory processing abilities, and their association with features of autism and ADHD, in a large sample of autistic people (n = 495) and people with ADHD (n = 461). Five similar data-driven sensory phenotypes characterized sensory processing abilities, and showed similar patterns of association with features of autism and ADHD, across both diagnostic groups. These results demonstrate the transdiagnostic nature of sensory processing abilities, while contributing to a growing body of literature that suggests the autism and ADHD diagnostic labels have poor explanatory power.

Identification procedures for autism spectrum disorders in paediatric settings include screening and routine clinical surveillance. Screening tools are perceived as challenging, and a preference for direct observation has been reported in Ecuadorian paediatric settings. Augmentative observational procedures could prompt the application of screening tools, increase professionals' sense of self-efficacy and support referral decision-making. Following the recommendations that identification procedures should be tested in a group of children without autism from local populations, we tested a set of observational tasks on 125 children from 12 to 59 months of age in various socio-economic settings, in semi-experimental conditions and on a group of 33 non-autistic children in a paediatric-setting condition. Results indicated that the social referencing task did not produce the expected response in most children in semi-experimental conditions. Responses to the elicitation of a gesture were significantly influenced by socio-economic status and geographic area. Three other tested tasks (response to name, eye contact, response to joint attention) produced the expected responses in semi-experimental and clinical conditions, suggesting that they could be used in daily routines if fidelity to training is ensured. We discuss the implication of those findings in clinical practice and professional education in an Ecuadorian context.

An earlier diagnosis of autism spectrum disorder might lead to an earlier intervention, yet knowledge and awareness of autism spectrum disorder in Latin America and Caribbean Countries are limited. A later autism spectrum disorder diagnosis has been associated with negative consequences, as it might imply later access to services. This study aims to identify factors associated with the age of autism spectrum disorder diagnosis as reported by 2520 caregivers of autistic children from six Latin America and Caribbean Countries. Results indicate that on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was 24 months later. Current age of autistic individuals, better language abilities, and having public health coverage increased the age of diagnosis. On the contrary, the presence of medical comorbidities, severity level, and type of diagnosis decreased the age of diagnosis. The age of diagnosis of autistic individuals in Latin America and Caribbean Countries corresponded to the start of formal schooling despite a much earlier age of first noticed developmental concern, highlighting the need to reduce this age gap and increase children's probability of benefiting from early intervention. Taken together, autism spectrum disorder personal/clinical characteristics and access to health service are the main determinants for the age of diagnosis.

Objective: To determine the demographic and clinical characteristics of children followed up with the diagnosis of autism spectrum disorder (ASD) at a tertiary center in Southeeast Turkey. Methods: Children followed up with the diagnosis of ASD at a university hospital child psychiatry clinic between June 2016 and June 2021 were evaluated retrospectively for comorbidities, intellectual functioning and age at diagnosis. Results: In the preschool group, females displayed significantly more frequent cognitive developmental delay. Median age at diagnosis was 36 months (IQR= 22) regardless of gender. Approximately three-fourth (73.7%) of the cases had at least one psychiatric comorbid disorder while 22.8% had at least one medical diagnosis. Psychiatric comorbidity was found to be associated with later diagnosis. Conclusion: Although the age at first diagnosis in this study is relatively earlier than the studies in the literature, most of the children with ASD are still diagnosed very late. Psychiatric comorbidities may lead to later diagnosis due to overshadowing. Training of educational and primary healthcare workers on symptoms of ASD may enable earlier diagnosis.

Diagnostic uncertainty is prevalent throughout medicine and significantly impacts patient care, especially when it goes unrecognized. However, we lack a reliable clinical means of identifying uncertainty. This study evaluates the narrative discourse within clinical notes in the Electronic Health Record as a means of identifying diagnostic uncertainty. Recognizing that discourse producers use language "semi-automatically" (Partington et al. 2013), we hypothesized that clinicians include distinct indications of uncertainty in their written assessments, which could be elucidated by linguistic analysis. Using a cohort of patients prospectively identified as having an uncertain diagnosis (UD), we conducted a detailed corpus-assisted discourse analysis. The analysis revealed a set of linguistic indicators constitutive of diagnostic uncertainty including terms of modality, register-specific terms, and linguistically identifiable clinical behaviours. This dictionary of UD indicators was thoroughly tested, and its performance was compared with a matched-control dataset. Based on the findings, we built a machine learning classification algorithm with the ability to predict UD patient cohorts with 87.0% accuracy, effectively demonstrating the feasibility of using clinical discourse to classify patients and directly impact the clinical environment.

Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical interns' calibration and diagnostic process. In a two-phase experiment, 125 medical interns from Dutch University Medical Centers were randomized to receive no feedback (control), feedback on their accuracy (performance feedback), or feedback with additional information on why a certain diagnosis was correct (information feedback) on 20 chest X-rays they diagnosed in a feedback phase. A test phase immediately followed this phase and had all interns diagnose an additional 10 X-rays without feedback. Outcome measures were confidence--accuracy calibration, diagnostic accuracy, confidence, and time to diagnose. Both feedback types improved overall confidence--accuracy calibration (R[superscript 2][subscript]No Feedback = 0.05, R[superscript 2][subscript]Performance Feedback = 0.12, R[superscript 2][subscript]Information Feedback = 0.19), in line with the individual improvements in diagnostic accuracy and confidence. We also report secondary analyses to examine how case difficulty affected calibration. Time to diagnose did not differ between conditions. Feedback improved interns' calibration. However, it is unclear whether this improvement reflects better confidence estimates or an improvement in accuracy. Future research should examine more experienced participants and non-visual specialties. Our results suggest that feedback is an effective intervention that could be beneficial as a tool to improve calibration, especially in cases that are not too difficult for learners.

Patients and families experiencing developmental disabilities (DDs) may lack trust in physicians due to negative experiences in healthcare. DDs include conditions impairing physical, learning, language, or behavior areas, beginning during the developmental period and impacting daily functioning ('Developmental Disabilities'). Medical students generally do not receive standard training to effectively communicate with and diagnose patients with DDs. ARIE is a program for medical students to meet and learn from these patients and their families. Students learn about these families' experiences during home visits, guided by standardized interview questions and surveys about families' trust in physicians. Families did not appear to strongly trust physicians, with no significant changes after the program. Families shared they experienced physicians' lack of empathy and knowledge when caring for patients with DDs. Families wanted future physicians to be empathetic and informed when treating children with disabilities. Students reported increased comfort and confidence in interacting with patients with DDs as well as their families after completing the training program. Implementing a service-learning model focused on DDs at other medical schools, incorporating training with communication techniques and home visits, can increase students' confidence and experiences when engaging with patients with DDs and their families.

Medicaid is a major insurer of autistic people. However, during the transition to adulthood, autistic individuals are more likely than people with intellectual disability to lose their Medicaid benefits. Individuals with intellectual disability may have greater success maintaining Medicaid coverage during this time because most states provide coverage to individuals with intellectual disability throughout adulthood, which is not the case for autism. Using national Medicaid data from 2008 to 2016, we estimated the probability of intellectual disability diagnosis accrual among autistic Medicaid beneficiaries. Medicaid beneficiaries ages 8 to 25 with 1+ inpatient or 2+ outpatient autism spectrum disorder claims, but no intellectual disability claim, in a 12-month eligibility period were included. We used a person-month discrete-time proportional hazards model. Disruptions in Medicaid coverage were operationalized as 2+ consecutive months of no coverage before coverage resumed (yes/no). One in five autistic individuals ages 8-25 accrued an intellectual disability diagnosis. The probability of accruing an intellectual disability diagnosis was higher among autistic individuals who had disruptions in Medicaid coverage compared to those without disruptions, and peaked at age 21 (during the transition to adulthood). Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual and improve health outcomes for autistic adults.

Purpose: Despite advances in screening and awareness, Black and multiracial families continue to experience challenges when seeking an autism diagnosis for their children. Methods: We surveyed 400 Black and multiracial families of young children with autism from an existing research database in the United States about their retrospective diagnostic experiences. We gathered quantitative and qualitative data and engaged in iterative coding to understand timing and content of first concerns, families' experiences of care providers and systems, and the impact of race and culture on accessing care. Results: Families provided examples of early developmental concern and described provider, systemic, and cultural barriers and facilitators to care. Families also provided insight into the influence of culture and made recommendations on how the medical system could better care for Black and multiracial families of children with autism. Conclusions: Results add to a growing body of literature supporting the need for culturally sensitive and accessible care related to developmental monitoring, diagnosis, and follow-up care for Black and multiracial children.

