Diagnosis despite clinical ambiguity: physicians' perspectives on the rise in Autism Spectrum disorder incidence.
Autism Spectrum disorder
Diagnosis
Physicians’ opinion
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
12 03 2021
12 03 2021
Historique:
received:
14
08
2020
accepted:
04
03
2021
entrez:
13
3
2021
pubmed:
14
3
2021
medline:
27
4
2021
Statut:
epublish
Résumé
To provide insight on physicians' perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders. A questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians' opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed. 115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03). The clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.
Sections du résumé
BACKGROUND
To provide insight on physicians' perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders.
METHOD
A questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians' opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed.
RESULTS
115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03).
CONCLUSION
The clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.
Identifiants
pubmed: 33711966
doi: 10.1186/s12888-021-03151-z
pii: 10.1186/s12888-021-03151-z
pmc: PMC7953811
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
150Références
Soc Psychiatry Psychiatr Epidemiol. 2019 Jun;54(6):693-701
pubmed: 30850887
Infant Ment Health J. 2016 Sep;37(5):471-5
pubmed: 27570937
Pediatrics. 2006 Apr;117(4):1028-37
pubmed: 16585296
J Autism Dev Disord. 2008 Jul;38(6):1036-46
pubmed: 17975721
Lancet Neurol. 2014 Mar;13(3):330-8
pubmed: 24556010
JAMA Pediatr. 2020 Jul 1;174(7):690-696
pubmed: 32310265
MMWR Surveill Summ. 2020 Mar 27;69(4):1-12
pubmed: 32214087
Dev Med Child Neurol. 2018 May;60(5):445-451
pubmed: 29574884
Arch Dis Child. 2006 Jan;91(1):8-15
pubmed: 15863467
Front Cell Neurosci. 2019 Aug 20;13:385
pubmed: 31481879
Am J Epidemiol. 2018 Apr 1;187(4):656-663
pubmed: 29452340
Mol Autism. 2017 Mar 17;8:13
pubmed: 28331572
Environ Health Perspect. 2015 Mar;123(3):264-70
pubmed: 25522338
Neurology. 2017 Apr 4;88(14):1371-1380
pubmed: 28275086
J Autism Dev Disord. 2017 Jan;47(1):163-171
pubmed: 27837300
Autism Res. 2020 Nov;13(11):1893-1901
pubmed: 33098226
Int J Epidemiol. 2009 Oct;38(5):1224-34
pubmed: 19737791
Front Psychiatry. 2014 Aug 04;5:53
pubmed: 25136320
BMC Pediatr. 2017 Dec 29;17(1):218
pubmed: 29284437