Editorial: Is autism overdiagnosed?, (2023), Fombonne E.

Οpen access article: (https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13806)

Abstract

After attention was drawn in the late 1960s to the poor reproducibility of psychiatric
diagnosis between clinicians, methods and procedures used to diagnose psychiatric
disorders were greatly improved. Sources of variance contributing to the poor
reliability of psychiatric diagnosis were identified that included: information variance
(how clinicians go about enquiring about symptoms), interpretation variance (how
clinicians weigh the observed symptomatology towards diagnostic formulations), and
criterion variance (how clinicians arrange symptom constellations to generate specific
diagnoses). To improve the reliability of diagnosis, progresses were made in two
major directions. First, diagnostic instruments were developed to standardize the way
symptoms are elicited, evaluated, and scored. These diagnostic interviews were either
highly structured for use in large-scale studies (e.g. the DIS), by lay interviewers
without a clinical background, and with a style of questioning that emphasized
adherence to the exact wording of probes, reliance on closed questions with simple
response formats (Yes/No) and recording respondents' answers without interviewer's
judgment contribution. By contrast, semi-structured interviews (e.g. the SADS) were
designed to be used by clinically trained interviewers and adopted a more flexible,
conversational style, using open-ended questions, utilizing all behavioral descriptions
generated in the interview, and developing scoring conventions that called upon the
clinical judgment of the interviewer. Second, diagnostic criteria and algorithms were
introduced in nosographies in 1980 for the DSM and soon after in ICD. Algorithm-
derived diagnoses could subsequently be tested for their validity using follow-up,
family history, treatment response studies, or other external criteria.

Citation: Fombonne, E. (2023), Editorial: Is autism overdiagnosed?. J Child Psychol
Psychiatr, 64: 711-714. https://doi.org/10.1111/jcpp.13806