Azu Margaret A, Han Gloria T, Wolf Julie M, Naples Adam J, Chawarska Katarzyna, Dawson Geraldine, Bernier Raphael A, Jeste Shafali S, Dziura James D, Webb Sara J, Sugar Catherine A, Shic Frederick, McPartland James C
Yale University, USA.
Vanderbilt University Medical Center, USA.
Autism. 2025 Mar;29(3):614-626. doi: 10.1177/13623613241279999. Epub 2024 Sep 30.
Clinician and caregiver reports of autism features are both integral to receiving an autism diagnosis and appropriate intervention, yet informant discrepancies are present in clinical practice and may differ by demographic characteristics of the child and family. The present study examined how clinician-caregiver discrepancies in ratings of a child's autism-related behaviors relate to a child's sex at birth, age at first diagnosis, and amount of intervention received. Participants were 280 children (76.8% male, 67.9% White), 6-11 years old ( = 8.5 ± 1.6), with a diagnosis of autism spectrum disorder. Variable-centered and person-centered approaches were used to examine relationships between standardized clinician-caregiver discrepancy and participant characteristics. Both analytic approaches indicated that clinicians rated autism-related behaviors lower than caregivers for females and higher than caregivers for males. In addition, lower clinician ratings of autism features, relative to caregiver ratings, were associated with older age at diagnosis and fewer hours of intervention. Findings underscore the importance of incorporating multiple informants, especially caregivers, in the diagnostic process and developing diagnostic procedures sensitive to the female autism phenotype to facilitate diagnosis, intervention, and subsequent development.Lay abstractIn some cases, a clinician's perceptions of a child's autism-related behaviors are not the same as the child's caregiver's perceptions. Identifying how these discrepancies relate to the characteristics of the child is critical for ensuring that diagnosis procedures are unbiased and suitable for all children. This study examined whether discrepancies between clinician and caregiver reports of autism features related to the child's sex at birth. We also explored how the discrepancies related to the age at which the child received their autism diagnosis and how much intervention they received. We found that clinicians rated autism features higher than caregivers for boys and rated autism features lower than caregivers for girls. In addition, lower clinician relative to parent ratings was related to being diagnosed at an older age and receiving less intervention. These findings suggest that there is more to learn about the presentation of autism-related behaviors in girls. When caregiver and clinician ratings of autism features do not align, it may be important to consider caregivers' ratings to obtain a more accurate picture of the child's autism features and the support they may need.
临床医生和照料者关于自闭症特征的报告对于获得自闭症诊断和进行适当干预都至关重要，但在临床实践中存在信息提供者之间的差异，且这些差异可能因儿童和家庭的人口统计学特征而异。本研究考察了临床医生与照料者在儿童自闭症相关行为评分上的差异如何与儿童的出生性别、首次诊断年龄以及接受的干预量相关。研究参与者为280名6至11岁（平均年龄=8.5±1.6岁）被诊断为自闭症谱系障碍的儿童（76.8%为男性，67.9%为白人）。采用以变量为中心和以人为中心的方法来考察标准化的临床医生-照料者差异与参与者特征之间的关系。两种分析方法均表明，临床医生对女性自闭症相关行为的评分低于照料者，对男性的评分则高于照料者。此外，相对于照料者的评分，临床医生对自闭症特征的较低评分与诊断时年龄较大以及干预时间较少有关。研究结果强调了在诊断过程中纳入多个信息提供者，尤其是照料者的重要性，并开发对女性自闭症表型敏感的诊断程序，以促进诊断、干预及后续发展。
在某些情况下，临床医生对儿童自闭症相关行为的认知与儿童照料者的认知并不相同。确定这些差异如何与儿童特征相关对于确保诊断程序公正且适用于所有儿童至关重要。本研究考察了临床医生与照料者关于自闭症特征的报告之间的差异是否与儿童的出生性别有关。我们还探讨了这些差异如何与儿童获得自闭症诊断的年龄以及他们接受的干预量相关。我们发现，临床医生对男孩自闭症特征的评分高于照料者，对女孩自闭症特征的评分低于照料者。此外，临床医生相对于家长的较低评分与诊断年龄较大和接受的干预较少有关。这些发现表明，关于女孩自闭症相关行为的表现还有更多需要了解的地方。当临床医生和照料者对自闭症特征的评分不一致时，考虑照料者的评分可能很重要，以便更准确地了解儿童的自闭症特征以及他们可能需要的支持。
