Inconsistencies in forensic assessments of individuals with Autismo Spectrum Disorder
DOI:
https://doi.org/10.11606/issn.2317-2770.v31i1e-248820Keywords:
Autism Spectrum Disorder, Disability, Medical Expert Examination, Functional Assessment, International Classification of Functioning, Disability and Health, Public PolicyAbstract
Objective: To characterize the prevalence of clinical and functional findings and the variability in autism severity levels reported in forensic medical assessments issued by the Institute of Social Medicine and Criminology of São Paulo (IMESC) between 2022 and 2024. Methods: A retrospective documentary study was conducted using forensic medical reports issued for motor vehicle property tax (IPVA) exemption in the State of São Paulo. A total of 134,729 reports were reviewed, of which 11,889 were coded as ICD-10 F84. Sociodemographic, clinical, and functional variables were analyzed using the chi-square test, Pearson's correlation coefficient, and one-way analysis of variance (ANOVA). Results: Childhood autism (ICD-10 F84.0) accounted for 91.5% of the cases. The median age was 7 years, and 75.7% of the individuals were male. Autism severity was classified as moderate in 59.2% of the cases, severe in 31.7%, and mild in 8.6%. The association between age group and severity was statistically significant (p < 0.001), as was the association between diagnostic subtype and functional severity (χ², p = 1.66 × 10⁻²¹⁸). Significant differences were also observed in severity ratings assigned by forensic experts (p < 0.001). Conclusions: Autism spectrum disorder represents a substantial demand for forensic medical assessments within the public system of the State of São Paulo, with a predominance of moderate and severe functional impairment. The associations between age, diagnostic subtype, and severity support the technical consistency of the assessments. The variability observed among forensic experts reinforces the need for standardized assessment procedures and continuing professional education. The adoption of functional criteria based on the International Classification of Functioning, Disability and Health (ICF) is essential to ensure more equitable and evidence-based forensic assessments.
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