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Friday, April 11, 2014

A Caution About Screening

Many posts have mentioned the many autistic children who go undiagnosed for a long time.  But overdiagnosis is also a potential problem.  At The Atlantic, psychologist Enrico Gnaulati discusses the problem of false positives:
What gets lost in the debate is an awareness of how the younger in age we assess for problems, the greater the potential a slow-to-mature kid will be given a false diagnosis. In fact, as we venture into more tender years to screen for autism, we need to be reminded that the period of greatest diagnostic uncertainty is probably toddlerhood. A 2007 study out of the University of North Carolina at Chapel Hill found that over 30 percent of children diagnosed as autistic at age two no longer fit the diagnosis at age four. Since ASD is still generally considered to be a life-long neuropsychiatric condition that is not shed as childhood unfolds, we have to wonder if a large percentage of toddlers get a diagnosis that is of questionable applicability in the first place.

Several years ago, Gary L. Freed, MD, chief of the Division of General Pediatrics at the University of Michigan, initiated a survey of physicians listed as pediatricians on state licensure files in eight states across the United States: Ohio, Wisconsin, Texas, Mississippi, Massachusetts, Maryland, Oregon, and Arizona. According to the survey, 39 percent of state-identified pediatricians hadn't completed a residency in pediatrics. And even for those who had, their training in pediatric mental health was minimal.
Currently, the American Academy of Pediatrics estimates that less than a quarter of pediatricians around the country have specialized training in child mental health beyond what they receive in a general pediatric residency. The latest data examining pediatricians who have launched themselves into practice reveals that 62 percent of them feel that mental health issues were not adequately covered in medical school. These figures hardly inspire widespread confidence as regards relying on pediatricians to accurately diagnose ASD.In a 2010 study, 45 percent of graduate students in child psychology had little exposure to coursework in child/adolescent lifespan development.
This brings me to my own cherished profession: child psychology. What does survey data tell us about the current training of child psychologists that speaks directly to their ability to separate out abnormalcy from normalcy?
Poring over the numbers of a 2010 study out of the University of Hartford in Connecticut, I discovered that 45 percent of graduate students in child psychology had either no exposure to, or had just an introductory-level exposure to, coursework in child/adolescent lifespan development. It is in these classes that emerging child psychologists learn about what is developmentally normal to expect in children.
It would appear that the education and training of a sizable percentage of pediatricians and child psychologists leaves them ill-equipped to tease apart the fine distinction between mild ASD and behaviors that fall within the broad swath of normal childhood development.