The Under- and Over-Identification of Autism: Factors Associated With Diagnostic Referral

Smith, I.; Swain, Deanna M.; Murphy, Haley G.; Ollendick, Thomas H.; White, Susan W.

doi:10.1080/15374416.2017.1342545

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Baghdadli et al [29] remarquent aussi que ces outils construits sur la base d'hypothèses catégoriques, appliquées à des phénotypes autistiques prototypiques, risquent de fixer un seuil de diagnostic trop élevé par exemple pour les adultes sans déficience intellectuelle, mais surtout pour les jeunes filles [80] et les femmes adultes [81], pour les sujets âgés [82] et pour les enfants en très bas âge [82,83] et présentant un phénotype sévère associé à un retard du développement intellectuel [65], ainsi que pour des individus enfants et adultes issus de cultures différentes (par ex., [84]). À l'inverse, un seuil peut être trop bas, dans d'autres circonstances, ce qui conduit à des faux-positifs [85].…”

Section: Limites De La Combinaison De L'adi-r Et De L'adosunclassified

L’ADI-R et l’ADOS face au diagnostic différentiel des troubles du spectre autistique : intérêts, limites et ouvertures

2019

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Troubles du spectre autistique Outils diagnostiques Diagnostic différentiel Introduction. -Les évolutions actuelles en santé publique amènent les autorités qualifiées à proposer, dans leurs recommandations de bonne pratique pour l'évaluation et le diagnostic des troubles du spectre autistique (TSA), des procédures qui s'appuient sur l'utilisation de l'Autism Diagnostic Interview-Revised (ADI-R) et l'Autism Diagnostic Observation Schedule (ADOS) considérés comme un « gold standard ». Cependant, la problématique du diagnostic différentiel reste prégnante dans la pratique clinique. Objectifs. -Notre objectif vise à souligner et nuancer les qualités métrologiques de l'ADI-R et de l'ADOS concernant le diagnostic différentiel des troubles autistiques, en proposant une synthèse des études récentes pour soutenir l'intérêt de maintenir ouverte une réflexion sur les modalités diagnostiques. Méthode. -Notre revue sélective de la littérature récente met en avant les études qui confrontent l'ADI-R et l'ADOS, utilisés indépendamment et en combinaison, à diverses problématiques différentielles en clinique adulte et infantile de l'autisme, afin d'en souligner les qualités et les limites.Résultats. -Les données issues de ces outils sont utiles dans le processus diagnostic des troubles du spectre autistique et constituent des preuves diagnostiques solides, à la condition d'une association avec un regard clinique critique. Cependant, ces éléments demeurent insuffisants car ces outils manquent de finesse pour l'évaluation des formes autistiques hétérogènes et des tableaux cliniques voisins. Conclusions. -La problématique de diagnostic différentiel reste au premier plan dans la clinique de l'autisme, dès lors une formalisation des démarches diagnostiques doit pouvoir rester ouverte et accompagnée d'une démarche clinique créative, en particulier dans les situations complexes peu solubles par les outils diagnostiques classiques.

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Section: Limites De La Combinaison De L'adi-r Et De L'adosunclassified

L’ADI-R et l’ADOS face au diagnostic différentiel des troubles du spectre autistique : intérêts, limites et ouvertures

2019

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“…Indeed, one study on the prevalence of final diagnoses of ASD among children (aged 1-19 years) referred to a regional diagnostic autism center revealed that only 61% met ASD diagnosis criteria [21]. Children who were referred for ASD evaluation and did not receive an ASD diagnosis were more frequently diagnosed with attention deficit hyperactivity disorder (ADHD) [21][22][23] and had more co-occurring diagnoses of developmental disorders and medical problems [23]. Other frequent alternative diagnoses included language disorder, disruptive behavior disorder/oppositional defiant disorder, intellectual disability, and anxiety disorder, with most children having multiple diagnoses [21].…”

Section: Introductionmentioning

confidence: 99%

“…Other frequent alternative diagnoses included language disorder, disruptive behavior disorder/oppositional defiant disorder, intellectual disability, and anxiety disorder, with most children having multiple diagnoses [21]. Studies that have sought to identify characteristics that may help to distinguish between those who will be diagnosed with ASD and those who will not, have shown that children who receive ASD diagnoses are characterized by lower cognitive ability [23], more severe RRB [22], and poorer abilities in the social communication domain, as determined by professionals [24].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Parental Concerns about Social–Emotional Reciprocity Deficits and Their Children’s Final ASD Diagnosis

Saban-Bezalel,

Avni,

Ben-Itzchak

et al. 2023

Children

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Concerns raised by parents regarding their child’s development are compatible with the child’s final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of autism spectrum disorder is therefore critical. In the current study, we compared the frequencies of parental concerns related to DSM-5 criteria for autism spectrum disorder between pair-matched groups with and without a final diagnosis of autism spectrum disorder and determined which parental concerns predicted a final diagnosis of autism spectrum disorder. The cohort included 80 participants (48–154 months of age, IQ > 70) assessed for a possible autism spectrum disorder diagnosis. Parental concerns were retrieved from the free-description portion of the introductory questions of the Autism Diagnostic Interview-Revised and analyzed to assess whether they corresponded to any of the seven DSM-5 criteria for ASD. The two groups only differed in the frequency of parental concerns relating to deficits in social–emotional reciprocity. Parents of children diagnosed with autism spectrum disorder were four times as likely to report deficits in social–emotional reciprocity. This finding highlights the significance of parental concerns regarding deficits in social–emotional reciprocity in predicting a final diagnosis of autism spectrum disorder.

