Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity / Ashley B. DE MARCHENA in Autism Research, 16-6 (June 2023)  

Public ISBD [article]  inAutism Research > 16-6 (June 2023) . - p.1138-1144 Titre : Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity Type de document : texte imprimé Auteurs : Ashley B. DE MARCHENA, Auteur ; Andrea Trubanova WIECKOWSKI, Auteur ; Yasemin ALGUR, Auteur ; Lashae N. WILLIAMS, Auteur ; Sherira FERNANDES, Auteur ; Rebecca P. THOMAS, Auteur ; Leslie A. MCCLURE, Auteur ; Sarah DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Aubyn C. STAHMER, Auteur ; Diana L. ROBINS, Auteur Article en page(s) : p.1138-1144 Langues : Anglais (eng) Mots-clés : autism  diagnosis  diagnostic confidence  early detection  initial impression  toddlers Index. décimale : PER Périodiques Résumé : Abstract Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current ?waitlist crisis? for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12 53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result. En ligne : https://doi.org/10.1002/aur.2933 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=507 [article] Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity [texte imprimé] / Ashley B. DE MARCHENA, Auteur ; Andrea Trubanova WIECKOWSKI, Auteur ; Yasemin ALGUR, Auteur ; Lashae N. WILLIAMS, Auteur ; Sherira FERNANDES, Auteur ; Rebecca P. THOMAS, Auteur ; Leslie A. MCCLURE, Auteur ; Sarah DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Aubyn C. STAHMER, Auteur ; Diana L. ROBINS, Auteur . - p.1138-1144. Langues : Anglais (eng) in Autism Research > 16-6 (June 2023) . - p.1138-1144 Mots-clés : autism  diagnosis  diagnostic confidence  early detection  initial impression  toddlers Index. décimale : PER Périodiques Résumé : Abstract Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current ?waitlist crisis? for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12 53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result. En ligne : https://doi.org/10.1002/aur.2933 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=507

Sex differences in early autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) / Sherief Y ELDEEB in Autism, 27-7 (October 2023)  

Public ISBD [article]  inAutism > 27-7 (October 2023) . - p.2112-2123 Titre : Sex differences in early autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) Type de document : texte imprimé Auteurs : Sherief Y ELDEEB, Auteur ; Natasha N. LUDWIG, Auteur ; Andrea Trubanova WIECKOWSKI, Auteur ; Mary F.S. DIECKHAUS, Auteur ; Yasemin ALGUR, Auteur ; Victoria RYAN, Auteur ; Sarah DUFEK, Auteur ; Aubyn STAHMER, Auteur ; Diana L. ROBINS, Auteur Article en page(s) : p.2112-2123 Langues : Anglais (eng) Mots-clés : autism  screening  sex differences  toddler Index. décimale : PER Périodiques Résumé : Males are more likely to be diagnosed with autism than females, and at earlier ages, yet few studies examine sex differences in screening. This study explored sex differences in psychometric properties, recommended cutoff scores, and overall scores of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. Participants were 28,088 toddlers enrolled in four early detection of autism studies. Children (N=731) at high likelihood for autism attended evaluations after screening and/or primary care clinician concern. Females were less likely to screen at high likelihood for autism at each stage of screening and therefore less likely to be invited for evaluations. Positive predictive value was significantly lower among females than males, but sensitivity was similar. False positive females were likely to have another developmental delay. Cutoff scores for males and females matched recommended guidelines. Final scores on the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up did not differ between males and females diagnosed with autism, but did for the overall sample identified at high likelihood for autism. Our findings suggest that females are less likely to be referred for evaluations, but the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identifies both males and females with autism at established cutoffs. Future research should examine methods to reduce false positive in females.Lay abstractThis study examined a widely used autism screening tool, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up to identify differences in screening for autism between toddler males and females. Examining sex differences in screening for autism in toddlerhood is important as it determines who will be referred for evaluations and receive diagnoses, which is critical for access to autism-specific early intervention. This study found that females were less likely to screen positive and be invited for evaluations compared with males. Females at high likelihood for autism were less likely to be diagnosed with autism, which decreases confidence in the screener?s results. Importantly, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identified both males and females with autism. Future research should examine ways to improve accuracy in screening results for females. En ligne : http://dx.doi.org/10.1177/13623613231154728 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=510 [article] Sex differences in early autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) [texte imprimé] / Sherief Y ELDEEB, Auteur ; Natasha N. LUDWIG, Auteur ; Andrea Trubanova WIECKOWSKI, Auteur ; Mary F.S. DIECKHAUS, Auteur ; Yasemin ALGUR, Auteur ; Victoria RYAN, Auteur ; Sarah DUFEK, Auteur ; Aubyn STAHMER, Auteur ; Diana L. ROBINS, Auteur . - p.2112-2123. Langues : Anglais (eng) in Autism > 27-7 (October 2023) . - p.2112-2123 Mots-clés : autism  screening  sex differences  toddler Index. décimale : PER Périodiques Résumé : Males are more likely to be diagnosed with autism than females, and at earlier ages, yet few studies examine sex differences in screening. This study explored sex differences in psychometric properties, recommended cutoff scores, and overall scores of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. Participants were 28,088 toddlers enrolled in four early detection of autism studies. Children (N=731) at high likelihood for autism attended evaluations after screening and/or primary care clinician concern. Females were less likely to screen at high likelihood for autism at each stage of screening and therefore less likely to be invited for evaluations. Positive predictive value was significantly lower among females than males, but sensitivity was similar. False positive females were likely to have another developmental delay. Cutoff scores for males and females matched recommended guidelines. Final scores on the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up did not differ between males and females diagnosed with autism, but did for the overall sample identified at high likelihood for autism. Our findings suggest that females are less likely to be referred for evaluations, but the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identifies both males and females with autism at established cutoffs. Future research should examine methods to reduce false positive in females.Lay abstractThis study examined a widely used autism screening tool, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up to identify differences in screening for autism between toddler males and females. Examining sex differences in screening for autism in toddlerhood is important as it determines who will be referred for evaluations and receive diagnoses, which is critical for access to autism-specific early intervention. This study found that females were less likely to screen positive and be invited for evaluations compared with males. Females at high likelihood for autism were less likely to be diagnosed with autism, which decreases confidence in the screener?s results. Importantly, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identified both males and females with autism. Future research should examine ways to improve accuracy in screening results for females. En ligne : http://dx.doi.org/10.1177/13623613231154728 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=510

