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

Authors :
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
Source :
Journal of Autism and Developmental Disorders. 2024 54(2):393-408.
Publication Year :
2024

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," v49:1391-1401, 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.

Details

Language :
English
ISSN :
0162-3257 and 1573-3432
Volume :
54
Issue :
2
Database :
ERIC
Journal :
Journal of Autism and Developmental Disorders
Publication Type :
Academic Journal
Accession number :
EJ1409393
Document Type :
Journal Articles<br />Reports - Research
Full Text :
https://doi.org/10.1007/s10803-022-05812-8