Abstract

Failure to correctly diagnosis autism is problematic in both the false-positive and false-negative directions. Diagnosing autism when it is not truly present can direct limited resources away from those who actually need the services, while also creating stress and confusion for individuals and families. In contrast, failure to correctly identify autism when it is indeed present can prevent individuals and families from receiving needed support, including early intervention services. Those familiar with current trends in autism assessment are likely aware of “gold standards” involving specific autism tests and “best practices” involving multi-disciplinary autism teams. Curiously, these “gold standard” and “best practice” proclamations have not been adequately scrutinized. The present article aims to address this gap in the literature by (a) discussing the value of autism tests/tools; (b) drawing attention to biasing influences in autism assessment; (c) identifying methodological flaws in “gold standard” autism assessment research; and (d) proposing that more assessment, not less, might be better in autism assessment. It is concluded that it is time to rethink “gold standards” and “best practices” in the assessment of autism.

摘要

未能正确诊断自闭症在假阳性和假阴性两个方向都是有问题的。在没有真正存在的情况下诊断自闭症可以将有限的资源从那些真正需要服务的人身上转移出去，同时也会给个人和家庭带来压力和困惑。相比之下，当自闭症确实存在时未能正确识别它可能会阻止个人和家庭获得所需的支持，包括早期干预服务。熟悉自闭症评估当前趋势的人可能知道涉及特定自闭症测试的“黄金标准”和涉及多学科自闭症团队的“最佳实践”。奇怪的是，这些“黄金标准”和“最佳实践”宣言并未得到充分审查。本文旨在通过 (a) 讨论自闭症测试/工具的价值来解决文献中的这一空白；(b) 提请注意自闭症评估中的偏见影响；(c) 识别“黄金标准”自闭症评估研究中的方法缺陷；(d) 建议在自闭症评估中，更多而不是更少的评估可能更好。结论是，是时候重新思考评估自闭症的“黄金标准”和“最佳实践”了。