The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children / Andrea T. WIECKOWSKI in Autism Research, 14-9 (September 2021)  

Public ISBD [article]  inAutism Research > 14-9 (September 2021) . - p.1923-1934 Titre : The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children Type de document : texte imprimé Auteurs : Andrea T. WIECKOWSKI, Auteur ; Ashley B. DE MARCHENA, Auteur ; Yasemin ALGUR, Auteur ; Lashae NICHOLS, Auteur ; S. FERNANDES, Auteur ; Rebecca P. THOMAS, Auteur ; Leslie A. MCCLURE, Auteur ; Sarah DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Lauren B. ADAMSON, Auteur ; Aubyn STAHMER, Auteur ; Diana L. ROBINS, Auteur Article en page(s) : p.1923-1934 Langues : Anglais (eng) Mots-clés : Autism Spectrum Disorder/diagnosis  Autistic Disorder  Child  Child, Preschool  Early Diagnosis  Family  Humans  autism spectrum disorder  clinician confidence in diagnosis  diagnosis  early detection  initial impression  toddlers Index. décimale : PER Périodiques Résumé : Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed). En ligne : http://dx.doi.org/10.1002/aur.2536 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=449 [article] The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children [texte imprimé] / Andrea T. WIECKOWSKI, Auteur ; Ashley B. DE MARCHENA, Auteur ; Yasemin ALGUR, Auteur ; Lashae NICHOLS, Auteur ; S. FERNANDES, Auteur ; Rebecca P. THOMAS, Auteur ; Leslie A. MCCLURE, Auteur ; Sarah DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Lauren B. ADAMSON, Auteur ; Aubyn STAHMER, Auteur ; Diana L. ROBINS, Auteur . - p.1923-1934. Langues : Anglais (eng) in Autism Research > 14-9 (September 2021) . - p.1923-1934 Mots-clés : Autism Spectrum Disorder/diagnosis  Autistic Disorder  Child  Child, Preschool  Early Diagnosis  Family  Humans  autism spectrum disorder  clinician confidence in diagnosis  diagnosis  early detection  initial impression  toddlers Index. décimale : PER Périodiques Résumé : Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed). En ligne : http://dx.doi.org/10.1002/aur.2536 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=449

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