Accuracy of initial diagnostic impressions of autism in toddlers and behaviors that inform these impressions.
Rebecca P Thomas, Ashley de Marchena, Andrea Trubanova Wieckowski and 6 others
PMID 38216522WHAT IT FOUND
When senior clinicians suspected autism after a brief first impression, all 22 were later diagnosed with autism, but they missed 37% of toddlers who ultimately had autism.
A brief non-autism impression should not rule out autism; longer evaluation is needed.
Key findings
01Senior clinicians missed 37% of children later diagnosed with autism after a first five-minute impression, but all 22 children they suspected of autism were later diagnosed with autism.
02Of 33 children for whom senior clinicians suspected non-autism, 20 were later confirmed as non-autism.
03Accurate initial impressions of autism were associated with atypical social reciprocity (n=13; 59%), nonverbal communication (n=14; 64%), focus of attention (n=12; 55%), and eye contact (n=12; 55%).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was small: 55 children, and only 46 had junior clinician ratings. The same clinician made the initial impression and the final diagnosis, so the initial impression could have been influenced by the later evaluation. All children were already referred for autism concerns, so the results do not show how these brief impressions would work in a general pediatric population. The clinicians were mostly experienced psychologists, with one occupational therapist among the senior clinicians, so the findings may not apply to all diagnostic settings. The setting for the first impression was not consistently recorded. There were no cases where a clinician suspected autism but the final diagnosis was non-autism, so false positives could not be studied.
Declared interests
The article is listed as supported by NIH extramural funding. Drs. Robins, Barton, and Fein are co-owners of M-CHAT LLC, which licenses use of the M-CHAT in electronic products. Dr. Robins also sits on the advisory board of Quadrant Biosciences Inc. and serves on the program quality committee at Bancroft. The other authors declared no conflicts.
The easy way to misread this
Do not treat a brief initial impression of non-autism as ruling out autism. Some children later diagnosed with autism showed typical social reciprocity, eye contact, facial expressions, and focus of attention during that brief observation.