Rethinking psychometric testing in autism: overcoming the challenges of comorbidity and diagnostic overshadowing

Epidemiological data indicates a rising prevalence of autism spectrum disorder (ASD) among eight-year-old children, with rates increasing from 1 in 44 to 1 in 36 between 2022 and 2023. This growing prevalence poses significant challenges in achieving accurate diagnoses, particularly due to comorbid conditions and diagnostic overshadowing. Certain subgroups-such as females with ASD, individuals with high cognitive abilities, and ethnic minorities-remain at heightened risk of underdiagnosis. Diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS-2) have limitations, particularly in clinical settings where gender biases and cultural differences in symptom presentation can complicate accurate assessment. Moreover, rural areas face additional burdens due to limited access to care, further exacerbating diagnostic challenges. The review underscores the necessity for improved screening and diagnostic methods tailored to diverse populations, acknowledging the current limitations of existing tools. It also highlights significant barriers such as workforce shortages and lengthy wait times for evaluations. Emphasizing the importance of clinician education and targeted diagnostic approaches, the review calls for attention to cultural and gender differences in ASD evaluation.