Diagnosing ASD in Adults Without ID: Accuracy of the ADOS-2 and the ADI-R

Fusar-Poli, Laura; Brondino, Natascia; Rocchetti, Matteo; Panisi, Cristina; Provenzani, Umberto; Damiani, Stefano; Politi, Pierluigi

doi:10.1007/s10803-017-3258-2

Cited by 67 publications

(68 citation statements)

References 40 publications

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“…41 In this paper, we used a random forest approach, 81 which classifies the participants averaging the results of an ensemble of 1000 different decision trees on different subsets of data and input variables. The maximum depth of the trees and the minimum number of samples per leaf were the hyperparameters: For depth of trees the used values were [1,2,4,8,16,32,64], and for samples per leaf [1,2,4,8,16,32,64].…”

Section: Machine-learning Analysismentioning

confidence: 99%

“…However, interratervariability may account for inconsistencies regarding diagnostic accuracy. 16 The lack of feasible standardized diagnostic instruments contributes to a high number of non-or late diagnosed individuals. 17 Especially individuals with ASD and average or above average intelligence are often diagnosed later in life, 18 as they develop strategies to compensate for their deficits, which has been referred to as camouflaging.…”

Section: Introductionmentioning

confidence: 99%

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Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

et al. 2020

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Social interaction deficits are evident in many psychiatric conditions and specifically in autism spectrum disorder (ASD), but hard to assess objectively. We present a digital tool to automatically quantify biomarkers of social interaction deficits: the simulated interaction task (SIT), which entails a standardized 7-min simulated dialog via video and the automated analysis of facial expressions, gaze behavior, and voice characteristics. In a study with 37 adults with ASD without intellectual disability and 43 healthy controls, we show the potential of the tool as a diagnostic instrument and for better description of ASD-associated social phenotypes. Using machine-learning tools, we detected individuals with ASD with an accuracy of 73%, sensitivity of 67%, and specificity of 79%, based on their facial expressions and vocal characteristics alone. Especially reduced social smiling and facial mimicry as well as a higher voice fundamental frequency and harmony-to-noise-ratio were characteristic for individuals with ASD. The time-effective and cost-effective computer-based analysis outperformed a majority vote and performed equal to clinical expert ratings.npj Digital Medicine (2020) 3:25 ; https://doi.

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Section: Machine-learning Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

et al. 2020

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“…Maddox et al 21 Adults in CMHC 100.0 74.0 Fusar-Poli et al 19 Adults referred to ASD clinic; no ID 85.9 82.9 AQ Baron-Cohen et al 23 ASD without ID; controls from an undergraduate college sample 79.3 98.0…”

Section: Participantsmentioning

confidence: 99%

“…A recent study of adults without ID found that the ADOS, but not ADI-R, was concordant with ASD diagnosis. 19 Bastiaansen et al 14 found that the ADOS was not able to distinguish between adults on the spectrum and with schizophrenia without modification of the scoring algorithm, but it was able to reliably distinguish between ASD and both typical development and psychopathy. Another sample found that 50% of individuals with schizophrenia exceeded the cutoff for ASD.…”

Section: Introductionmentioning

confidence: 99%

Examining the Diagnostic Validity of Autism Measures Among Adults in an Outpatient Clinic Sample

