Michael Davidovitch1,2, Dorit Shmueli3, Ran Shmuel Rotem4,5, Aviva Mimouni Bloch6,7. 1. Child Development, Medical Division and Research Institute, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel. davidom@netvision.net.il. 2. Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel. davidom@netvision.net.il. 3. Clalit Child Development Center, Clalit Healthcare Services, 75 Betlehem Rd., 9362410, Jerusalem, Israel. 4. Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel. 5. Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA. 6. Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza St., 4310000, Raanana, Israel. 7. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: 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. METHOD: A 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. RESULTS: 115 (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). CONCLUSION: The 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.
BACKGROUND: 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. METHOD: A 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. RESULTS: 115 (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). CONCLUSION: The 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.
Authors: Helen Coo; Hélène Ouellette-Kuntz; Jennifer E V Lloyd; Liza Kasmara; Jeanette J A Holden; M E Suzanne Lewis Journal: J Autism Dev Disord Date: 2007-11-02
Authors: Charles H Zeanah; Alice S Carter; Julie Cohen; Helen Egger; Mary Margaret Gleason; Miri Keren; Alicia Lieberman; Kathleen Mulrooney; Cindy Oser Journal: Infant Ment Health J Date: 2016-08-29
Authors: Lisa D Wiggins; Catherine E Rice; Brian Barger; Gnakub N Soke; Li-Ching Lee; Eric Moody; Rebecca Edmondson-Pretzel; Susan E Levy Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2019-03-08 Impact factor: 4.519
Authors: Matthew J Maenner; Kelly A Shaw; Jon Baio; Anita Washington; Mary Patrick; Monica DiRienzo; Deborah L Christensen; Lisa D Wiggins; Sydney Pettygrove; Jennifer G Andrews; Maya Lopez; Allison Hudson; Thaer Baroud; Yvette Schwenk; Tiffany White; Cordelia Robinson Rosenberg; Li-Ching Lee; Rebecca A Harrington; Margaret Huston; Amy Hewitt; Amy Esler; Jennifer Hall-Lande; Jenny N Poynter; Libby Hallas-Muchow; John N Constantino; Robert T Fitzgerald; Walter Zahorodny; Josephine Shenouda; Julie L Daniels; Zachary Warren; Alison Vehorn; Angelica Salinas; Maureen S Durkin; Patricia M Dietz Journal: MMWR Surveill Summ Date: 2020-03-27