Diagnosis despite clinical ambiguity: physicians’ perspectives on the rise in Autism Spectrum disorder incidence

BMC Psychiatry

Michael Davidovitch¹  Dorit Shmueli²  Ran Shmuel Rotem³  Aviva Mimouni Bloch⁴ 

[1] Child Development, Medical Division and Research Institute, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel;Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel;Clalit Child Development Center, Clalit Healthcare Services, 75 Betlehem Rd., 9362410, Jerusalem, Israel;Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel;Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA;Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza St., 4310000, Raanana, Israel;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

关键词: Autism Spectrum disorder;    Diagnosis;    Physicians’ opinion;   

DOI  :  10.1186/s12888-021-03151-z

来源: Springer

【 摘 要 】

BackgroundTo provide insight on physicians’ perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders.MethodA questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians’ opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed.Results115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03).ConclusionThe clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.

【 授权许可】

CC BY