Compare developmental profiles and core ASD symptom manifestation between male and female toddlers with DSM-5 ASD. Retrospective record review of 500 toddlers (79% male) at time of ASD diagnosis. There were no differences in developmental functioning between males and females. When adjusting for multiple comparisons, sex differences were only noted for sensory seeking behavior occurring at a higher frequency in females. Overall, there were no significant differences in demographic characteristics, developmental functioning, or manifestation of core ASD symptoms between males versus female toddlers at the time of DSM-5 ASD diagnosis.

Families of children with autism spectrum disorder (ASD) face challenges engaging in services following diagnosis. This study: (1) developed and implemented a toolkit to tailor ASD evaluation feedback to families' needs, and (2) evaluated caregiver and provider perceptions of the toolkit. Focus groups with providers (N = 11) informed toolkit development. Seven providers participated in pilot training and implementation. Provider and caregiver toolkit perceptions were assessed using interviews, surveys, and a fidelity checklist. Toolkit strategies reflect focus group themes. Provider and caregiver ratings suggest the initial feasibility, acceptability, and utility of the toolkit. This toolkit may be feasible to implement in community settings and may increase caregiver satisfaction, though further refinements are needed to support service connection.

This research explores the experiences of Beth, a university student in the UK, as she comes to be labelled as 'dyslexic', and as she has her diagnosis taken away. Through use of Interpretative Phenomenological Analysis (IPA) and discourse analysis, the research seeks to understand how Beth made sense of these experiences, and to explore the discursive 'life' of dyslexia within this sense-making. The discussion in this paper proceeds chronologically through Beth's story, from 'struggle', to 'legitimation' to 'derogation', and concludes with a call to recognise the role of diagnosis in the field of special educational needs (SEN) from a social constructionist and relational perspective.

Extreme demand avoidance (EDA) is increasingly described as part of the autism spectrum and is sometimes diagnosed as Pathological Demand Avoidance (PDA). Yet little is known, about the educational experiences of children with and without EDA behaviours. Using an online survey collecting both quantitative and qualitative data, 211 parents reported on the school experiences of their autistic children. 57 parents had a child with an additional diagnosis of PDA (AUT-PDA); 91 had a child with no diagnosis of PDA but, according to parent report, displayed EDA behaviours (AUT-EDA); and 63 had a child with neither a PDA diagnosis nor EDA behaviours (AUT). Results demonstrated that there were few group differences in terms of the frequency of failed school placements and exclusions. However, children in the AUT-EDA/-PDA groups had higher levels of behaviour that challenges, which were particularly high in those with a PDA diagnosis. There were no significant differences in school exclusions, but the fact that these occurred across all groups is of concern. Qualitative results suggested overwhelmingly negative school experiences for all groups but especially the AUT-EDA and AUT-PDA groups. Parents attributed such experiences to misunderstanding of their children's diagnoses and a lack of targeted support.

Background: Colorectal cancer (CRC) is the most common cancer diagnosed worldwide. CRC can be effectively prevented or treated if detected early, through screening. Purpose: This study aimed to determine the influencing factors of CRC screening participation in 50-70-year adults in Iran. Method: A total of 354 adults who never participated in the CRC screening from two health centers in Isfahan in September 2022 were selected randomly. A group of 329 sex and age-matched adults with a history of CRC screening was selected as a control group. Logistic regression analyses were applied to assess the cognitive differences between the two groups. Results: According to the results, Knowledge (OR = 1.61, 95% CI:1.36-1.9), perceived susceptibility (OR = 1.17, 95% CI:1.04-1.3), response efficacy (OR = 1.24, 95% CI:1.09-1.41), and self-efficacy (OR = 1.13, 95% CI:1.06-1.2) among the control group and perceived barriers (OR = 0.88, 95% CI:0.85-0.92) in the case group, were significant factors influencing participation in the CRC screening. Discussion Results of this study suggest that an HBM education model is an advantageous approach to increase CRC screening participation in adults. Translation to Health Education Practice: Certified Health Education Specialists are key personnel in using the HBM model of care and facilitators of behavioral change that will be resulted in improved participation in CRC screening.

