Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

Holzinger, Daniel; Weber, Christoph; Bölte, Sven; Fellinger, Johannes; Hofer, Johannes

doi:10.1007/s10803-021-05203-5

Cited by 7 publications

(6 citation statements)

References 58 publications

(77 reference statements)

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“…As the BEC diagnosis of ASD is dependent not only on ADOS/2 results but also on the clinical impression as well as on further diagnostics, individuals with similar ADOS/2 results can receive different diagnoses. From this point of view, conspicuous behaviors during ADOS/2 assessment situations are seemingly not sufficiently specific for distinguishing between individuals with below average IQ plus ID and individuals with ASD, which is in line with recent research ( 42 ). However, further studies are needed to confirm this hypothesis.…”

Section: Discussionsupporting

confidence: 84%

Abilities and Disabilities—Applying Machine Learning to Disentangle the Role of Intelligence in Diagnosing Autism Spectrum Disorders

et al. 2022

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ObjectiveAlthough autism spectrum disorder (ASD) is a relatively common, well-known but heterogeneous neuropsychiatric disorder, specific knowledge about characteristics of this heterogeneity is scarce. There is consensus that IQ contributes to this heterogeneity as well as complicates diagnostics and treatment planning. In this study, we assessed the accuracy of the Autism Diagnostic Observation Schedule (ADOS/2) in the whole and IQ-defined subsamples, and analyzed if the ADOS/2 accuracy may be increased by the application of machine learning (ML) algorithms that processed additional information including the IQ level.MethodsThe study included 1,084 individuals: 440 individuals with ASD (with a mean IQ level of 3.3 ± 1.5) and 644 individuals without ASD (with a mean IQ level of 3.2 ± 1.2). We applied and analyzed Random Forest (RF) and Decision Tree (DT) to the ADOS/2 data, compared their accuracy to ADOS/2 cutoff algorithms, and examined most relevant items to distinguish between ASD and Non-ASD. In sum, we included 49 individual features, independently of the applied ADOS module.ResultsIn DT analyses, we observed that for the decision ASD/Non-ASD, solely one to four items are sufficient to differentiate between groups with high accuracy. In addition, in sub-cohorts of individuals with (a) below (IQ level ≥4)/ID and (b) above average intelligence (IQ level ≤ 2), the ADOS/2 cutoff showed reduced accuracy. This reduced accuracy results in (a) a three times higher risk of false-positive diagnoses or (b) a 1.7 higher risk for false-negative diagnoses; both errors could be significantly decreased by the application of the alternative ML algorithms.ConclusionsUsing ML algorithms showed that a small set of ADOS/2 items could help clinicians to more accurately detect ASD in clinical practice across all IQ levels and to increase diagnostic accuracy especially in individuals with below and above average IQ level.

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Section: Discussionsupporting

confidence: 84%

Abilities and Disabilities—Applying Machine Learning to Disentangle the Role of Intelligence in Diagnosing Autism Spectrum Disorders

et al. 2022

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“…Every participant underwent an in-depth multi-disciplinary diagnostic assessment for ASD during data collection. Firstly, this involved administration of the adapted ADOS-2 by a multidisciplinary team competent in signed communication and with many years of clinical experience in the fields of hearing loss, ID and ASD over the whole life course (40). Secondly, DiBAS-R with minimal adaptations to signed communication was completed by a clinical professional at the therapeutic living communities who had insights into the daily behaviors of each participant during the period of data collection.…”

Section: Methodsmentioning

confidence: 99%

“…Two different instruments were used for the assessment of ASD within the sample: Firstly, The autism diagnostic observation schedule (ADOS-2) (39) was adapted for use with adults with ID and deafness (40). It includes a number of age-appropriate play-based activities that are designed to obtain information in the areas of communication, reciprocal social interactions, and restricted and repetitive behaviors associated with a diagnosis of ASD.…”

Section: Autism Spectrum Disordermentioning

confidence: 99%

Development of a Social Communication Questionnaire (QSC-ID) for People With Intellectual Disability in a Deaf Sample: A Pilot and Feasibility Study

