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

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 recen...

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Autores principales: Klaiman, Cheryl, White, Stormi, Richardson, Shana, McQueen, Emma, Walum, Hasse, Aoki, Christa, Smith, Christopher, Minjarez, Mendy, Bernier, Raphael, Pedapati, Ernest, Bishop, Somer, Ence, Whitney, Wainer, Allison, Moriuchi, Jennifer, Tay, Sew-Wah, Deng, Yiming, Jones, Warren, Gillespie, Scott, Klin, Ami
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672659/
https://www.ncbi.nlm.nih.gov/pubmed/36396807
http://dx.doi.org/10.1007/s10803-022-05812-8
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author Klaiman, Cheryl
White, Stormi
Richardson, Shana
McQueen, Emma
Walum, Hasse
Aoki, Christa
Smith, Christopher
Minjarez, Mendy
Bernier, Raphael
Pedapati, Ernest
Bishop, Somer
Ence, Whitney
Wainer, Allison
Moriuchi, Jennifer
Tay, Sew-Wah
Deng, Yiming
Jones, Warren
Gillespie, Scott
Klin, Ami
author_facet Klaiman, Cheryl
White, Stormi
Richardson, Shana
McQueen, Emma
Walum, Hasse
Aoki, Christa
Smith, Christopher
Minjarez, Mendy
Bernier, Raphael
Pedapati, Ernest
Bishop, Somer
Ence, Whitney
Wainer, Allison
Moriuchi, Jennifer
Tay, Sew-Wah
Deng, Yiming
Jones, Warren
Gillespie, Scott
Klin, Ami
author_sort Klaiman, Cheryl
collection PubMed
description 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, 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10803-022-05812-8.
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spelling pubmed-96726592022-11-18 Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis Klaiman, Cheryl White, Stormi Richardson, Shana McQueen, Emma Walum, Hasse Aoki, Christa Smith, Christopher Minjarez, Mendy Bernier, Raphael Pedapati, Ernest Bishop, Somer Ence, Whitney Wainer, Allison Moriuchi, Jennifer Tay, Sew-Wah Deng, Yiming Jones, Warren Gillespie, Scott Klin, Ami J Autism Dev Disord Original Paper 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, 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10803-022-05812-8. Springer US 2022-11-17 /pmc/articles/PMC9672659/ /pubmed/36396807 http://dx.doi.org/10.1007/s10803-022-05812-8 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Paper
Klaiman, Cheryl
White, Stormi
Richardson, Shana
McQueen, Emma
Walum, Hasse
Aoki, Christa
Smith, Christopher
Minjarez, Mendy
Bernier, Raphael
Pedapati, Ernest
Bishop, Somer
Ence, Whitney
Wainer, Allison
Moriuchi, Jennifer
Tay, Sew-Wah
Deng, Yiming
Jones, Warren
Gillespie, Scott
Klin, Ami
Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title_full Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title_fullStr Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title_full_unstemmed Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title_short Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis
title_sort expert clinician certainty in diagnosing autism spectrum disorder in 16–30-month-olds: a multi-site trial secondary analysis
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672659/
https://www.ncbi.nlm.nih.gov/pubmed/36396807
http://dx.doi.org/10.1007/s10803-022-05812-8
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