Diagnosis despite clinical ambiguity: physicians\u2019 perspectives on the rise in Autism Spectrum disorder incidence

Michael Davidovitch,Ran Shmuel Rotem,Aviva Mimouni Bloch,Dorit Shmueli

doi:10.1186/s12888-021-03151-z

Abstract

BackgroundTo provide insight on physicians’ perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders.MethodA questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians’ opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed.Results115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03).ConclusionThe clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.

Highlights

To provide insight on physicians’ perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders
Most physicians had more than 5 years of practice experience (86% of experts in child neurology and development; 75% of child psychiatrists), overall, 90% of them diagnosed ASD in their practice, and 86% worked in both public and private clinics
The majority of physicians (67.2%) indicated that there is a moderate or significant increase in the incidence of ASD diagnosis, which was statistically significantly different compared to the number of similar responses provided for cerebral palsy (CP) (2.9%, p < 0.01) and other mental disorders (14.4%, p < 0.01), not compared to Attention Deficit Hyperactivity Disorder (ADHD) (70.1%, p = 0.56) (Table 2)

Summary

Introduction

To provide insight on physicians’ perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders. While the cumulative effect of the above factors likely contributes to the rising trend in ASD incidence, ASD has no biological markers, and the diagnosis relies solely on the evaluation of developmental history, questionnaires, clinical observations, and semi-structured tests. This has led some researchers to suggest that there are other, extrinsic determinants related to seeking a diagnosis and to the diagnostic process itself that account for the increasing trend in ASD. To provide some insight on physicians’ perspectives concerning the possible effects of the above factors, we surveyed specialists in child neurology and development and child psychiatry on recent changes in the incidence and diagnostic process of ASD compared to other mental and neurodevelopmental disorders

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Results

Conclusion