Weber

Fellinger

et al. 2021

Front. Psychiatry

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Background: Social communication (SC) includes the use and interpretation of verbal and non-verbal messages within a social context and thus requires more than knowledge of language. Social communication skills are essential for connecting and engaging with others, and SC deficits are often associated with emotional and behavioral problems. There is a lack of feasible instruments for assessing SC skills in individuals with intellectual disability (ID).Methods: A questionnaire on social communication in adults with ID (QSC-ID) comprising 20 Likert-scaled items was developed and completed on behalf of participants (n = 52) from three Austrian therapeutic living communities for people with ID and deafness by their living- and working-facility key caregivers. The sample of adults with hearing loss was considered ideal for the development of a measure of SC that is not restricted to a specific communication mode or overly related with language skills.Results: The preliminary results showed high construct validity. Correlations were high between SC and language, social skills, and severity of autism spectrum disorder (ASD), moderate between SC and adaptive skills, and non-verbal intelligence and, as expected, low between SC and motor skills. Interrater reliability was found to be good or at least acceptable for all items. Total raw scores were well-distributed over the whole range—Cut-offs based on the 10th and 20th percentile are suggested to identify atypical and borderline SC skills. Caregiver feedback and completeness of data suggest that the questionnaire is highly feasible.Conclusion: Questionnaire on social communication in adults with ID is an easy-to-use caregiver-reported questionnaire for use with individuals with mild to severe forms of ID. Initial testing of validity looks promising. Further validation in populations with typical hearing is required. Due to substantial correlations between SC and structural language skills the calculation of specific SC cut-offs for different levels of linguistic skills should be considered when sufficient data is available.

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“…The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Mania Rating Scale for Children and Adolescents [ 17 ] was administered to parents and confirmed a clinical score for Autism and ADHD. Due to deficits in social communication and repetitive patterns of interests, an ADOS-2 (Autism Diagnostic Observation Schedule) [ 18 ] was administered, reporting a total score of 13, which therefore exceeds the Autism cut-off in the ADOS-2 classification. An Autism diagnosis, according to DSM 5 criteria, ADOS2 and ADI-r scores [ 19 ], was made.…”

Section: Case Presentationmentioning

confidence: 99%

Diagnostic and Therapeutic Challenges of Comorbid ASD, ADHD and Psychosis: A Case Report

Scarselli

Martucci

Novelli

et al. 2022

Behavioral Sciences

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Autism Spectrum Disorder (ASD) and attention deficit hyperactivity disorder (ADHD) comorbidity is common in clinical practice and it seems to be related to shared etiological mechanisms and genetic susceptibility. Moreover, occurrence of psychosis can further complicate these complex clinical pictures. Here, we discuss the case of a nine-years-old boy presenting with an episode of abnormal sustained posture of the upper limbs, resembling dystonia, at the age of 3. At this time, auditory and visual hallucinations, as well as obsessive thoughts and attentional lability were also present and a diagnosis of “Early onset psychosis” was initially made. Due to the worsening of clinical picture, several hospitalizations were necessary and pharmacological treatment with carbamazepine, risperidone and aripiprazole was carried out. Extensive clinic evaluation revealed a past medical and personal history of toe walking, weak social skills and stereotyped behavior observed and ADOS-2 Module 2 administration revealed severe Autism scores. Moreover, signs of attention and hyperactivity were consistent with ADHD diagnosis. This work highlights the importance of a complete diagnostic assessment in patients with complex presentation, suggesting the possible overlap diagnosis of ADHD and Autism even in presence of psychotic-like symptoms.

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Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

Cited by 7 publications

References 58 publications

Abilities and Disabilities—Applying Machine Learning to Disentangle the Role of Intelligence in Diagnosing Autism Spectrum Disorders

Abilities and Disabilities—Applying Machine Learning to Disentangle the Role of Intelligence in Diagnosing Autism Spectrum Disorders

Development of a Social Communication Questionnaire (QSC-ID) for People With Intellectual Disability in a Deaf Sample: A Pilot and Feasibility Study

Diagnostic and Therapeutic Challenges of Comorbid ASD, ADHD and Psychosis: A Case Report

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