Title: Diagnosing Autism: Interaction Order and the Use of Narrative in Clinical Talk
Legend: As researchers have investigated the socio-historical conditions responsible for the upsurge in autism spectrum disorder (ASD) diagnosis, they have neglected how clinicians determine the diagnoses in local encounters in the first place. We investigate how the interaction order of the clinic articulates with larger-scale historical forces that have affected the definition and distribution of ASD. Data from three decades exhibit clinicians’ regular use of narrative practices as they transform shifting conceptions of autism into diagnostic determinations. Parents as well as clinicians participate in the clinic’s interaction order, drawing on its resources to negotiate the meaning of autism in each historical era.
Citation: Douglas W. Maynard and Jason Turowetz. (With Waverly Duck, Trini Stickle, and Adam Talkington.) Accepted with revisions. Social Psychology Quarterly.
Abstract: The sociological literature on (ASD) has concentrated on the distribution of the diagnosis within populations and the institutional determinants of this process. Responding to Hacking’s (2004) call for a “Goffmanian” mode of analysis to complement, and balance, the emphasis on large-scale transformations and discourses, our question is how clinicians produce findings consistent with ASD diagnosis, and convey the findings and diagnoses to each other and then to families. Accordingly, this paper also goes beyond previous research on the delivery and reception of diagnostic news to explore how clinicians determine a diagnosis in the first place. Using recordings and transcripts of clinical visits across two eras, we show how clinicians deploy narrative components to interpret their tests and other data, formulate findings, and communicate diagnoses to family members and other caretakers.
About the Lab: The goal of the Maynard Lab is to study the diagnostic process involving ASD. We have a grant from the National Science Foundation to study both the testing of children, the discussions whereby clinicians put their testing and other information together to decide on a diagnosis, and then present the diagnosis to parents or others. For the testing part, we are interested in “directive-response” sequences, wherein clinicians are able to elicit the cooperation necessary to deliver questions and get answers, or to be able to observe how children act or react in different circumstances. For the diagnostic part, we are interested in the narrative means by which clinicians draw on clinical and other evidence to ascertain what kind of diagnosis (such as ASD) does or does not fit the profile of a particular child. Such diagnostic decision-making is not easy, in part because there are no bio-markers or other straightforward indicators that can be used. However, clinicians are skillful in ways that they use not only the various kinds of evidence at hand, including their own tests, but also interviews with parents, and information from schools, pediatricians and elsewhere. Diagnosis is putting all the pieces together using narrative inquiry.