Preliminary evidence of the validity process of the Autism Diagnostic Observation Schedule (ADOS): translation, cross-cultural adaptation and semantic equivalence of the Brazilian Portuguese version

Abstract

Objectives: To translate and back-translate the Autism Diagnostic Observation Schedule (ADOS) into Brazilian Portuguese, to assess its cross-cultural semantic equivalence, and to verify indicators of quality of the final version by analyzing the inter-rater reliability of the ADOS scores. Methods: This study had three stages: 1) translation and back-translation; 2) semantic equivalence analysis; and 3) pre-test to verify the agreement between mental health specialists and an ADOS senior examiner regarding the scoring procedure. Authorization to translate and carry out the cultural adaptation of the instrument was first obtained from the Western Psychological Services, publishers of the instrument. Results: The main preliminary results pointed to good equivalence between the original English version and the final version and the Brazilian version following the cultural adaptation process. Some semantic differences were found between the original version and the back-translation into English, but they did not interfere with the first translation into Portuguese or into the final version. One of the limitations of the study was the small sample size; for that reason, the inter-rater reliability of the ADOS scores between the specialists and the senior examiner using the kappa coefficient was adequate for 7 out of 10 areas. Conclusions: We conclude that the creation of an official Brazilian version of ADOS will help to strengthen clinical and scientific research into ASD, and deter the use of other unauthorized versions of ADOS in the country.

Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries

“…In addition, three observational screening tools, the Childhood Autism Rating Scale (CARS), the Structured Observation for Autism Screening (OERA), and the Autism Mental Status Examination (AMSE), have been validated in Argentina, Brazil, Chile, and Mexico (Galdino et al, 2020; Paula et al, 2018; Pereira et al, 2008; Stewart & Lee, 2017; Cukier et al, 2019 and Saffre et al, 2019 [October 17, 2019; in press—personal communication]). The “gold standard” diagnosis instruments for ASD, the Autism Diagnostic Interview-Revised (ADI-R) (Becker et al, 2012) and the Autism Diagnostic Observation Schedule (ADOS; Pacífico et al, 2019) now have official Spanish and Brazilian Portuguese versions, and in Brazil both of them have preliminary validation data.…”

Autistic People's Access to Bilingualism and Additional Language Learning: Identifying the Barriers and Facilitators for Equal Opportunities

“…First, given the cultural variation in the identification and presentation of autism, research should focus on understanding and comparing the applicability and sensitivity of assessments across different cultures. To date, several autism screening tools have been developed for use with people from specific countries, including Iran (Samadi et al, 2014 ; Samadi and McConkey, 2015 ), China (Wang et al, 2020 ) and Brazil (Pacífico et al, 2019 ). All four studies highlighted a need to account for cultural variation, and that cultural and linguistic backgrounds play a crucial role in interpreting assessments.…”

A validation study of the LABIRINTO scale for the evaluation of autism spectrum disorder in children aged 2 to 4 years

“…This stage in the validation process considered the clinical diagnosis of autism as defined in the DSM-5 and used the CARS as a reference. [3][4][5][6][7][8][9][10][11][12][13] In both cases, the diagnosis was made by the same team, consisting of a psychiatrist and a psychologist.…”

“…Portuguese versions of both of these instruments already exist but are not yet available for use. 5,6 The ADI-R is a semi-structured interview to be applied to parents regarding the child's development between the ages of 4 and 5 years. Because it is an interview and does not involve direct assessment of the child, it has widely recognized limitations.…”