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The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder from Those of Other Childhood Conditions: a Delphi Study

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The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder from Those of Other Childhood Conditions: a Delphi Study University of Denver Digital Commons @ DU Electronic Theses and Dissertations Graduate Studies 1-1-2019 The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder from Those of Other Childhood Conditions: A Delphi Study Staci Jordan University of Denver Follow this and additional works at: https://digitalcommons.du.edu/etd Part of the School Psychology Commons Recommended Citation Jordan, Staci, "The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder from Those of Other Childhood Conditions: A Delphi Study" (2019). Electronic Theses and Dissertations. 1587. https://digitalcommons.du.edu/etd/1587 This Dissertation is brought to you for free and open access by the Graduate Studies at Digital Commons @ DU. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ DU. For more information, please contact [email protected],[email protected]. The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder From Those of Other Childhood Conditions: A Delphi Study A Dissertation Presented to the Faculty of the Morgridge College of Education University of Denver ____________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy ____________ by Staci Jordan June 2019 Advisor: Dr. Devadrita Talapatra ©Copyright by Staci Jordan 2019 All Rights Reserved Abstract Author: Staci Jordan Title: The Use of Clinical Judgment in Differentiating Symptoms of Autism Spectrum Disorder From Those of Other Childhood Conditions: A Delphi Study Advisor: Dr. Devadrita Talapatra Degree Date: June 2019 Abstract More and more, due to long waiting lists at diagnostic clinics and access barriers for certain segments of the population, schools are often the first environment in which children are evaluated for ASD (Sullivan, 2013). And while accurate identification of autism spectrum disorders (ASD) is essential for proper treatment and service provision, large percentages of school and community-based identifications of ASD are overturned when children are re-evaluated with strict clinical criteria (Wiggins et al., 2015). In part, challenges faced in accurately differentiating ASD from other conditions may be contributed to the diagnostic complexities of the condition itself. Clinical expertise is one of, if not the most important factors in accurate diagnostic decision-making during evaluations of ASD. However, there exists little insight into what comprises this expert judgment. Using the Delphi methodology, a panel of clinical and school psychology experts in ASD identification were surveyed until consensus was reached about their use of clinical judgment in differentiating ASD from other conditions. The results of these rounds of questioning were compiled into a decision-making guideline entitled “Beyond Test Results: Developing Clinical Judgment to Differentiate Symptoms of Autism Spectrum Disorders from Those of Other Childhood Conditions.” Implications of this ii guide include incorporation into school psychology training courses and guidance for school-based evaluation teams. iii Table of Contents Abstract ........................................................................................................................ ii Table of Contents ....................................................................................................... iv List of Tables ............................................................................................................. vii List of Figures ............................................................................................................. ix Chapter 1: Introduction ............................................................................................. 1 ASD Evaluation in the School Setting ...................................................................... 2 Diagnostic Complexities of ASD ............................................................................. 3 The Role of Clinical Expertise in ASD Identification .............................................. 4 Statement of the Problem .......................................................................................... 5 Purpose of Study ....................................................................................................... 6 Research Questions ................................................................................................... 7 Chapter 2: Review of the Literature ......................................................................... 9 Symptom Interpretation and Differentiation ............................................................. 9 Distinguishing ASD from other conditions. ....................................................... 10 Symptom Terminology: ASD and Related Conditions .......................................... 16 Autism spectrum disorders.................................................................................. 16 Other health impairment. .................................................................................... 31 Speech and language impairment. ...................................................................... 40 Specific learning disability. ................................................................................ 45 Emotional disability. ........................................................................................... 51 Traumatic brain injury. ....................................................................................... 74 Intellectual disability. .......................................................................................... 77 Multiple disabilities. ........................................................................................... 82 Intellectual giftedness. ........................................................................................ 83 Comorbidities. ..................................................................................................... 87 Summary. ............................................................................................................ 88 Best Practices in School-Based ASD Evaluation ................................................... 88 Review of records. .............................................................................................. 89 Parent interview. ................................................................................................. 90 Teacher interviews. ............................................................................................. 91 Classroom observations. ..................................................................................... 92 Functional behavior assessment. ......................................................................... 93 Formal assessments. ............................................................................................ 94 Issues in Diagnostic Decision Making .................................................................... 95 Decision-making errors ....................................................................................... 98 Strategies to reduce decision-making error. ...................................................... 105 The role of clinical expertise in diagnostic decision-making. .......................... 106 Integrating clinical expertise with decision-making supports........................... 108 Cognitive maps. ................................................................................................ 109 Summary ............................................................................................................... 110 iv Chapter 3: Method .................................................................................................. 113 Delphi Method ...................................................................................................... 114 Study Design ......................................................................................................... 116 Respondents .......................................................................................................... 117 Recruitment. ...................................................................................................... 120 Participant Demographics ..................................................................................... 122 Instrument Development ....................................................................................... 123 Pilot. .................................................................................................................. 124 Data Collection and Analysis ............................................................................... 125 Preparation: Scoping ......................................................................................... 126 Convergence: Round 1. ..................................................................................... 127 Convergence: Round 2. ..................................................................................... 128 Convergence: Round 3. ..................................................................................... 128 Consensus: Final member check. ...................................................................... 129 Trustworthiness ..................................................................................................... 129 Addressing Bias ...................................................................................................
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