Journal of Autism and Developmental Disorders

, Volume 46, Issue 7, pp 2340–2348 | Cite as

The Relationship Between Clinicians’ Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder

  • Darren HedleyEmail author
  • Neil Brewer
  • Rose Nevill
  • Mirko Uljarević
  • Eric Butter
  • James A. Mulick
Original Paper


The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical judgement accuracy was compared against final diagnosis for high and low confidence levels (with confidence assessed on a 0–100 % scale). We identified a significant CA relationship with predictive accuracy highest at confidence levels of 90–100 %. Parent report of unusual behaviors was the only significant independent predictor of confidence. Clinicians’ confidence may be important when evaluating decisions to refer, or not to refer, children for further diagnostic assessment.


Autism Spectrum Disorder Screening Diagnosis Clinical judgement Confidence Accuracy Assessment 



This research was supported by Nationwide Children’s Hospital Clinical and Translational Intramural Grant #203213 awarded to Darren Hedley. We would like to thank the staff and families who participated in the study. We also thank Sarah Beinkampen, Natalie Fields, Mark Jones, Emily Mariotti, Yessica Monroy Moreno and Brianna Murphy for their assistance with data collection, and Dr. Elizabeth Kryszak and Dr. Nathan Weber for their contributions to the study design.

Author Contributions

DH, NB and JAM conceived and designed the study. DH and RN collected the data. DH, NB, RN and MU performed the analysis. All authors contributed to the writing and review of the manuscript. All authors approved the final version.

Compliance with Ethical Standards

Conflict of interest

The authors confirm that there are no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study where required to do so by the Institutional Review Board.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Darren Hedley
    • 1
    • 2
    • 3
    Email author
  • Neil Brewer
    • 4
  • Rose Nevill
    • 2
  • Mirko Uljarević
    • 1
    • 5
  • Eric Butter
    • 2
    • 3
  • James A. Mulick
    • 2
  1. 1.Olga Tennison Autism Research Centre, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
  2. 2.Department of PediatricsOhio State UniversityColumbusUSA
  3. 3.Child Development CenterNationwide Children’s HospitalColumbusUSA
  4. 4.School of PsychologyFlinders UniversityAdelaideAustralia
  5. 5.Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneAustralia

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