McDonnell Christina G, Andrzejewski Theresa, Gomez Batista Saily, DeLucia Elizabeth A, Fok Megan, Stanton Kasey
Department of Psychology, University of Wyoming.
Department of Psychology, Virginia Tech.
J Clin Child Adolesc Psychol. 2025 Jan-Feb;54(1):152-162. doi: 10.1080/15374416.2023.2191282. Epub 2023 Apr 3.
Autism diagnosis is fraught with inequities, including misdiagnosis and delayed identification that disproportionately affect minoritized youth. Aspects of clinician decision-making, particularly diagnostic certainty, may contribute to these inequities. Little is known about how closely clinician certainty corresponds with autistic traits, nor whether certainty relates to socio-demographic factors.
Autistic youth from the Simons Simplex Collection ( = 2,853) completed assessments after which clinicians rated how certain they were that the child met autism diagnostic criteria. Core clinical factors included clinician-observed (Autism Diagnostic Observation Schedule; ADOS) and parent-reported autistic traits (Social Communication Questionnaire), and an overall IQ score.
Clinician certainty was moderately positively associated with parent-reported and observed autistic traits and was just as strongly negatively associated with IQ. Socio-demographic factors significantly associated with certainty, even accounting for clinical measures. Lower income and older child age related to less certainty. In contrast, clinicians rated higher certainty for youth identified as Hispanic, Black or African American, or Asian. Race and income also moderated the concordance between certainty with clinical factors. The agreement between higher ADOS scores and higher certainty was significantly weaker for lower-income families. The association between lower IQ and higher certainty was non-significant for Asian youth.
Diagnostic certainty ratings do not necessarily correspond closely with the level of autistic traits, and clinician perception of autism diagnosis may be related to demographic factors. Caution is needed when relying on clinician certainty to inform diagnosis. Future research on diagnostic practices is urgently needed among diverse and minoritized communities.
自闭症诊断充满了不公平现象，包括误诊和诊断延迟，这些现象对少数族裔青少年的影响尤为严重。临床医生的决策因素，尤其是诊断确定性，可能是造成这些不公平现象的原因。目前对于临床医生的确定性与自闭症特征的吻合程度，以及确定性是否与社会人口统计学因素相关，了解甚少。
来自西蒙斯单纯型病例集（n = 2853）的自闭症青少年完成评估后，临床医生对他们确定该儿童符合自闭症诊断标准的程度进行评分。核心临床因素包括临床医生观察到的（自闭症诊断观察量表；ADOS）和家长报告的自闭症特征（社会沟通问卷），以及总体智商得分。
临床医生的确定性与家长报告和观察到的自闭症特征呈中度正相关，与智商呈同样强烈的负相关。社会人口统计学因素与确定性显著相关，即使在考虑临床指标的情况下也是如此。低收入和年龄较大与确定性较低相关。相比之下，临床医生对被认定为西班牙裔、黑人或非裔美国人或亚裔的青少年的确定性评分较高。种族和收入也调节了确定性与临床因素之间的一致性。对于低收入家庭，ADOS得分较高与确定性较高之间的一致性显著较弱。对于亚洲青少年，智商较低与确定性较高之间的关联不显著。
诊断确定性评分不一定与自闭症特征水平密切相关，临床医生对自闭症诊断的认知可能与人口统计学因素有关。在依靠临床医生的确定性来指导诊断时需要谨慎。迫切需要在不同的少数族裔社区开展关于诊断实践的未来研究。
