Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA.
A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA.
Autism Res. 2024 Mar;17(3):568-583. doi: 10.1002/aur.3088. Epub 2024 Jan 12.
Clinicians form initial impressions about a child's diagnosis based on behavioral features, but research has not yet identified specific behaviors to guide initial diagnostic impressions. Participants were toddlers (N = 55, mean age 22.9 months) from a multi-site early detection study, referred for concern for ASD due to screening or parent/provider concern. Within 5 min of meeting a child, clinicians noted ASD or non-ASD impression, confidence in impression, and behaviors that informed their impression. These clinicians also determined final diagnoses for each child. When a child's final diagnosis was ASD (n = 35), senior clinicians formed an initial impression of ASD in 22 cases (63%) but missed 13 cases (37%). When final diagnosis was non-ASD (n = 20), senior clinicians made an initial impression of non-ASD in all cases (100%). Results were similar among junior clinicians. Senior and junior clinicians used the same behaviors to form accurate impressions of ASD and non-ASD: social reciprocity, nonverbal communication, and eye contact. Senior clinicians additionally used focus of attention when forming accurate impressions of ASD and non-ASD; junior clinicians used this behavior only when forming accurate non-ASD impressions. Clinicians' initial impressions of ASD are very likely to be consistent with final diagnoses, but initial impressions of non-ASD need follow-up. Toddlers who show all four atypical behaviors (social reciprocity, nonverbal communication, eye contact, and focus of attention) might receive expedited ASD diagnoses. However, presence of apparently typical behaviors should not rule out ASD; for some children a longer evaluation is necessary to allow for more opportunities to observe subtle social behavior.
临床医生根据行为特征对儿童的诊断形成初步印象，但研究尚未确定具体的行为来指导初步诊断印象。参与者为来自多地点早期检测研究的幼儿（N=55，平均年龄 22.9 个月），因筛查或父母/提供者的关注而被转诊为疑似 ASD。在与孩子见面后的 5 分钟内，临床医生记录了 ASD 或非 ASD 印象、对印象的信心以及影响印象的行为。这些临床医生还为每个孩子确定了最终诊断。当孩子的最终诊断为 ASD（n=35）时，高级临床医生在 22 例（63%）中形成了 ASD 的初步印象，但错过了 13 例（37%）。当最终诊断为非 ASD（n=20）时，高级临床医生在所有情况下（100%）都做出了非 ASD 的初步印象。初级临床医生的结果也类似。高级和初级临床医生使用相同的行为来形成 ASD 和非 ASD 的准确印象：社交互惠、非言语交流和眼神接触。高级临床医生在形成 ASD 和非 ASD 的准确印象时还额外使用了注意力焦点；初级临床医生仅在形成准确的非 ASD 印象时使用此行为。临床医生对 ASD 的初步印象很可能与最终诊断一致，但对非 ASD 的初步印象需要随访。表现出所有四种非典型行为（社交互惠、非言语交流、眼神接触和注意力焦点）的幼儿可能会被快速诊断为 ASD。然而，存在明显典型的行为不应排除 ASD；对于一些孩子，需要进行更长时间的评估，以便有更多机会观察微妙的社交行为。
