Demographic Factors Relate to Autism Diagnostic Certainty: Implications for Enhancing Equitable Diagnosis Among Youth.

OBJECTIVE: Autism diagnosis is fraught with inequities, including misdiagnosis and delayed identification that disproportionately affect minoritized youth. Aspects of clinician decision-making, particularly diagnostic certainty, may contribute to these inequities. Little is known about how closely clinician certainty corresponds with autistic traits, nor whether certainty relates to socio-demographic factors. METHOD: Autistic youth from the Simons Simplex Collection (N = 2,853) completed assessments after which clinicians rated how certain they were that the child met autism diagnostic criteria. Core clinical factors included clinician-observed (Autism Diagnostic Observation Schedule; ADOS) and parent-reported autistic traits (Social Communication Questionnaire), and an overall IQ score. RESULTS: Clinician certainty was moderately positively associated with parent-reported and observed autistic traits and was just as strongly negatively associated with IQ. Socio-demographic factors significantly associated with certainty, even accounting for clinical measures. Lower income and older child age related to less certainty. In contrast, clinicians rated higher certainty for youth identified as Hispanic, Black or African American, or Asian. Race and income also moderated the concordance between certainty with clinical factors. The agreement between higher ADOS scores and higher certainty was significantly weaker for lower-income families. The association between lower IQ and higher certainty was non-significant for Asian youth. CONCLUSIONS: Diagnostic certainty ratings do not necessarily correspond closely with the level of autistic traits, and clinician perception of autism diagnosis may be related to demographic factors. Caution is needed when relying on clinician certainty to inform diagnosis. Future research on diagnostic practices is urgently needed among diverse and minoritized communities.

Expanding the cross-cultural psychological assessment tool box with IQ test short forms.

OBJECTIVE: Short forms of standard intelligence tests are useful in clinical and research settings where administration of a full intelligence test is impractical or unnecessary. In cross cultural contexts where few tests are available, including brief intelligence tests, short forms may be particularly useful to meet clinical and research needs. However, there is little cross-cultural research on the validity of short forms. This study evaluated feasibility of short form development for the Spanish version of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and examined comparability of short-form IQ estimates in Spanish- and English-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: Participants included children with ADHD who were administered the WISC-IV Spanish (n = 165) or WISC-IV (n = 299). Full Scale IQs (FSIQs) were calculated for two-, three-, four-, and five-subtest short forms. Misclassification rates, mean absolute differences, and intraclass correlation coefficients (ICCs) were used to determine short form accuracy in estimating FSIQ. RESULTS: The WISC-IV short forms examined had generally strong psychometric properties (e.g., ICCs ranged from .78 to .94) and level of accuracy in estimating FSIQ did not differ across primary language of Spanish or English. CONCLUSIONS: Findings support feasibility of IQ short form development to help address mental health disparities in research and clinical screening for Spanish- and English-speaking pediatric populations with ADHD.

Testing a self-determination theory perspective of informal caregiving: A preliminary study.

Informal caregivers provide valuable care for ill or disabled adults. Nevertheless, many caregivers experience negative consequences from caregiving such as reduced mental health. Balancing personal costs of caregiving with caregivers' desires or obligations to provide care, is necessary to promote the well-being of these individuals and their care recipients. Drawing on a self-determination theory (SDT) perspective, caregivers whose psychological needs for relatedness, autonomy, and competence are satisfied with their care recipient, and their care recipients' healthcare providers, should be more autonomously motivated to care. Greater autonomous motivation should promote better mental health. This study tested mediation models in a sample of 158 caregivers in the United States. Autonomous motivation was examined as a mediator of the (a) associations between caregivers' need satisfaction with their care recipient and caregiver burden and depressive symptoms, and (b) associations between caregivers' autonomy support received from their care recipients' healthcare providers and caregiver burden and depressive symptoms. Next, specific types of motivation that vary in their relative autonomy were examined as unique mediators. Support was found for models using autonomous motivation as the mediator. Additionally, caregivers' autonomy support and female caregivers' need satisfaction were positively associated with intrinsic motivation to care which was negatively associated with burden. Although much research suggests caregivers' outcomes stem from the care recipients' condition, such as their functional dependence on others, the present study focused on the caregivers' relationships and motivations. Results support an SDT perspective of caregiving. (PsycInfo Database Record (c) 2021 APA, all rights reserved).