The method for producing monoclonal antibodies (MAbs) was first published in 1975. MAbs have revolutionised research, diagnosis, and disease treatment approaches. While students need a good understanding of MAb production, teaching the key steps via traditional methods can be challenging. Numerous resources exist, but these focus on hybridoma selection omitting other key steps. In 2016, an interactive simulation was developed where students produced a virtual MAb. The simulation was used in conjunction with a lecture and tutorial, providing an alternate approach for students to learn and test their understanding. The simulation is interactive, placing students in charge of all key decisions, with immediate feedback provided at all stages. The impact of the simulation on student learning was assessed between 2017-19. Ten formative multiple-choice questions were included so students could test their understanding. The impact of the simulation on student performance was assessed in a quiz. Students that used the simulation consistently scored significantly higher in all assessment items than students who did not access the simulation. Students were engaged and the positive feedback indicated that they enjoyed this novel, alternative teaching method. This demonstrates that a simulation is a novel, learning aid for teaching students all aspects of MAb production.

Although sometimes perceived as a well-known condition, there are numerous aspects of Attention Deficit Hyperactivity Disorder (ADHD) which we do not fully understand. Given the preponderance of previous ADHD research with males, the need for understanding females' experiences of living with the condition is pressing. This article presents research findings from a study conducted in Ireland which examined the social and academic experiences of 17 young women (ages 13-20 years) who were medically diagnosed with ADHD. Findings reveal the significant and impeding impact that gender stereotypes commonly had on participants' trajectory towards obtaining an ADHD diagnosis, as teachers and clinicians alike often struggled to recognise participants' behaviours as symptomatic indicators of the condition. It is posited that an inequitable gendered cycle may be at work in how we generally conceptualise, recognise, and understand the condition.

It is well-known that a key to promoting students' mathematics learning is to provide opportunities for problem solving and reasoning, but also that maintaining such opportunities in student-teacher interaction is challenging for teachers. In particular, teachers need support for identifying students' specific difficulties, in order to select appropriate feedback that supports students' mathematically founded reasoning without reducing students' responsibility for solving the task. The aim of this study was to develop a diagnostic framework that is functional for identifying, characterising, and communicating about the difficulties students encounter when trying to solve a problem and needing help from the teacher to continue the construction of mathematically founded reasoning. We describe how we reached this aim by devising iterations of design experiments, including 285 examples of students' difficulties from grades 1-12, related to 110 tasks, successively increasing the empirical grounding and theoretical refinement of the framework. The resulting framework includes diagnostic questions, definitions, and indicators for each diagnosis and structures the diagnostic process in two simpler steps with guidelines for difficult cases. The framework therefore has the potential to support teachers both in eliciting evidence about students' reasoning during problem solving and in interpreting this evidence.

Early differences in sensory responsiveness may contribute to difficulties with communication among autistic children; however, this theory has not been longitudinally assessed in infants at increased familial versus general population-level likelihood for autism (Sibs-autism vs. Sibs-NA) using a comprehensive battery of sensory responsiveness and communication. In a sample of 40 infants (20 Sibs-autism, of whom six were later diagnosed with autism; 20 Sibs-NA), we tested (a) associations between sensory responsiveness at 12-18 months and communication 9 months later and (b) evaluated whether such associations were moderated by sibling group, autism diagnosis, or age. We found negative zero-order correlations between sensory responsiveness (i.e., caregiver reported hyperresponsiveness and hyporesponsiveness; an observational measure of hyperresponsiveness) and later communication. Additionally, caregiver reported sensory seeking was negatively associated with later expressive communication only in Sibs-NA. Limitations include our relatively small sample size of infants diagnosed with autism. Implications for future research are discussed.

This study aimed to explore experiences of support after adulthood autism diagnosis. In this mixed-methods survey study of 137 adults, we found that most common formal supports received were counselling and mental health. Common unmet support needs were sensory sensitivities and accessing other services. Cost, lack of information, and fear of not being taken seriously were common barriers. Informal support was mainly helpful for self-understanding and emotions toward diagnosis. Qualitative findings included difficulties accessing formal support, need for practical quality-of-life supports and support from autistic peers and online communities. Based on these findings, future development of supportive interventions should address unmet needs, improve access, and explore the integration of autistic peer support and online support into formal services.