Université de Montréal, Canada.
CIUSSS du Nord-de-L'Île de Montréal, Canada.
Autism. 2022 Jul;26(5):1153-1164. doi: 10.1177/13623613211042719. Epub 2021 Sep 11.
The diagnostic criteria for autism are relatively vague and can lead to both under- and over-diagnosis if applied as a checklist. The highest level of agreement that a person is autistic occurs when experienced clinicians are able to make use of their clinical judgment. However, it is not always clear what this judgment consists of. Given that particular issues exist when assessing for autism in adult women, we wanted to explore how expert clinicians address difficult diagnostic situations in this population. We interviewed 20 experienced psychologists and psychiatrists from seven countries and discussed how they conducted autism assessments in adult women. We then came up with a list of 35 statements that described participant views. Our participants completed an online survey where they rated their agreement with these statements and provided feedback on how the statements were worded and organized. We obtained a final list of 37 suggested clinical guidelines. Participants agreed that diagnostic tools and questionnaires had to be coupled with judgment and expertise. Participants felt that trauma and Borderline Personality Disorder could be difficult to differentiate from autism, and agreed on some ways to address this issue. Participants agreed that self-identification to the autism spectrum was frequent, and that it was important to provide alternative support when they did not ultimately diagnose autism.
自闭症的诊断标准相对模糊，如果作为清单来应用，可能会导致诊断不足或过度。当经验丰富的临床医生能够运用他们的临床判断时，一个人被诊断为自闭症的一致性最高。然而，这种判断具体包括哪些内容并不总是清楚的。鉴于在评估成年女性自闭症时存在特定问题，我们想探讨专家临床医生如何解决该人群中困难的诊断情况。我们采访了来自七个国家的 20 名经验丰富的心理学家和精神科医生，讨论了他们如何对成年女性进行自闭症评估。然后，我们列出了 35 条描述参与者观点的陈述。我们的参与者完成了一份在线调查，他们对这些陈述的同意程度进行了评估，并就陈述的措辞和组织方式提供了反馈。我们最终得出了 37 条建议的临床指南列表。参与者一致认为诊断工具和问卷必须与判断和专业知识相结合。参与者认为创伤和边缘型人格障碍可能难以与自闭症区分开来，并就解决这个问题的一些方法达成了一致。参与者一致认为，自我认同到自闭症谱系是常见的，当他们最终没有诊断出自闭症时，提供替代支持很重要。
