Evaluation of Diagostic and Services Practices in Autism

描述（由申请人提供）：对自闭症儿童进行正确诊断和评估的临床复杂性，以及联邦和州提供服务的授权，对当地学校和公共服务提供者提出了重大挑战。自闭症越来越被概念化为包括一系列障碍，而不是一个单一的、经典定义的发育障碍。考虑到定义“自闭症谱系障碍”（ASD）的大量行为，以及即使在同一诊断类别中个体儿童的可变性，正确的识别和评估需要经验丰富的临床医生和教育工作者。更好的识别和更广泛的分类似乎导致了越来越多的儿童被确诊为自闭症谱系障碍。标准化的诊断仪器已被证明是可靠和有效的，现在广泛应用于自闭症谱系障碍的研究。虽然全面、有效的评估对教育计划至关重要，但自闭症谱系内的诊断区分是否能直接带来临床或教育上的好处仍存在争议。申请人建议评估在自闭症类别下接受教育干预的儿童中存在的诊断差异的范围。将调查自闭症儿童服务提供系统所使用的诊断和教育评估的性质。这些数据将用于确定学校使用的更广泛的自闭症定义与由经验丰富的专业人员使用基于研究的标准化测试工具进行的诊断如何比较。申请人正在申请职业发展奖（K23），以获得解决这些问题所需的服务研究方面的高级培训。申请人在儿童诊断和神经心理学评估，研究设计和统计以及自闭症具体问题方面的强大学术，研究和临床培训背景将为这项工作提供良好的基础。拟议的培训目标，包括熟悉服务研究中使用的统计和纵向技术，以及获得更多关于学校和校本评估服务的知识，结合研究计划，将使申请人能够追求创新的方法，在社区环境中对自闭症儿童实施基于研究的诊断和评估方法。

DESCRIPTION (provided by applicant): The clinical complexities of proper diagnosis and assessment of children with ASD, together with federal and state mandates to provide services, present significant challenges to local schools and public service providers. Autism is increasingly conceptualized to encompass a spectrum of disorders rather than a unitary, classically defined developmental disorder. Given the large number of behaviors that define the "autistic spectrum disorders" (ASD) and the variability seen across individual children even within the same diagnostic category, proper identification and assessment requires experienced clinicians and educators. It appears that better identification and broader categorization have contributed to the increasing numbers of children who are being identified with ASD. Standardized diagnostic instruments that have been demonstrated to be reliable and valid are now widely used in ASD research. While comprehensive, valid assessments are essential for educational planning, the direct clinical or educational benefits of diagnostic distinctions within the autism spectrum are a matter of debate. The applicant proposes to evaluate the range of diagnostic distinctions that are present in children who are receiving educational interventions under the autism category. The nature of diagnostic and educational assessments used by service delivery systems for children with autism will be investigated. These data will be used to determine how the broader definition of autism used by schools compares with a diagnosis based on the use of research-based standardized test instruments by experienced professionals. The applicant is requesting a Career Development Award (K23) to obtain the advanced training in services research she needs to address these issues. The applicant's strong background of academic, research, and clinical training in diagnostic and neuropsychological assessment in children, research design and statistics, and autism specific issues will provide an excellent foundation for this work. The proposed training goals, including becoming familiar with statistics and longitudinal techniques used in services research, and obtaining greater knowledge about schools and school-based assessment services, in conjunction with the research plan, will allow the applicant to pursue innovative approaches to implementing research-based diagnostic and assessment methods for children with autism in community settings.