Abstract
Social science literature has documented how the concept of diagnosis can be seen as an interactive process, imbued with uncertainty and contradiction, which undermines a straightforward notion of diagnosis as a way to identify underlying biological problems that cause disease. We contribute to this body of work by examining the process of resolving contradiction in autism diagnosis for adults and adolescents. Autism is a useful case study as diagnosis can be a complex and protracted process due to the heterogeneity of symptoms and the necessity to interpret behaviours that may be ambiguous. We audio-recorded and transcribed 18 specialist clinical assessment meetings in four teams in England, covering 88 cases in two adult, one child and one adolescent (14+) setting. We undertook a qualitative analysis of discursive processes and narrative case-building structure utilised by clinicians to counteract contradiction.We identified a three-part interactional pattern which allows clinicians to forward evidence for and against a diagnosis, facilitates their collaborative decision-making process and enables them to build a plausible narrative which accounts for the diagnostic decision. Pragmatism was found to operate as a strategy to help assign diagnosis within a condition which, diagnostically, is permeated by uncertainty and contradiction. Resolution of contradiction from different aspects of the assessment serves to create a narratively-coherent, intelligible clinical entity that is autism.
Highlights
Diagnosis is traditionally thought of as a way to identify underlying biological problems that cause disease
The ‘moral certainty’ of practical reasoning, experience or routine, is adop ted in day-to-day clinical practice; and the uncertainty of theoretical discourse is the knowledge of the laboratory (Atkinson, 1995)
In four cases the diagnostic decision made was in contradiction to the Autism Diag nostic Observation Schedule (ADOS) result
Summary
Diagnosis is traditionally thought of as a way to identify underlying biological problems that cause disease. This article contributes further to the sociology of diagnosis literature by using a discursive approach to examine narrative case-building in clinical assessment teams Autism diagnosis for both adults and children can be a complex and protracted process due to heterogeneity of symptoms, the necessity of interpreting behaviours that may be ambiguous, and a lack of clinical biomarkers (Klin et al, 2000; Vllasaliu et al, 2016). It is an ideal case study to explore how clinicians, in their role as diagnosticians, manage these complicating factors
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