Diagnosis of autism spectrum disorders: A study of community practice

Aim: The goal of this study was to characterize the practices of community clinicians who evaluate children for a possible autism spectrum disorder (ASD).

Methods: Clinical reports from a developmental evaluation clinic were examined from 200 children (ages 2 to 6) who were given an ASD diagnosis.

Results: A standard method of record review was utilized to examine the diagnostic descriptions and terminology noted, the types of diagnostic information presented, the sources of information that were utilized to reach a diagnostic conclusion, and the specific behaviors/symptoms that clinicians rely on to determine a diagnosis. Consistent with the research literature, there was variation in agreement between diagnostic measures and clinical diagnosis. The strongest agreement between a standardized diagnostic measure and clinical diagnosis was observed for the measure that is considered part of the “gold standard” for diagnosis in research studies. Across this age range, a nonspecific ASD was given to approximately 30% of cases.

Discussion: In contrast to the research literature on diagnosis of ASD in young children, community clinicians appear to be less likely to give a diagnosis of autistic disorder in very young children and more likely to give a nonspecific diagnostic classification across this age range. This may reflect the greater diversity of children that are evaluated in community settings compared with specialty and research clinics. Differences in results may also be related to diagnostic practices and validity of measures used. Issues related to diagnostic specificity and eligibility for services will also be discussed.