尽管临床情况存在模糊性，但仍能做出诊断：医生对自闭症谱系障碍发病率上升的看法。
Diagnosis despite clinical ambiguity: physicians' perspectives on the rise in Autism Spectrum disorder incidence.
机构信息
Child Development, Medical Division and Research Institute, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel.
Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel.
出版信息
BMC Psychiatry. 2021 Mar 12;21(1):150. doi: 10.1186/s12888-021-03151-z.
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.
背景
为了深入了解医生对自闭症谱系障碍（ASD）发病率和诊断过程的变化的看法，与其他精神和神经发育障碍相比。
方法
向以色列的 191 名儿童神经病学和儿童发育专家以及 200 名儿童精神科医生发送了一份问卷。收集了专业背景信息，以及医生对 ASD 诊断准确性和速度的看法，与脑瘫（CP）、精神疾病和注意力缺陷多动障碍（ADHD）相比。对于每个封闭式问题，对分类变量进行全局卡方检验。
结果
115 名儿童神经病学和发育专家（60.2%）和 59 名儿童精神科医生（29.5%）做出了回应。大多数医生（67.2%）表示 ASD 的发病率有中度/显著增加，高于 CP（2.9%，p<0.01）和精神疾病（14.4%，p<0.01）的类似反应，与 ADHD（70.1%，p=0.56）的反应相似。52.8%的医生认为，在超过 10%的临床评估中，尽管评估结果不确定，但仍给出了 ASD 诊断（CP：8.6%，p<0.01；精神疾病：25.8%，p=0.03；ADHD：68.4%，p=0.03）。
结论
临床医生认为 ASD 和 ADHD 都是过度诊断的疾病。ASD 与其他疾病之间的共同症状，加上 ASD 意识的提高和公众对其污名化的消除，以及 ASD 特定服务的可用性，这些服务不适用于其他疾病的儿童，可能导致临床医生过度诊断 ASD。建议采用一种治疗资格取决于功能而非仅取决于诊断的方法。医学界应努力准确诊断，并不断审查诊断标准。
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