Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16-30-Month-Olds: A Multi-site Trial Secondary Analysis.
Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16-30-Month-Olds: A Multi-site Trial Secondary Analysis.
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DOI：
10.1007/s10803-022-05812-8
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发表时间：
2024-02
影响因子：
3.9
通讯作者：
Klin, Ami
中科院分区：
文献类型：
--
作者：
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
疑似自闭症谱系障碍（ASD）的幼儿的鉴别诊断具有挑战性，临床医生对儿童诊断的不确定性可能导致误诊和随后的早期治疗延误。目前的研究旨在复制和扩展该杂志上最近的一份报告（McDonnell等人，J Autism Dev Disord 49：1391-1401，10.1080/15374416.2020.1823850，2019），其中只有60%的诊断是由临床医生评估478名幼儿和学龄前儿童的诊断完全确定的。在这项研究中，对496名16-30个月大的儿童的诊断，人口统计学和临床数据进行了二次分析，这些儿童连续转诊到由专业中心执行的6个临床试验中心，由经验丰富的临床医生按照最佳实践程序诊断ASD。总体而言，70.2%的诊断是完全确定的。与临床医生不确定性相关的最重要因素是中等水平的自闭症相关障碍。中等水平的言语年龄当量也与临床医生的不确定性相关，但症状学指标是更强的预测因素。没有一个社会人口统计学变量，包括孩子的性别，与临床医生的确定性显著相关。近三分之一的ASD早期诊断具有一定程度的不确定性。本研究中确定的ADOS-2最可能导致临床医生不确定性的特定范围的划定，可以提供一个机会，通过基于后期纵向诊断结果数据校准儿童诊断阈值，并通过临床医生经常遇到的临床情况下的决策标准化，减少诊断决策中的随机主观性。在线版本包含补充材料，可通过10.1007/s10803-022-05812-8获得。
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. The online version contains supplementary material available at 10.1007/s10803-022-05812-8.
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影响因子：
3.3
作者：
Klin A;Micheletti M;Klaiman C;Shultz S;Constantino JN;Jones W
通讯作者：
Jones W
DOI：
10.15585/mmwr.ss6706a1
发表时间：
2018-04-27
期刊：
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002)
影响因子：
--
作者：
Baio J;Wiggins L;Christensen DL;Maenner MJ;Daniels J;Warren Z;Kurzius-Spencer M;Zahorodny W;Robinson Rosenberg C;White T;Durkin MS;Imm P;Nikolaou L;Yeargin-Allsopp M;Lee LC;Harrington R;Lopez M;Fitzgerald RT;Hewitt A;Pettygrove S;Constantino JN;Vehorn A;Shenouda J;Hall-Lande J;Van Naarden Braun K;Dowling NF
通讯作者：
Dowling NF
DOI：
10.1080/15374416.2020.1823850
发表时间：
2020-11-01
影响因子：
4.2
作者：
McDonnell, Christina G.;DeLucia, Elizabeth A.;Stevenson, Ryan A.
通讯作者：
Stevenson, Ryan A.
影响因子：
3.9
作者：
McDonnell, Christina G.;Bradley, Catherine C.;Carpenter, Laura A.
通讯作者：
Carpenter, Laura A.
影响因子：
3.3
作者：
Johnson, MH
通讯作者：
Johnson, MH