ConnerCaitlin

CramerRyan

McGonigleJohn

2019

Autism in Adulthood

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Background: Previous research has questioned the validity of diagnostic measures for autism spectrum disorder (ASD) among adults. This study examined the correspondence between several measures and clinician diagnosis. Methods: We conducted a retrospective chart review for 93 adults (18-61 years; 72% male) who received an ASD evaluation at a specialty outpatient clinic. Thirty-one individuals (33%) in the sample were diagnosed with ASD. We compared participant scores on the Autism Spectrum Quotient (AQ), the Ritvo Autism Asperger's Diagnostic Scale-Revised (RAADS-R), and the Autism Diagnostic Observation Schedule (ADOS) to clinician diagnosis of ASD. We calculated sensitivity, specificity, and area under the curve (AUC) for each measure. Results: Participants diagnosed with ASD scored significantly higher, on average, on the ADOS than those who were not diagnosed with ASD, but not on the RAADS-R or AQ. The AUC was relatively low for each measure: ADOS = 0.69 (95% confidence interval [CI] 0.58-0.81), RAADS-R = 0.58 (95% CI 0.46-0.72), and AQ = 0.40 (95% CI 0.28-0.52). Sensitivity and specificity of all three measures were in the poor to fair range. When dichotomized at the optimal cutoffs for this sample, the ADOS had a sensitivity of 0.65 and a specificity of 0.76; the RAADS-R had a sensitivity of 0.52 and a specificity of 0.73; and the AQ had a sensitivity of 0.45 and a specificity of 0.52. Conclusions: Results of the study suggest that clinicians should not rely solely on self-report measures or the ADOS when diagnosing adults on the spectrum. Further development of measures is needed, including selfreport measures with higher diagnostic validity, that are sensitive across age, gender, and cognitive functioning, and that differentiate autism from psychiatric diagnoses. Lay SummaryWhy was this study done?Diagnosing adults with autism spectrum disorder (ASD) is difficult. Other research has suggested that the few measures that exist for autistic adults may not be very effective for accurate diagnoses. We wanted to see how closely the results of commonly used ASD assessment tools compared with clinical diagnoses in a real-life outpatient setting. What did the researchers do?This study looked at adults who went to an adult ASD outpatient clinic for an initial ASD diagnosis over 3 years. Of these 93 adults, one-third were diagnosed as autistic. As part of the evaluation, all participants completed two commonly used autism screening surveys-the Autism Spectrum Quotient (AQ) and the Ritvo Autism Asperger's Diagnostic Scale-Revised (RAADS-R)-and took part in a semistructured diagnostic interview called the Autism Diagnostic Observation Schedule (ADOS). The clinicians also collected additional information and, when possible, spoke to family members before jointly making a diagnosis. The researchers compared how those diagnosed with ASD and those who were not diagnosed with ASD scored on the AQ, the RAADS-R, and the ADOS. What were the results of this study?Although adults on the spectrum scored higher on average on the ...

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“…[4][5][6] Assessment may also need to proceed without information from a developmental history, which many diagnostic tools rely upon. [7][8][9] Diagnostic tools also need to be structured and sufficiently detailed to be accurate and efficient for use in specialist and nonspecialist assessment settings and brief enough given service and resource constraints. 8,[10][11][12][13] The Family History Interview (FHI) was designed to quantify the broader autism phenotype (traits related to the autism spectrum).…”

Section: What Do These Findings Add To What Is Already Known?mentioning

confidence: 99%

Development and Initial Utility of the Autism Clinical Interview for Adults: A New Adult Autism Diagnostic Measure

Wigham

Ingham

LeCouteur

et al. 2020

Autism in Adulthood

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Background: Clinicians use diagnostic interviews to help them gather and organize information collected in the assessment of autism. Most instruments are developed for children and few measures have been developed that are reliable, valid, and appropriate for use in adulthood. This is a significant barrier to providing a high-quality, timely service for adults. The aim of this development study was to assess the initial utility of the recently developed Autism Clinical Interview for Adults (ACIA) for use in autism diagnostic clinical services before further large-scale testing and evaluation. Methods: We invited adults who had received an autism spectrum diagnosis through a U.K. National Health Service (NHS) multidisciplinary adult autism assessment to participate. Seventeen autistic adults (8 women and 9 men, mean age of 37 years) and four relatives agreed to an interview. The semistructured ACIA interview comprises subject and informant versions, and a self-report preinterview questionnaire. In combination, the ACIA components cover topics relevant to autism and co-occurring condition assessment. We evaluated clinical utility and content validity via comparison with the Diagnostic and Statistical Manual Fifth Edition (DSM-5) and NHS diagnostic reports. Results: Each interview took between 60 and 90 minutes to complete. Comparison with DSM-5 and the NHS autism diagnostic report demonstrated that the ACIA accurately identified information on core autism characteristics needed for a diagnosis, and identified co-occurring conditions. In response to participant suggestions we revised the interview. Conclusions: These initial findings support the potential utility and validity of the ACIA for adult autism diagnostic clinical services. Further investigations of the acceptability, utility, and validity of this interview are planned.

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Diagnosing ASD in Adults Without ID: Accuracy of the ADOS-2 and the ADI-R

Cited by 67 publications

References 40 publications

Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

Examining the Diagnostic Validity of Autism Measures Among Adults in an Outpatient Clinic Sample

Development and Initial Utility of the Autism Clinical Interview for Adults: A New Adult Autism Diagnostic Measure

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