Clinician-caregiver informant discrepancy is associated with sex, diagnosis age, and intervention use among autistic children.
Margaret A Azu, Gloria T Han, Julie M Wolf and 10 others
PMID 39344965WHAT IT FOUND
Clinicians rated boys higher than caregivers, but rated girls lower than caregivers.
This discrepancy linked to earlier diagnosis and more intervention hours. Therapists should note that girls may appear less impaired in clinic than at home due to camouflaging.
Key findings
01Clinicians reported higher overall autism features for males and lower for females relative to caregiver reports.
02Higher clinician ratings relative to caregiver ratings were associated with earlier age at diagnosis and more hours of intervention.
03Male sex predicted lower odds of belonging to the profile where clinician ratings were lower than caregiver ratings.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The data were cross-sectional, so the study cannot determine if discrepancy causes later diagnosis or if later diagnosis causes discrepancy. The sample was relatively small for latent profile analysis and had a high proportion of male participants (76.8%). Participants were required to have an IQ above 60 and meet strict diagnostic cutoffs, excluding children with intellectual disability or those who did not meet full criteria on all measures, which may over-exclude females. The study only collected data on sex at birth, not gender identity. The measures used (ADOS-2 and SRS-2) assess different aspects of autism, so discrepancies may reflect differences in what the tools capture rather than just informant bias.
Declared interests
The study was supported by the National Institutes of Health (Extramural) and non-U.S. government research support. No specific commercial conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret the lower clinician ratings for girls as evidence that girls have fewer autism traits. The discrepancy reflects that girls may camouflage in structured clinical settings, meaning their needs are still present as reported by caregivers.