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Citing conduct, individualizing symptoms: Accomplishing autism diagnosis in clinical case conferences

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  • Turowetz, Jason

Abstract

In this paper, I examine how clinicians at a clinic for developmental disabilities in the United States determine whether children being evaluated for autism spectrum disorder (ASD) showed symptoms of that condition. Drawing on a convenience sample of 61 audio and video recorded case conferences from two time periods (1985 and 2011–15), and combining Conversation Analysis with insights from Actor Network Theory, I find that clinicians describe (via a representational practice called “citation”) children's conduct in ways that advance diagnostic claims. More specifically, they portray key actants in the assessment process in patterned ways: the test instrument is represented as a neutral tool of measurement, the clinician as administrator and instructor; and the child as the focal figure whose conduct is made to appear independent of the other participants and suggestive of diagnostic symptoms. These tacit representational conventions conform to and reproduce the assumptions of standardized testing, according to which clinicians and tests are to be neutral arbiters of the child's abilities, and thereby provide for objective, warrantable findings. At the same time, however, by designing representations around the child's symptomatic conduct in this way, clinicians may minimize or elide their own contributions, and those of the test instrument, to the child's performance, and thereby make the child alone appear responsible for what are, in fact, interactionally-occasioned behaviors.

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  • Turowetz, Jason, 2015. "Citing conduct, individualizing symptoms: Accomplishing autism diagnosis in clinical case conferences," Social Science & Medicine, Elsevier, vol. 142(C), pages 214-222.
    • Handle: RePEc:eee:socmed:v:142:y:2015:i:c:p:214-222
    DOI: 10.1016/j.socscimed.2015.08.022
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    References listed on IDEAS

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    1. Gardner, John & Dew, Kevin & Stubbe, Maria & Dowell, Tony & Macdonald, Lindsay, 2011. "Patchwork diagnoses: The production of coherence, uncertainty, and manageable bodies," Social Science & Medicine, Elsevier, vol. 73(6), pages 843-850, September.
    2. Jutel, Annemarie & Nettleton, Sarah, 2011. "Towards a sociology of diagnosis: Reflections and opportunities," Social Science & Medicine, Elsevier, vol. 73(6), pages 793-800, September.
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    1. Rasmussen, Pernille Skovbo & Pedersen, Inge Kryger & Pagsberg, Anne Katrine, 2020. "Biographical disruption or cohesion?: How parents deal with their child's autism diagnosis," Social Science & Medicine, Elsevier, vol. 244(C).
    2. Chiri, Giuseppina & Bergey, Meredith & Mackie, Thomas I., 2022. "Deserving but not entitled: The social construction of autism spectrum disorder in federal policy," Social Science & Medicine, Elsevier, vol. 301(C).
    3. Hayes, Jennie & McCabe, Rose & Ford, Tamsin & Parker, Daisy & Russell, Ginny, 2021. "‘Not at the diagnosis point’: Dealing with contradiction in autism assessment teams," Social Science & Medicine, Elsevier, vol. 268(C).

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