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“…Evidence for this complexity was given by Kentrou et al (2019), who showed that the delayed autism diagnosis with co-occurring ADHD stretched out a further year when the child was female in comparison with male children with autism + ADHD. The more complex a diagnostic picture, and the less typical symptom profile, the more difficult the diagnosis (Avlund et al, 2020;Smith et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Co-occurring Autism and Attention Deficit Hyperactivity Disorder

Sainsbury¹

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Autism and attention deficit hyperactivity disorder (ADHD) both have onset in early childhood and have multifaceted lifelong effects. The two conditions are separated by different core behavioural symptoms and clinical management. However, autism and ADHD have significant co-occurrence rates. Both autism and ADHD are associated with social differences, high sensory needs, attention difficulties and increased co-occurrence with other conditions. This has resulted in debate about whether autism and ADHD should be viewed as one condition on a gradient or as two separate conditions. Regardless of such the taxonomic classification issues, it appears that, in those children most affected by autism + ADHD characteristics, there are additive challenges across the behavioural and cognitive domains associated with both conditions. Autistic and ADHD children both benefit from early support, which can reduce some of the negative outcomes associated with these conditions. However, the opportunities to access early support during a sensitive developmental period are reduced by the delayed diagnosis of autism that happens when ADHD co-occurs. A literature review conducted as part of this thesis established that this delay is observed across international jurisdictions. The literature review also demonstrated that there is evidence for an earlier ADHD diagnosis when autism is present. There was also some limited evidence for later age of parental first concern and longer wait time to diagnosis for the autism + ADHD group. Other characteristics which further exacerbated the delay were being female and an ADHD diagnosis being given before the autism diagnosis. The literature review indicated an international pattern in delayed diagnosis of autism for autistic + ADHD children and that there did not appear to be any studies examining the diagnostic pathway for these children in New Zealand. Therefore, understanding whether this delay is relevant for autistic + ADHD children in New Zealand is an important area of study. As is a further understanding of the mechanism by which autism + ADHD children might present differently to children with a singular diagnosis of either autism or ADHD. Variables indicated by the literature review, such as wait time to diagnosis and age of parental first concern, were also explored as possibly contributing to delay in autism diagnosis when ADHD was present. In the first study of this thesis, 288 New Zealand parents of children diagnosed with autism (n = 111), ADHD (n = 93), or both conditions (n = 84) participated in an online survey. The results indicated that co-occurring autism and ADHD was associated with an earlier ADHD diagnosis and a later autism diagnosis in New Zealand, thus fitting the international trend. Parents of children with both diagnoses reported less atypical development in language and social behaviours compared to parents of autistic children. The co-occurring group also experienced longer times to diagnosis, and saw more types of specialists prior to a diagnosis than those with autism. The experience of parents might also enhance an understanding of delays and challenges in the diagnostic process. Therefore, the second study of this thesis used qualitative reflexive-thematic analysis to understand the experiences of parents on their journey to diagnosis for their children. The findings suggest that parents view the process to diagnosis as an adversarial one, which required extensive knowledge, finances, and network resources. Parents also described a second ‘battle’, which was often unexpected, to get support for their child post-diagnosis. Parents identified that the relief of the removal of parenting guilt and blame, as well as situating the issue outside of the child, was an important part of the diagnosis label. The literature review and both studies one and two indicated that the diagnostic process for autism + ADHD is complex. In the final study, these complexities were further explored by an anonymous online survey of clinicians' (psychologists, paediatricians, psychiatrists) responses (n = 29) to two complex neurodevelopmental cases described in vignettes. These vignette cases included autism + ADHD characteristics and a number of other co-occurring characteristics. Clinicians reported multiple possible lines of inquiry including specific assessments for particular hypothesised diagnoses and more general assessments. The results of this study suggested that complex cases require lengthy consideration and multiple resources. The thesis identified and elucidated the phenomena in the timing of diagnosis when autism and ADHD co-occur. This included understanding the delay in autism diagnosis when ADHD is present and provided possible evidence for where along a diagnostic pathway such a delay might be occurring. A biopsychosocial framework was also used to consider multiple psychological and social aspects of this process including the experiences of complex neurodevelopmental cases for families and clinicians. The experience for families and clinicians grappling with an imperfect diagnostic model suggests that multiple resources, time delays and stressful situations are common. This thesis concludes with theoretical and practical recommendations for an improved diagnostic pathway and experience for clinicians and families.

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The Under- and Over-Identification of Autism: Factors Associated With Diagnostic Referral

Cited by 8 publications

References 22 publications

L’ADI-R et l’ADOS face au diagnostic différentiel des troubles du spectre autistique : intérêts, limites et ouvertures

L’ADI-R et l’ADOS face au diagnostic différentiel des troubles du spectre autistique : intérêts, limites et ouvertures

Relationship between Parental Concerns about Social–Emotional Reciprocity Deficits and Their Children’s Final ASD Diagnosis

Diagnosis of Co-occurring Autism and Attention Deficit Hyperactivity Disorder

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