The Autism Diagnostic Observation Schedule (ADOS) is a first-choice diagnostic tool in autism spectrum disorder (ASD). Excellent interpersonal objectivity (interrater reliability) has been demonstrated for the ADOS under optimal conditions, i.e., within groups of highly trained "research reliable" examiners in research setting. We investigated the spontaneous interrater reliability among clinically trained ADOS users across multiple sites in clinical routine. Forty videotaped administrations of the ADOS modules 1-4 were rated by five different raters each from a pool of in total 15 raters affiliated to 13 different clinical sites. G(q,k) coefficients (analogous to intraclass correlations), kappas (ĸ) and percent agreement (PA) were calculated. The median interrater reliability for items across the four modules was G(q,k) = .74-.83, with the single ADOS items ranging from .23 to .94. G(q,k) for total scores was .85-.92. For diagnostic classification (ASD/non-spectrum), PA was 64-82 % and Fleiss' ĸ .19-.55. Objectivity was lower for pervasive developmental disorder not otherwise specified and non-spectrum diagnoses as compared to autism. Interrater reliabilities of the ADOS items and domain totals among clinical users across multiple sites were in the same range as previously reported for research reliable users, while the one for diagnostic classification was lower. Differences in sample characteristics, rater skills and statistics compared with previous studies are discussed. Findings endorse the objectivity of the ADOS in naturalistic clinical settings, but also pinpoint its limitations and the need and value of adequate and continuous rater training.
Intercountry adoptees emerge as a risk group for placements in out-of home care during adolescence, especially for entries into residential care (in Sweden usually triggered by persistent behaviour problems).
Aim: To evaluate cognitive and neuropsychological abilities of adopted delinquent adolescents in institutional care. Methods: Transnationally adopted adolescents admitted to institutional care (n= 20) and non‐delinquent controls who were also transnationally adopted (n= 21) were compared concerning the Wechsler Intelligence Scale for Children and Adults (WISC and WAIS), the Wisconsin Card Sorting Test (WCST) and the Tower of London test (TOL). The adoptive parents answered questions about the adoption, early childhood and family circumstances by a questionnaire sent by mail. Results: The adopted delinquents had a significantly lower IQ and significantly lower results on several other measurements in the WISC/WAIS compared to the controls even after adjustment for age of arrival in the adoptive home. Both groups of adoptees scored low in the WISC/WAIS subscale of arithmetics when compared to the population mean. The TOL test showed that the delinquents were slower and made more errors than the controls. Conclusion: The delinquent adoptees scored significantly lower on many variables in the WISC/WAIS. Both delinquent and non‐delinquent adoptees had some difficulties with arithmetic. The weak performances in arithmetics might point to some weaknesses in the neuropsychological domain. These results probably have complex explanatory causes and need to be further evaluated.
Objective: Internationally adopted delinquents are overrepresented in juvenile Swedish institutions. With the purpose of investigating possible reasons for this overrepresentation, this study compared adopted delinquent adolescents and internationally adopted controls in the structure and functioning of their current relations, especially with their parents.Methods: Internationally adopted adolescents admitted to institutional care (N=20) and non-delinquent internationally adopted controls (N=21) were compared through: a questionnaire; "family relations", a subscale in I think I am; "Family climate" (from Karolinska Scale of Personality); Individual Schedule of Social Interaction; and an Attachment Test.
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