"Frank" presentations as a novel research construct and element of diagnostic decision-making in autism spectrum disorder.
Ashley de Marchena, Judith Miller
PMID 27770496WHAT IT FOUND
Most ASD diagnosticians recognise a rapid, clear 'frank' presentation in about 40% of their patients.
Clinicians form these impressions quickly, often within 10 minutes, primarily through observed social and repetitive behaviors. This suggests experience shapes diagnostic intuition, though it requires careful checking against formal criteria.
Key findings
0197% of eligible providers reported experiencing the 'you know it when you see it' phenomenon of frank ASD.
02On average, clinicians reported that 40% of patients diagnosed with ASD have a frank presentation.
0352% of participants described themselves as detecting frank features within 10 minutes.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relied entirely on self-report, with no verification of actual diagnostic outcomes or accuracy. Speech-language pathologists and other non-diagnostic clinicians were excluded from the analysis, limiting generalizability to those disciplines. The response rate was low (14%), which may introduce bias if only certain types of clinicians responded. There was no data on the specific training, setting, or types of referrals seen by respondents, making it hard to account for environmental factors.
Declared interests
The authors declared no conflicts of interest. The study was deemed exempt by the Institutional Review Board at the Children’s Hospital of Philadelphia.
The easy way to misread this
Do not interpret the rapid formation of 'frank' impressions as evidence that formal diagnostic tools are unnecessary. The authors note that while these impressions are common, they can lead to confirmation bias, and most clinicians still proceed with standard evaluations regardless of initial impressions.