Introductory editorial to the special issue: Assessment and diagnosis of autism spectrum disorder (ASD) and related clinical decision making in neuropsychological practice

Abstract

Autism spectrum disorder (ASD) is a complex developmental disability characterized by challenges with social communication, restricted interests, and repetitive behaviors. Recent CDC estimates of US prevalence for ASD suggests that 23 out of 1,000 8-yearold children (i.e. one in 44) meet criterion for ASD, an increase from prior estimates (Maenner, et al., 2021). While some have raised concerns regarding the methodology of this research (e.g. due to varying metrics for identifying ASD cases, high cross-site variation, regional differences, and systemic disparities in educational supports and health care) (Mandell & Lecavalier, 2014; Yuan et al., 2021), it is stil clear that ASD is a fairly common disorder with clinically significant challenges persisting into adulthood. Given the high prevalence, ASD characteristics should be considered in neuropsychological differential diagnostic conceptualization across settings and patient populations. This special issue brings together original research, literature reviews, and clinical guidance to enhance neuropsychological practice in the assessment of ASD while emphasizing holistic diagnostic considerations and person-centered care. We begin with a survey of neuropsychologists’ first-person reflections on ASD assessment practices, the training they received, and where they believe the field should progress. This article sets the stage for the subsequent three sections, which focus on: (1) assessment tools and evaluative approaches; (2) case conceptualization in the context of complex comorbidities; and (3) higher level clinical recommendations and person-centered approaches to recognizing and diagnosing ASD. Section 1, comprised of 5 articles, focuses on assessment measures and approaches. Pulsipher and Lieb (2022) paper opens the discussion through their evaluation of an ASD symptom intake screening measure. Despite aligning this measure with DSM-5 criteria (which most screening measures have yet to do), this approach did not improve diagnostic predictions. As such, their findings continue to support the need for behavioral assessment by trained clinicians. On the other hand, McKernan and Kim’s (2022) paper demonstrates that screeners relating to semantic, syntactic, and pragmatic communication skills at kindergarten entry do predict academic, social, and adaptive skills at kindergarten exit, emphaszing the importance of early social pragmatic/ semantic skills intervention, even in children who historically may not receive them due to their many intact skills. Hudock and Esler (2022) provide a concise summary