Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16-30-Month-Olds: A Multi-site Trial Secondary Analysis.
Cheryl Klaiman, Stormi White, Shana Richardson and 16 others
PMID 36396807WHAT IT FOUND
Expert clinicians were certain in their diagnosis for 70.2% of toddlers.
Uncertainty clustered in children with mid-range autism symptoms. For those diagnosed with ASD, mild presentation was the top reason for doubt. For non-ASD cases, repetitive behaviors alongside social strengths drove uncertainty.
Key findings
01Clinicians reported certainty in their diagnosis for 348 of 496 cases (70.2%).
02Diagnostic uncertainty was strongly associated with mid-range scores on the ADOS-2, specifically Social Affect and Restricted and Repetitive Behaviors.
03The most common reason for uncertainty in ASD diagnoses was mild symptom presentation, while for non-ASD diagnoses it was the presence of repetitive behaviors alongside social strengths.
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 drawn from specialized centers with highly experienced clinicians, so uncertainty rates in community settings may be higher. The study did not follow up to see if uncertain diagnoses changed over time or how families experienced the diagnostic process. There is no validated tool for measuring clinician certainty, so the study used a non-standardized rating scale. The sample had less racial and ethnic diversity than previous studies, limiting generalizability.
Declared interests
The study was funded by the Marcus Foundation. The authors did not report other conflicts of interest in the provided text.
The easy way to misread this
Do not interpret the 70.2% certainty rate as a failure of clinical judgment or a sign of poor training. The study shows that uncertainty is concentrated in the 'gray zone' of mid-range symptoms, which is an inherent challenge in diagnosing very young children where behaviors are still emerging. It does not suggest that clinicians are guessing, but rather that the boundary between ASD and other developmental delays is often unclear in mild cases.