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Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity / Ashley DE MARCHENA in Autism Research, 16-6 (June 2023)
[article]
Titre : Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity Type de document : Texte imprimé et/ou numérique Auteurs : Ashley 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 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
in Autism Research > 16-6 (June 2023) . - p.1138-1144[article] Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity [Texte imprimé et/ou numérique] / Ashley 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 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 The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children / A. T. WIECKOWSKI in Autism Research, 14-9 (September 2021)
[article]
Titre : The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children Type de document : Texte imprimé et/ou numérique Auteurs : A. T. WIECKOWSKI, Auteur ; A. DE MARCHENA, Auteur ; Y. ALGUR, Auteur ; L. NICHOLS, Auteur ; S. FERNANDES, Auteur ; R. P. THOMAS, Auteur ; L. A. MCCLURE, Auteur ; S. DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Lauren B. ADAMSON, Auteur ; A. 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
in Autism Research > 14-9 (September 2021) . - p.1923-1934[article] The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children [Texte imprimé et/ou numérique] / A. T. WIECKOWSKI, Auteur ; A. DE MARCHENA, Auteur ; Y. ALGUR, Auteur ; L. NICHOLS, Auteur ; S. FERNANDES, Auteur ; R. P. THOMAS, Auteur ; L. A. MCCLURE, Auteur ; S. DUFEK, Auteur ; Deborah A. FEIN, Auteur ; Lauren B. ADAMSON, Auteur ; A. 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