Narrative Methods for Differential Diagnosis in a Case of Autism

Turowetz, Jason; Maynard, Douglas W.

doi:10.1002/symb.344

Cited by 13 publications

(11 citation statements)

References 41 publications

(59 reference statements)

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“…This one physician said that tools were not really helpful to diagnose ASD with certainty, because the test scores were regularly overruled by a clinical intuition in the team. Previous research has highlighted the narrative process of diagnosing ASD in teams (57, 58). Our interviewees value contextual information and a multidisciplinary diagnostic assessment.…”

Section: Discussionmentioning

confidence: 99%

Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children

Jacobs

Steyaert²,

Dierickx

et al. 2019

Front. Psychiatry

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Introduction: Clinicians working with children with autism spectrum disorder (ASD) occupy an important position between parents and the wide-ranging research findings. However, it is not widely known how clinicians view and experience ASD in children, even though their perspective has been shown to significantly influence their work. Material and methods: Sixteen physicians working with preschool children without a diagnosis of (intellectual or other) disability with a (presumed) diagnosis of ASD participated in a semistructured interview. They described their professional views on ASD, and how they experienced its use in their clinical practice. The data were analyzed by applying the qualitative research method of interpretative phenomenological analysis of the data through Nvivo 11. Results: The main topic of the interviewed physicians’ views and experiences of ASD in a young child comprised three inductively established themes: 1) physicians’ views on ASD are multifaceted but fit within their personal clinical styles; 2) the ASD diagnosis is a “descriptive” part of a clinical trajectory; and 3) ASD treatment is a mix of “standard” approaches and a personalized search. These physicians’ perspectives on ASD are composed of multiple and sometimes ambiguous facets. However, their views are embedded in their personal clinical styles in general (i.e., beyond ASD) and are experienced as clinically “workable.” With the aim of finding an adequate approach to the problems parents bring to their office, many interviewed physicians say that—complementary to or rather than a classificatory diagnosis—they prefer using a personalized “profile” of a child in a therapeutic “process.” Conclusions: The interviewed physicians consider doubts and concerns to be an inherent part of their clinical work with ASD in young children, but do not experience this ambiguity as an obstacle to clinical care. These physicians deal with the multiplicity of their views on ASD by basing their eclectic views on their generally adopted clinical styles, and by selecting what works for them, and for the parents and child, from what they regard as the ‘textbook knowledge’ on ASD. We discuss the implications of these findings for translating research results to the clinic.

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Section: Discussionmentioning

confidence: 99%

Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children

Jacobs

Steyaert²,

Dierickx

et al. 2019

Front. Psychiatry

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“…Our previous research (Maynard and Turowetz 2017a; Turowetz and Maynard 2018) has analyzed the narrative structure of diagnosis, showing how professionals participating in the interaction order of the clinic collaboratively make sense of test results and other information (e.g., teachers’ reports) by telling stories to and with one another about children’s behavior during examination or elsewhere (e.g., in school, at home). The resulting chain of stories coalesces in an overall narrative about the child that is, or is not, consistent with an autism diagnosis.…”

Section: Diagnostic Narrativementioning

confidence: 99%

“…From each period, we use cases that are representative of wider patterns in the corpus. Because cases from the latter two periods (1985, 2015) have already been analyzed in depth (Maynard and Turowetz 2017a; Turowetz and Maynard 2018), in this article we include a transcript to illustrate the orderly detail of narrative structure only from the earlier era (1972) and summarize the more recent interactions.…”

Section: Datamentioning

confidence: 99%

Doing Abstraction: Autism, Diagnosis, and Social Theory

Maynard

Turowetz

2019

Sociological Theory

Self Cite

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Recent decades have witnessed a dramatic upsurge in the prevalence of autism spectrum disorder (ASD). As researchers have investigated the responsible sociohistorical conditions, they have neglected how clinicians determine the diagnosis in local encounters in the first place. Articulating a position “between Foucault and Goffman,” we ask how the interaction order of the clinic articulates with larger-scale historical forces affecting the definition and distribution of ASD. First, we show how the diagnostic process has a narrative structure. Second, case data from three decades show how narrative practices accommodate to different periods in the history of the disorder, including changing diagnostic nomenclatures. Third, we show how two different forms of abstraction—Type A, which is categorical, and Type B, which is concrete and particular—inhabit the diagnostic process. Our analysis contributes to the sociology of autism, the sociology of diagnosis, the sociology of abstraction, and social theory.

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“…) and of multidisciplinary team meetings (Parish ). The empirical body of work most relevant to our study is that undertaken in the US by Turowetz and Maynard (Maynard and Turowetz , , Turowetz 2015a, 2015b, Turowetz and Maynard , , ). In their analysis of talk‐in‐interaction in autism assessments, case conferences and diagnostic feedback meetings, Maynard and Turowetz demonstrate how diagnostic stories are methodically produced through interaction between clinicians themselves and between the child and clinicians.…”

Section: Talk Between Healthcare Practitioners About Diagnosismentioning

confidence: 99%

Drawing a line in the sand: affect and testimony in autism assessment teams in the UK

Hayes

Ford

Russell

2020

Sociology Health & Illness

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Diagnosis of autism in the UK is generally made within a multidisciplinary team setting and is primarily based on observation and clinical interview. We examined how clinicians diagnose autism in practice by observing post-assessment meetings in specialist autism teams. Eighteen meetings across four teams based in the south of England and covering 88 cases were audio-recorded, transcribed and analysed using thematic analysis. We drew out two themes, related to the way in which clinicians expressed their specialist disciplinary knowledge to come to diagnostic consensus: Feeling Autism in the Encounter; and Evaluating Testimonies of Nonpresent Actors. We show how clinicians produce objective accounts through their situated practices and perform diagnosis as an act of interpretation, affect and evaluation to meet the institutional demands of the diagnostic setting. Our study contributes to our understanding of how diagnosis is accomplished in practice.

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Narrative Methods for Differential Diagnosis in a Case of Autism

Cited by 13 publications

References 41 publications

Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children

Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children

Doing Abstraction: Autism, Diagnosis, and Social Theory

Drawing a line in the sand: affect and testimony in autism assessment teams in the UK

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