Sorting Out Autism Spectrum Disorders: Evidence-Based Medicine and the Complexities of the Clinical Encounter

Abstract

Clinical decisions regarding the diagnosis and treatment of Autism Spectrum Disorders (ASDs) are commonly based upon heterogeneous evidence and ‘expert opinion’. To date, research examining how paediatricians are using (or not using) evidence-based medicine (EBM) to diagnose and treat patients with an ASD has been absent within the literature across all disciplines. To understand how Australian paediatricians are using EBM to conceptualise, diagnose, and treat patients with an ASD, this study interviewed nine paediatricians in private practice using a face-to-face, semi-structured approach. Participants were asked questions about diagnosis and treatment of ASDs, and general questions about their attitudes towards EBM. Analysis of the interviews revealed four key factors affecting the clinical encounter with the ASD patient: the role of experience in the clinical encounter, the tacit and experiential nature of diagnosing and treating ASDs, skilful and creative interaction between the paediatrician and the diagnostic tools (tool “tinkering”), and the influence of political and social forces. This study contributes to sociological understandings of EBM and how it is used by paediatricians to diagnose and treat ASDs. It also demonstrates that this process involves constant negotiation between clinical experience, the evidence, intersubjective evaluation, and social forces.