From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders

Skellern, Catherine, Schluter, Philip and McDowell, Michael (2005) From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders. Journal of Paediatrics And Child Health, 41 8: 407-412. doi:10.1111/j.1440-1754.2005.00634.x

Author Skellern, Catherine
Schluter, Philip
McDowell, Michael
Title From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders
Journal name Journal of Paediatrics And Child Health   Check publisher's open access policy
ISSN 1034-4810
Publication date 2005-08
Sub-type Article (original research)
DOI 10.1111/j.1440-1754.2005.00634.x
Volume 41
Issue 8
Start page 407
End page 412
Total pages 6
Editor F. Oberklaid
Place of publication Australia
Publisher Blackwell Publishing Asia
Collection year 2005
Language eng
Subject C1
321019 Paediatrics
730204 Child health
Abstract Objective: Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland. Methods: Using anonymous self-report, all Queensland child psychiatrists and paediatricians who see paediatric patients with development/behavioural problems were surveyed and asked whether they had ever specified an ASD diagnosis in the presence of diagnostic uncertainty. Using logistic regression, elicited responses to the diagnostic uncertainty questions were related to other clinical- and practice-related characteristics. Results: Overall, 58% of surveyed psychiatrists and paediatricians indicated that, in the face of diagnostic uncertainty, they had erred on the side of providing an ASD diagnosis for educational ascertainment and 36% of clinicians had provided an autism diagnosis for Carer's Allowance when Centrelink diagnostic specifications had not been met. Conclusion: In the absence of definitive biological markers, ASD remains a behavioural diagnosis that is often complex and uncertain. In response to systems that demand a categorical diagnostic response, specialists are providing ASD diagnoses, even when uncertain. The motivation for this practice appears to be a clinical risk/benefit analysis of what will achieve the best outcomes for children. It is likely that these practices will continue unless systems change eligibility to funding based on functional impairment rather than medical diagnostic categories.
Keyword Pediatrics
Pervasive Developmental Disorders
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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Created: Wed, 15 Aug 2007, 06:01:27 EST