Disorder or difference? How clinician-patient interaction and patient age shape the process and meaning of autism diagnosis.

This article follows Blaxter's foundational call for a sociology of diagnosis that addresses the dual aspects of diagnosis-as-category and diagnosis-as-process. Drawing on video recordings from an autism clinic, we show how the process of attaching the diagnosis to a child involves interactions between clinicians, parents and children, and that in the course of such interactions, a diagnostic category officially defined in terms of deficits can instead be formulated in terms of valuable social and cognitive differences. More specifically, we show that the child's age is crucial for how clinicians formulate the diagnosis: with younger children, clinicians treat autism exclusively as a deficit to be remedied, whereas with older children, clinicians may treat autism either as a deficit or as a social-cognitive difference.

Doing Abstraction: Autism, Diagnosis, and Social Theory.

Recent decades have witnessed a dramatic upsurge in the prevalence of autism spectrum disorder (ASD). As researchers have investigated the responsible sociohistorical conditions, they have neglected how clinicians determine the diagnosis in local encounters in the first place. Articulating a position "between Foucault and Goffman," we ask how the interaction order of the clinic articulates with larger-scale historical forces affecting the definition and distribution of ASD.

Documenting diagnosis: testing, labelling, and the production of medical records in an autism clinic.

All diagnosis depends on communication between doctors and patients. This is especially so with behavioural disorders such as autism, where structured interactions involving clinicians and children (e.g.

Creating space to discuss end-of-life issues in cancer care.

Objectives: Analyze entire oncology clinical visits and examine instances in which oncologists have to break the bad news that patients' treatments are no longer effective.

Methods: Using conversation analysis we examine 128 audio recorded conversations between terminal cancer patients, their caregivers, and oncologists.

Results: When oncologists break the bad news that a patient's treatment is no longer effective, they often use a conversational device we call an "exhausted current treatment" (ECT) statement, which avoids discussing prognosis in favor of further discussing treatment options.

Delivering bad news in emergency care medicine.

Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to "realize" the bad news because it involves the deliverer and recipient in a particular social relation.

Category attribution as a device for diagnosis: fitting children to the autism spectrum.

The practice of medicine involves applying abstract diagnostic classifications to individual patients. Patients present with diverse histories and symptoms, and clinicians are tasked with fitting them into generic categories. They must also persuade patients, or family members, that the diagnosis is appropriate and elicit compliance with prescribed treatments.

Parents as a Team: Mother, Father, a Child with Autism Spectrum Disorder, and a Spinning Toy.

This paper is a single case study involving a visit to a diagnostic clinic for autism spectrum disorder. A young boy finds a toy that he can hold with one hand and spin with another. In order to retrieve the toy and leave it in the clinic, the parents engage in a team effort.

‘What Brings Him Here Today?’: Medical Problem Presentation Involving Children with Autism Spectrum Disorders and Typically Developing Children.

Conversation and discourse analyses were used to examine medical problem presentation in pediatric care.Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children’s communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are interactionally achieved.

Asking to Speak to Another: A Skill for Soliciting Survey Participation.

This paper is in the vein of applied conversation analysis, dealing with a problem of declining participation rates for survey interviews. When calling a household to request participation in a survey, interviewers may ask for a pre-selected "sample person." We first explore how interviewers design this request in a more or less presumptive way, depending on how and when they identify themselves.

An Interactional Model of the Call for Survey Participation: Actions and Reactions in the Survey Recruitment Call.

Previous research has proposed that the actions of sample members may provide encouraging, discouraging, or ambiguous interactional environments for interviewers soliciting participation in surveys. In our interactional model of the recruitment call that brings together the actions of interviewers and sample members, we examine features of actions that may contribute to an encouraging or discouraging environment in the opening moments of the call. Using audio recordings from the 2004 wave of the Wisconsin Longitudinal Study and an innovative design that controls for sample members' estimated propensity to participate in the survey, we analyze an extensive set of interviewers' and sample members' actions, the characteristics of those actions, and their sequential location in the interaction.

An interactional approach to conceptualising small talk in medical interactions.

In medical interactions, it may seem straightforward to identify 'small talk' as casual or social talk superfluous to the institutional work of dealing with patients' medical concerns. Such a broad characterisation is, however, extremely difficult to apply to actual talk, and more specificity is necessary to pursue analyses of how small talk is produced and what it achieves for participants in medical interactions. We offer an approach to delineating a subgenre of small talk called topicalised small talk (TST), derived on the basis of conversation analytically-informed analyses of routine consultations involving orthopaedic surgeons and older patients.

Dialling for donations: practices and actions in the telephone solicitation of human tissues.

Altruistic actions such as the donation of public goods have long been the subject of social scientific debate. While scholars have recognised the importance of analysing the solicitation of donated goods such as human organs and tissues, to date none has examined actual interaction for this fateful event as it unfolds in real time. In this paper, we use data from 186 audio-recorded telephone interactions between donation centre personnel and family members of the recently deceased along with in-depth interviews and observations conducted in the call centre, to examine this particular donation solicitation interaction.

"Does it mean I'm gonna die?": on meaning assessment in the delivery of diagnostic news.

This paper investigates how, in the delivery of diagnostic news, participants to the delivery may engage in meaning assessment or interpreting the news. It draws on data from 24 conversations in developmental disabilities clinics, internal medicine clinics and HIV counselling and testing clinics in the USA. The analysis shows that participants initiate meaning assessment sequences whereby one participant proposes what the news means and the other aligns or disaligns with the proposal.

Conversation analysis, doctor-patient interaction and medical communication.

Introduction: This paper introduces medical educators to the field of conversation analysis (CA) and its contributions to the understanding of the doctor-patient relationship.

The Conversation Analysis Approach: Conversation analysis attempts to build bridges both to the ethnographic and the coding and quantitative studies of medical interviews, but examines the medical interview as an arena of naturally occurring interaction. This implies distinctive orientations and issues regarding the analysis of doctor-patient interaction.