Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity.
Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity.
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受训者在自闭症评估过程中的初步诊断印象：特异性高，但敏感性低。
DOI：
10.1002/aur.2933
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Robins,DianaL
中科院分区：
文献类型：
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作者：
deMarchena,Ashley;Wieckowski,AndreaTrubanova;Algur,Yasemin;Williams,LashaeN;Fernandes,Sherira;Thomas,RebeccaP;McClure,LeslieA;Dufek,Sarah;Fein,Deborah;Stahmer,AubynC;Robins,DianaL
降低首次诊断自闭症的年龄有助于获得关键的早期干预服务。因此，当前自闭症诊断评估的“等待名单危机”要求我们考虑现有临床资源的新用途。以前的工作发现，自闭症专家临床医生只需简短的观察就可以识别出具有高度特异性的幼儿自闭症；非专家的快速识别仍未得到检验。在目前的研究中，252名年龄在12-53 月的儿童接受了一项全面的自闭症诊断评估。我们发现，接受自闭症专家培训的初级临床医生(n= 29)在75%的病例中，在就诊的前五分钟内准确地确定了幼儿是否会被诊断为自闭症。简短观察的特异度很高(0.92)，这表明简短的观察可能是将幼儿分流到针对自闭症的干预措施的有效工具。相比之下，简短观察的较低负预测值(0.71)表明，它们不应该被用来统治自由主义。当受训者对他们最初的印象表现出更多的信心时，他们的印象更有可能与最终的诊断相匹配。这些发现增加了一系列文献，表明应该认真对待疑似自闭症的临床观察，但临床医生的担忧不应被用来排除自闭症或否定其他可能的自闭症指标，例如父母的担忧或阳性的筛查结果。
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 ruleoutautism. 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, butlack of clinician concernshould not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.