Date of Award

12-31-2015

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical Psychology

First Advisor

Alice S. Carter

Second Advisor

Laurel Wainwright

Third Advisor

Abbey Eisenhower

Abstract

The criteria for diagnosing autism spectrum disorder (ASD) in the Diagnostic and Statistics Manual-5th edition (DSM-5) includes “hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment” as one of the manifestations that can be used as one of two required indicators of criterion B, “restricted, repetitive patterns of behavior, interests, or activities.” Therefore, reliable assessment of sensory symptoms is necessary for diagnosing ASD, which is most often diagnosed by psychologists, psychiatrists, and pediatricians, while sensory processing disorders are routinely assessed by occupational therapists. This study examined clinician reliability, accuracy and confidence in assessing ASD sensory symptoms and the adequacy of the gold standard tools currently used for assessing ASD (i.e., ADOS) in making determinations about the presence or absence of sensory symptoms as the use of reliable tools is essential for accurate classification in relation to repetitive behaviors. Additionally, this study also examined whether clinical decisions about sensory symptoms in children with ASD varied as a function of child race.

Overall, results suggest that clinicians generally rated true positive sensory clips at a rate below 0.70, with the exception of psychologists rating ADOS clips at a rate of 0.71. However, clinicians rated true negative sensory clips at a rate above 0.70. Similarly, clinicians across disciplines displayed relatively low levels of agreement in their ratings of sensory symptoms (< 0.65). There were no significant differences in accuracy ratings or inter-rater agreement across clinical discipline type (psychologists, psychiatrists, pediatricians, occupational therapists). Clinicians’ ratings of alternative symptoms (hyperactivity, compulsivity, anxiety, oppositionality) were not higher for children of color. The generally low accuracy and agreement rates of sensory symptoms across disciplines suggest the difficult nature of identifying sensory symptoms as a diagnostic indicator of ASD. Further work is needed to examine the specific type of training that is necessary to achieve adequate agreement among clinicians from various disciplines identifying sensory symptoms as a diagnostic indicator of ASD.

Comments

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