Autism diagnosis deficiencies

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Time to act on autism diagnosis deficiencies

The article highlights the main problems I have found around access to a comprehensive diagnosis by someone who knows what they are doing.

Accurate diagnosis of autism requires a very highly trained clinician who is experienced in diagnosing autism. I'm a clinical psychologist who trains psychologists in a clinical program and I find that inexperienced clinicians have a lot of trouble with learning autism assessment as there is no one symptom that everyone on the spectrum shares and so the DSM-5 criteria can't provide specific examples of definite "autistic" behaviours. There are also lots of conditions that share similar features with autism. Autism also usually co occurs with other conditions, which makes for many rabbit holes for a novice diagnostician to fall down, especially when assessing adults.

So anyone who has any skill in assessing autism is typically a mid career specialist who's time is VERY expensive. The current best practice diagnosis guidelines require many hours of time so thorough testing is not financially viable for many people. But a quick and cheap alternative that is easy to train a diagnostician to do doesn't currently exist, screening instruments are not diagnostic, so we end up with a bottleneck and people experiencing excessive waiting times. In my country there is little funding for assessment. Parents of children might be willing to pay privately as they see it as an investment to gain access to NDIS funding. I do fewer adult assessments as when they are told how much it will cost few call back to book an assessment.

It will be interesting to see if anyone develops something that can more definitively pick up autism rather than other conditions which overlap.
There've been some interesting studies recently which might lead towards development of a more objective test.
One was measuring auditory responses, I think, and another was related to differences in visual attention, from eye-tracking while looking at images on a screen.
Personally I think it would be great to be less reliant on the subjective views of the diagnostic professional.

Yep...objective tests would certainly help!

Anything of a subjective nature will inevitably have “deficiencies.”

This is why reliance on the results of social science research for how one perceives one’s self is absurd.

I like the idea.

I'd want to see differences between cases. Harder results.


Hopefully it's also the kind of tests that no amount of practicing or extreme aptitudes can emulate or bypass it.

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I guess the answer to that is that we do all generally suffer from the same umbrella condition,
and may very well share some of the traits, but not all the traits / symptoms.

Over the past few years, I have met a few different people with ASD and none of us are exactly the same.
I would say that there are some similarities among most of the people whom i met,
with some aspects of our behaviour and some aspects of our general presentation of ailments to be the same,
while the rest being completely different.

I would say that anxiety and a low capacity for stress is very common.
I would also say that tangential communication manner is also common (varying in levels).
Other than that, I am not sure what else is common. Although i note I am not a qualified clinical psychologist
specialised in this area nor a health care provider with experience in treating or caring for people with ASD.

There are likely other aspects of the condition that I am unaware of.
Perhaps the main similarity is that most of us think having ASD sucks?

Well, to be diagnosed with ASD, you need to show deficits in social communication and have restricted or repetitive behavior--the criteria for those are stated in DSM-5. These must be evident from childhood. It seems we need to share two traits, regardless of how they are manifested in an individual.

While there a many comorbidities and related conditions associated with ASD, they don't define ASD.

Autism as a medical diagnosis is different than a social definition of autism. A medical diagnosis is required in order to justify treatment. Treatment may not be something standard like medication or therapy, it would also include work, school, or living accommodations.

All social groups decide collectively what constitutes membership. There will always be some disagreement for people who only partially fit in, or people who fit in just as well in another social group. For example, if you have social anxiety, this could be present because of autism, instead of autism, or alongside autism. It is up to each member and those around them to decide where the person belongs.

And yes, autism characteristics are so debatable because there is NO definitive test. If I had a broken leg, we could all see the objectively broken bone and agree that I have a broken leg. If my behaviors and subjective feelings are used to diagnose me, there is quite a lot of room for argument.