Department of Psychiatry, Oregon Health & Science University, Portland, OR.
Department of Family Medicine, Oregon Health & Science University, Portland, OR.
J Dev Behav Pediatr. 2020 Aug;41(6):428-435. doi: 10.1097/DBP.0000000000000797.
The prevalence of autism spectrum disorder (ASD) has increased 10-fold in the past 40 years, and disparities have been noted by race/ethnicity and socioeconomic status, prompting concern about diagnostic accuracy. Provider perceptions of ASD diagnostic accuracy are not known. We conducted a survey of providers who diagnose ASD assessing how nonclinical factors might affect ASD diagnostic rates.
The mixed-mode survey was sent to the members of the Society of Developmental and Behavioral Pediatrics with clinical interest in ASD (n = 400). Respondents used a Likert-type scale to address how often they and their colleagues overdiagnosed or underdiagnosed ASD. They were also asked how families grouped by race/ethnicity, education, socioeconomic status, and urbanicity perceived an ASD diagnosis.
Sixty-three percent of providers completed the survey. Eight point seven percent of providers self-reported that they overdiagnose ASD at least sometimes. However, 58% of providers reported that local colleagues overdiagnose ASD at least sometimes. Seven point eight percent of providers self-reported underdiagnosing ASD at least sometimes and cited parents not wanting a diagnosis as one of the most common reasons they may underdiagnose. Providers reported that non-white and rural families were more likely to think that ASD diagnosis was "a bad thing" than "a good thing" than white and urban and suburban families, respectively.
Providers report moderate rates of ASD misdiagnosis and perceive differences in diagnostic preferences according to family characteristics. The study results may help explain the trends and disparities in ASD diagnosis.
自闭症谱系障碍（ASD）的患病率在过去 40 年中增加了 10 倍，而且在种族/族裔和社会经济地位方面存在差异，这引起了人们对诊断准确性的关注。目前尚不清楚提供者对 ASD 诊断准确性的看法。我们对诊断 ASD 的提供者进行了一项调查，评估非临床因素如何影响 ASD 的诊断率。
该混合模式调查发送给了对 ASD 有临床兴趣的发育和行为儿科学会的成员（n = 400）。受访者使用李克特量表来评估他们自己和同事是否经常过度诊断或漏诊 ASD。他们还被问及按种族/族裔、教育程度、社会经济地位和城市划分的家庭如何看待 ASD 诊断。
63%的提供者完成了调查。8.7%的提供者自我报告说他们至少有时会过度诊断 ASD。然而，58%的提供者报告说当地同事至少有时会过度诊断 ASD。7.8%的提供者自我报告说至少有时会漏诊 ASD，并将父母不想诊断为漏诊的常见原因之一。提供者报告说，非白人和农村家庭比白人、城市和郊区家庭更有可能认为 ASD 诊断是“一件坏事”而不是“一件好事”。
提供者报告 ASD 误诊率适中，并根据家庭特征感知诊断偏好的差异。研究结果可能有助于解释 ASD 诊断的趋势和差异。
