Rethinking “gold standards” and “best practices” in the assessment of autism

Abstract

Failure to correctly diagnosis autism is problematic in both the false-positive and false-negative directions. Diagnosing autism when it is not truly present can direct limited resources away from those who actually need the services, while also creating stress and confusion for individuals and families. In contrast, failure to correctly identify autism when it is indeed present can prevent individuals and families from receiving needed support, including early intervention services. Those familiar with current trends in autism assessment are likely aware of “gold standards” involving specific autism tests and “best practices” involving multi-disciplinary autism teams. Curiously, these “gold standard” and “best practice” proclamations have not been adequately scrutinized. The present article aims to address this gap in the literature by (a) discussing the value of autism tests/tools; (b) drawing attention to biasing influences in autism assessment; (c) identifying methodological flaws in “gold standard” autism assessment research; and (d) proposing that more assessment, not less, might be better in autism assessment. It is concluded that it is time to rethink “gold standards” and “best practices” in the assessment of autism.

Keywords:

• ADI-R
• ADOS
• assessment
• autism
• autism spectrum disorder
• “best practices”
• “gold standard”
• neuropsychological
• psychological

Disclosure statement

No potential conflict of interest was reported by the author(s).