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

Abstract

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.

National Profile of Caregivers’ Perspectives on Autism Spectrum Disorder Screening and Care in Primary Health Care: The Need for Autism Medical Home

“…This might be because most physicians in primary health care are not experienced in diagnosing ASD. This finding was supported by previous studies that reported that ASD is difficult to define, diagnose, and the physicians cannot translate their theoretical knowledge of ASD into their clinical practice, which shows a lack of experience in ASD diagnosis in primary health care physicians [ 22 , 23 ]. To overcome this, a previous study suggested a valid scale easily performed by any healthcare provider and does not require special training which might be distributed to primary health care and even to educators [ 5 ].…”

Parents’ views and experiences of the autism spectrum disorder diagnosis of their young child: a longitudinal interview study

“…Later on in the diagnostic trajectory, a clinician may address potential feelings in the parents of the child's vulnerability and the parents' responsibility. In this regard, she may prefer to elaborate a 'profile' or 'clinical case formulation' of the child including both stronger and more vulnerable characteristics of the child and his context -in combination with or instead of a categorical diagnosis of ASD (Jacobs et al, 2019;Macneil, Hasty, Conus, & Berk, 2012). Throughout this clinical trajectory, we argue against the partition of the diagnostic and the therapeutic phases, as is the case in Flanders -and in many other regions and countries.…”

“…Several strategies were employed to strengthen the trustworthiness of the findings (Shenton, 2004). For example, the analytic process was subjected to peer scrutiny by researchers from the local psychology and pedagogy faculties during several meetings and seminars; the data were triangulated by also interviewing physicians working with the same group of children -and their parents-with a similar research question Jacobs et al, , 2019; and, by conducting several interviews, the study's credibility was increased because of its improved potential to generate data which fitted the views of the participants and properly represented the dynamic process (Barbour, 2001;Carter, Bryant-Lukosius, DiCenso, Blythe, & Neville, 2014).…”

Parents’ multi-layered expectations when requesting an Autism Spectrum Disorder assessment of their young child: an in-depth interview study

“…The longitudinal evolution from T1 to T2 to T3 is described in another article [39] which addresses the understanding and experiences of ASD throughout time by the included Flemish parents. This longitudinal study in turn is part of a broader research project which triangulates this study's findings by investigating doctors' understanding and clinical experiences of an ASD diagnosis [40][41][42][43].…”