The Challenge of Making a Diagnosis: Understanding the Diagnostic Variation Among Autism Professionals

Background:  Diagnosis of children with Autism Spectrum Disorders (ASDs) is challenging for children who present confusing or conflicting symptoms. Providers of different professional disciplines often disagree regarding a diagnosis based perhaps on discipline perspective, opportunity for multi-disciplinary assessments, clinical experience and other variables.  The current study investigates some of the factors that might relate to diagnostic challenges and disagreement by examining data collected from clinicians during an interactive, conference of diverse professional backgrounds in Washington State.

Objectives:

1. To describe and to evaluate the degree of diagnostic agreement for ASDs among and between participants of various professional disciplines as well as professional characteristics such as work setting and years of clinical experience.
2. To determine which professional characteristics and/or clinical observations are associated with assignment of an ASD diagnosis.

Methods: The conference attendees included medical providers, psychologists, speech language pathologists, and others (n= 77).  Three cases were presented to the conference participants, including a 3 y/o boy, a 6 y/o girl and a 16 y/o boy.  Each case was presented to attendees in sections, the first being historical information, followed by viewing 30 minutes of edited ADOS testing and finally additional test information that was gathered after ADOS testing.  Each participant was asked at the end of each section to complete a short questionnaire to evaluate their immediate diagnostic impressions.  The online questionnaire data were collected simultaneously from each attendee using a web-based survey tool.  Attendees were asked not to discuss their impressions until after entering their final conclusions, and then encouraged to discuss cases in small groups at the termination of each case presentation.  We provide a frequency analysis of assignment of an ASD diagnosis by case for each professional discipline and characteristic. We will also query which characteristics are positively and negatively associated with the assignment of an ASD to a given case.

Results:  For cases 1, 2, and 3 the percentage of medical providers who assigned an ASD diagnosis was 37.5%, 33.3%, and 64.7% respectively. Among the psychologists, the percentage of providers who assigned an ASD diagnosis was 23.8%, 50%, and 66.7% for the same cases.  For each of the 3 cases, chi-square analyses indicated that psychologists were not significantly more likely to assign an ASD diagnosis than medical providers. The analysis is still ongoing, and we hope to provide a model of the associations of different professional characteristics or patient characteristics with assignment of an ASD diagnosis.

Conclusions: In our initial analysis, we have found that there is a lack of consistency among professional disciplines in assignment of an ASD diagnosis not necessarily attributable to differences in the diagnosticians' professional disciplines.  To increase diagnostic consistency among the varied professionals who care for individuals with ASDs, more research should further characterize the varying diagnostic approaches between different professional disciplines.  Our research will begin to address these approaches which could perhaps lead to more consistent identification and classification of this complex disorder.