Introduction:
The study investigated clinical first impressions of autistic features, especially “frank autism,” in adolescents and young adults with a previous or current diagnosis of Autism Spectrum Disorder (ASD). The focus included individuals who lost their diagnosis in adolescence (LAD) and neurotypical (NT) groups, exploring the concordance between initial impressions and gold standard diagnostic criteria.
Methods:
Seventy-four individuals aged 12 to 39 years participated in the study, distributed into groups with ASD (n=24), LAD (n=24) and NT (n=26). Assessments included five-minute observations conducted by clinical graduates and specialists, and the use of the ADOS-2 as a diagnostic reference. Behaviors analyzed included prosody, facial expressions, social reciprocity and other autistic signs. Statistical analysis used linear models for correlations between impressions and severity scores (CSS).
Results:
Clinical impressions showed high specificity (88%) and negative predictive values (84.6%), indicating accuracy in ruling out ASD. However, sensitivity (66.7%) and positive predictive values (72.7%) were moderate, revealing challenges in identifying autistic cases. The most predictive features were atypical prosody and facial expressions. In the LAD group, although autistic features were subtle, some persisted, which impacted the accuracy of initial impressions.
Discussion:
Initial impressions were generally consistent with formal diagnoses but insufficient to detect all cases of ASD. Behavioral differences between the ASD, LAD, and NT groups highlighted variations in clinical presentation, with implications for underdiagnosis of atypical features in adults and adolescents.
Conclusions:
This study reinforces that brief assessments capture useful information, but should be complemented by structured methods for more accurate diagnoses. The persistence of subtle signs in LAD individuals suggests the need for greater attention to subclinical criteria in diagnoses and interventions.
Reference :
Canale, RR, et al. (2024). Investigating frank autism: clinician initial impressions and autism characteristics. Molecular Autism, 15(48). https://doi.org/10.1186/s13229-024-00627-z
