Abstract
Parish reports a study of the social organisation of team meetings that decide whether to give a child a diagnosis of autism spectrum disorder (ASD). There is currently little known about the use of multidisciplinary team (MDT) approach, despite the strong recommendations for such an approach to be used when assessing for ASD. Three meetings from two MDTs were recorded, capturing the discussion of 16 children. Conversation analysis revealed three practices that encouraged information to be elaborated upon, even in time-pressured meetings. These ‘opened up’ the team discussions to consider different possible explanations for a child’s presentation. Parish concludes by discussing the clinical implications of these practices, including whether they could reduce the risk of over-diagnosing ASD.
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- 1.
The services referred to themselves as ASC services, since they preferred the term autistic spectrum condition. The term ASD has been used, however, for consistency within the literature.
- 2.
Adapted from term ‘candidate explanation’, Pomerantz et al. (2007) used to describe how patients give possible explanations for an illness. ‘Candidate suggestions’ is here used because the suggestions did not appear to be offered as a definitive explanation, but as a possible consideration.
- 3.
Pseudonyms have been used throughout, including those within the talk.
References
Arber, A. (2007). “Pain talk” in hospice and palliative care team meetings: An ethnography. International Journal of Nursing Studies, 44, 916–926.
Bartolo, P. A., Dockrell, J., & Lunt, I. (2001). Naturalistic decision-making task processes in multiprofessional assessment of disability. Journal of School Psychology, 39, 499–519.
Basu, S., & Parry, P. (2013). The autism spectrum disorder ‘epidemic’: Need for biopsychosocial formulation. Australian and New Zealand Journal of Psychiatry, 47, 1116–1118.
Croker, A, Loftus, S., & Higgs, J. (2008). Multidisciplinary clinical decision making. In Clinical reasoning in the health professions (pp. 291–298). Amsterdam: Butterworth-Heinemann.
Dew, K., Stubbe, M., Signal, L., Stairmand, J., Dennett, E., Koea J., …, Ellison-Loschmann, L. (2014) Cancer care decision making in multidisciplinary meetings. Qualitative Health Research, 25(3), 397–407.
Falkmer, T., Anderson, K., Falkmer, M., & Horlin, C. (2013). Diagnostic procedures in autism spectrum disorders: A systematic literature review. European Child and Adolescent Psychiatry, 22, 329–340.
Jefferson, G. (2004). Glossary of transcript symbols with an introduction. Pragmatics and Beyond New Series, 125, 13–34.
Kidger, J., Murdoch, J., Donovan, J. L., & Blazeby, J. M. (2009). Clinical decision-making in a multidisciplinary gynaecological cancer team: A qualitative study. An International Journal of Obstetrics & Gynaecology, 116, 511–517.
Le Couteur, A. (2003). National Autism Plan for Children (NAPC): Plan for the identification, assessment, diagnosis and access to early interventions for pre-school and primary school aged children with autism spectrum disorders (ASD). London: National Autistic Society.
McHoul, A., & Rapley, M. (2005). A case of attention-deficit/hyperactivity disorder diagnosis: Sir Karl and Francis B. slug it out on the consulting room floor. Discourse & Society, 16, 419–449.
Mendel, R., Traut-Mattausch, E., Jonas, E., Leucht, S., Kane, J. M., Maino, K., …, Hamann J. (2011). Confirmation bias: Why psychiatrists stick to wrong preliminary diagnoses. Psychological Medicine, 41, 2651–2659.
Moran, H. (2010). Clinical observations of the differences between children on the autism spectrum and those with attachment problems: The Coventry Grid. Good Autism Practice (GAP), 11, 46–59.
National Institute for Health and Care Excellence (NICE). (2011). Autism diagnosis in children and young people: Recognition, referral and diagnosis of children and young people on the autism spectrum. In NICE clinical guidance (p. 128). Manchester: NICE.
Palmer, E., Ketteridge, C., Parr, J. R., Baird, G., & Le Couteur, A. (2011). Autism spectrum disorder diagnostic assessments: Improvements since publication of the National Autism Plan for Children. Archives of Disease in Childhood, 96, 473–475.
Potter, J., & Hepburn, A. (2005). Qualitative interviews in psychology: Problems and possibilities. Qualitative Research in Psychology, 2, 281–307.
Rolls, L., & Relf, M. (2006). Bracketing interviews: Addressing methodological challenges in qualitative interviewing in bereavement and palliative care. Mortality, 11, 286–305.
Sarkar, S., Arora, S., Lamb, B. W., Green, J. S., Sevdalis, N., & Darzi, A. (2014). Case review in urology multidisciplinary team meetings: What members think of its functioning. Journal of Clinical Urology, 7, 394–402.
Schegloff, E. A. (2007). Sequence organization in interaction: Volume 1: A primer in conversation analysis. Cambridge: Cambridge University Press.
Sidnell, J. (2010). Conversation analysis: An introduction. Chichester: Wiley-Blackwell.
Silverman, D., & Peräkylä, A. (1990). AIDS counselling: The interactional organisation of talk about ‘delicate’ issues. Sociology of Health & Illness, 12, 293–318.
Westman Andersson G., Miniscalco, C., & Gillberg, C. (2013). Autism in preschoolers: Does individual clinician’s first visit diagnosis agree with final comprehensive diagnosis? The Scientific World Journal, 2013, 1–7.
Acknowledgements
Firstly, I would like to thank the two teams that took part in this study. I appreciate how exposing it must have been to have someone record their work and they demonstrated great practices in collaborative team working. Secondly, I would like to thank my supervisors: Cordet Smart for her encouragement and enthusiasm throughout, and Jacqui Stedmon for her calming and reflective influence. Finally, I would also like to say a big thank you to Dr Lindsay Aikman for all of your help and support.
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Parish, N. (2018). Does This Child Have Autism? Exploring Team Discussions When Diagnosing Autistic Spectrum Disorder. In: Smart, C., Auburn, T. (eds) Interprofessional Care and Mental Health. The Language of Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-98228-1_8
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