First, there was the study last year showing that clinicians and health professionals vary greatly in how they assess for and diagnose ASD. Some taking much more time and using standardised assessment tools as a part of their diagnostic practices. Others spending far less time and simply briefly observing a child before diagnosing them with a lifelong developmental disorder.
Then, last week, we saw the release of a study showing what we’ve been arguing at Annie’s Centre for a long time…the huge increase in numbers diagnosed with ASD is mostly due to clinicians diagnosing much milder symptoms as being part of the Autism Spectrum.
Professor Andrew Whitehouse, one of the lead authors of the study and Nicole Rogerson, CEO of Autism Awareness Australia are both correct when they say that our understanding of ASD has changed over recent years. Indeed, the latest diagnostic criteria, DSM 5 includes “milder” symptoms that were not included in past versions of the criteria. BUT… something still doesn’t add up…
FACT 1: It is harder to detect ASD at the mild end of the spectrum not easier. There is more possibility of symptoms overlapping with other conditions and more time is required for the diagnostician to rule out other explanations like learning, language, behaviour disorders. In short, the less obvious the ASD the more time one needs to spend ensuring the ASD symptoms are in fact ASD symptoms.
FACT 2: We know clinicians vary hugely in how they go about assessing for ASD and now we also know it is these very assessments which are accounting for the huge increase in ASD numbers. Isn’t it also likely that there is some mis-diagnosing or sloppy diagnosing going on?
FACT 3: It is impossible to have such huge variations in diagnostic practices across clinicians especially at the “milder” end of the spectrum, and still expect that we are doing a thorough enough job of getting ASD assessment right.
The only way that can occur is via consistent national standards for ASD diagnostic assessment practices across all clinicians.
Let’s hope the growing numbers of clinicians “specialising” in this area is only due to them being well intentioned in solving the assessment puzzle and being as thorough as possible for families not because ASD is being seen as a lucrative, growing field.