Abstract

Objective: Given the high population prevalence of Autism Spectrum Disorder (ASD) and overlapping symptoms with medically complex groups, ASD is a common rule out diagnosis for neuropsychologists even when not identified in the referral or initial presenting concerns. This paper presents practical guidance to support neuropsychologists in their ability to accurately assess, diagnose, and/or rule out ASD, especially in patients with more subtle presentations. Method: This paper combines clinical experience and empirical literature to highlight important assessment measures and related considerations, differential diagnostic considerations, common misconceptions about ASD and person/family characteristics, as well as variability in presentation and comorbidities that can obscure the diagnosis. Characteristics that may be considered “red flags” (clearly diagnostic, classic symptoms) and “pink flags” (associated features and symptoms that are suggestive of ASD but not quite definitive and that may overlap with symptoms seen in other neurodevelopmental or psychiatric diagnoses) will be discussed. Conclusions: Neuropsychologists in all clinical settings should be able to effectively screen for and/or diagnose ASD, even when its presentation is more subtle and/or when symptoms are masked by patient strengths in a way that makes their clinical presentation less obvious. Practical strategies for communicating the diagnosis and next steps/recommendations for interventions are reviewed.

摘要

目的：鉴于自闭症谱系障碍 (ASD) 在人群中的高患病率以及与医学上复杂的群体重叠的症状，即使在转诊或最初提出的问题中未发现，ASD 也是神经心理学家的常见排除诊断。本文提供了实用指南，以支持神经心理学家准确评估、诊断和/或排除自闭症谱系障碍（ASD）的能力，特别是对于表现更微妙的患者。方法：本文结合临床经验和实证文献，强调重要的评估措施和相关考虑因素、鉴别诊断考虑因素、关于自闭症谱系障碍和个人/家庭特征的常见误解，以及可能掩盖诊断的临床表现和合并症的变异性。可能被视为“红旗”（明确诊断的典型症状）和“粉红旗”（提示自闭症谱系障碍但不十分明确且可能与其他神经发育或精神病诊断中出现的症状重叠的相关特征和症状）的特征将进行讨论。结论：所有临床环境中的神经心理学家都应该能够有效地筛查和/或诊断自闭症谱系障碍，即使其表现更加微妙和/或症状被患者的优势所掩盖，从而使其临床表现不那么明显。回顾了沟通诊断的实用策略和后续步骤/干预建议。