The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.
The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.
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前五分钟：幼儿自闭症谱系障碍诊断评估期间的初步印象。
DOI：
10.1002/aur.2536
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Robins DL
中科院分区：
文献类型：
--
作者：
Wieckowski AT;de Marchena A;Algur Y;Nichols L;Fernandes S;Thomas RP;McClure LA;Dufek S;Fein D;Adamson LB;Stahmer A;Robins DL
诊断专家报告称，自闭症谱系障碍（ASD）在一些最终被确诊的儿童中显而易见，但并非所有儿童都是如此。临床医生的初步诊断印象对自闭症的早期发现有影响，然而文献对其准确性提出了质疑。本研究探讨了自闭症专家在见到幼儿的前五分钟内形成的诊断印象，并调查了与初步印象和最终诊断相符相关的因素。参与者是儿童（n = 294，年龄12 - 53个月），他们作为多地点自闭症筛查研究的一部分被转诊进行自闭症评估。在观察每个孩子五分钟后，具有自闭症诊断专业知识的临床医生记录他们认为孩子在完成全面评估后是否符合自闭症标准，并记录他们对这一印象的信心。临床医生的初步印象在81%的病例中与最终诊断相符。在最初被认为患有自闭症的病例中，92%在全面评估后符合标准；然而，最初被认为没有自闭症的病例中有24%也符合标准，这表明漏诊率较高。临床医生通常对自己的初步印象有信心，对最初被正确认为没有自闭症的儿童报告的信心最高。自闭症的行为表现，而非人口统计学特征或发育水平，与初步印象和最终诊断的相符以及信心相关。表明自闭症的简短观察应促使转诊至干预服务，但可能会漏诊阳性病例，不应被用于排除自闭症，这凸显了纳入初步临床印象之外信息的必要性。
当儿童来进行自闭症评估时，临床医生在进行任何正式测试之前，经常会对儿童是否患有自闭症形成早期印象。我们研究了这些早期印象与最终诊断相符的频率，发现临床医生不容易排除自闭症（许多最初看起来没有自闭症的儿童最终被确诊），但在判定自闭症方面通常是准确的（当一个孩子在五分钟内看起来患有自闭症时，他们几乎总是被如此诊断）
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 five 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 five 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. 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 five minutes, they were almost always so diagnosed).
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影响因子：
3.9
作者：
Gotham, Katherine;Pickles, Andrew;Lord, Catherine
通讯作者：
Lord, Catherine
DOI：
10.3109/17549507.2013.858773
发表时间：
2014-02-01
影响因子：
1.8
作者：
Camarata, Stephen
通讯作者：
Camarata, Stephen
影响因子：
8
作者：
Fountain, Christine;Winter, Alix S.;Bearman, Peter S.
通讯作者：
Bearman, Peter S.
影响因子：
4.7
作者：
de Marchena, Ashley;Miller, Judith
通讯作者：
Miller, Judith
影响因子：
2.6
作者：
Gordon-Lipkin, Eliza;Foster, Jessica;Peacock, Georgina
通讯作者：
Peacock, Georgina