Curnow Eleanor, Utley Izy, Rutherford Marion, Johnston Lorna, Maciver Donald
School of Health Sciences, Queen Margaret University, Musselburgh, United Kingdom.
Front Psychiatry. 2023 Oct 5;14:1258204. doi: 10.3389/fpsyt.2023.1258204. eCollection 2023.
Services for the assessment and diagnosis of autism in adults have been widely criticized and there is an identified need for further research in this field. There is a call for diagnostic services to become more accessible, person-centered, neurodiversity affirming, and respectful. There is a need for workforce development which will increase capacity for diagnostic assessment and support for adults. ADOS-2 is a gold-standard diagnostic assessment tool for autism recommended in clinical guidelines. However, diagnostic procedures such as the ADOS-2 are rooted in the medical model and do not always sit comfortably alongside the neurodiversity paradigm or preferences of the autistic community. Training and educational materials need to account for the differences between these approaches and support clinicians to provide services which meet the needs of the adults they serve. The National Autism Implementation Team worked alongside ADOS-2 training providers to support clinicians in Scotland, to provide effective and respectful diagnostic assessment. The team engaged with clinicians who had attended ADOS training to identify areas of uncertainty or concern. Training materials were developed to support ADOS assessors to incorporate key principles including "nothing about us without us"; "difference not deficit"; "environment first"; "diagnosis matters," "language and mindsets matter"; and "a neurodevelopmental lens," to support the provision of neurodiversity affirming assessment practice. The National Autism Implementation Team also provided examples of actions which can be undertaken by clinicians to improve the assessment experience for those seeking a diagnosis. Training materials are based on research evidence, clinical experience, and the needs and wishes of autistic people.
针对成年人自闭症的评估和诊断服务受到了广泛批评，该领域明确需要进一步开展研究。有人呼吁诊断服务应更易获得、以患者为中心、肯定神经多样性且尊重患者。需要进行劳动力发展，以提高对成年人进行诊断评估和支持的能力。《自闭症诊断观察量表第二版》（ADOS-2）是临床指南中推荐的用于自闭症诊断的金标准评估工具。然而，诸如ADOS-2之类的诊断程序植根于医学模式，并不总是能与神经多样性范式或自闭症群体的偏好相契合。培训和教育材料需要考虑到这些方法之间的差异，并支持临床医生提供满足其服务对象需求的服务。国家自闭症实施团队与ADOS-2培训提供商合作，为苏格兰的临床医生提供支持，以进行有效且尊重患者的诊断评估。该团队与参加过ADOS培训的临床医生进行交流，以确定不确定或令人担忧的领域。开发了培训材料，以支持ADOS评估人员纳入关键原则，包括“没有我们的参与就没有关于我们的一切”；“差异而非缺陷”；“环境优先”；“诊断很重要”；“语言和思维模式很重要”；以及“神经发育视角”，以支持提供肯定神经多样性的评估实践。国家自闭症实施团队还提供了临床医生可以采取的行动示例，以改善寻求诊断者的评估体验。培训材料基于研究证据、临床经验以及自闭症患者的需求和愿望。
