Diagnosing autism spectrum disorder in community settings using the Development and Well‐Being Assessment: validation in a UK population‐based twin sample

Abstract

BackgroundIncreasing numbers of people are being referred for the assessment of autism spectrum disorder (ASD). The NICE (UK) and the American Academy of Pediatrics recommend gathering a developmental history using a tool that operationalises ICD/DSM criteria. However, the best‐established diagnostic interview instruments are time consuming, costly and rarely used outside national specialist centres. What is needed is a brief, cost‐effective measure validated in community settings. We tested the Development and Well‐Being Assessment (DAWBA) for diagnosing ASD in a sample of children/adolescents representative of those presenting in community mental health settings.MethodsA general population sample of twins (TEDS) was screened and 276 adolescents were selected as at low (CAST score < 12; n = 164) or high risk for ASD (CAST score ≥ 15 and/or parent reported that ASD suspected/previously diagnosed; n = 112). Parents completed the ASD module of the DAWBA interview by telephone or online. Families were visited at home: the ADI‐R and autism diagnostic observation schedule (ADOS) were completed to allow a best‐estimate research diagnosis of ASD to be made.ResultsDevelopment and Well‐Being Assessment ASD symptom scores correlated highly with ADI‐R algorithm scores (ρ = .82, p < .001). Good sensitivity (0.88) and specificity (0.85) were achieved using DAWBA computerised algorithms. Clinician review of responses to DAWBA questions minimally changed sensitivity (0.86) and specificity (0.87). Positive (0.82–0.95) and negative (0.90) predictive values were high. Eighty‐six per cent of children were correctly classified. Performance was improved by using it in conjunction with the ADOS.ConclusionsThe DAWBA is a brief structured interview that showed good sensitivity and specificity in this general population sample. It requires little training, is easy to administer (online or by interview) and diagnosis is aided by an algorithm. It holds promise as a tool for assisting with assessment in community settings and may help services implement the recommendations made by NICE and the American Academy of Pediatrics regarding diagnosis of young people on the autism spectrum.

Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

“…• Kiddie-SADS DSM-5 Screen Interview (K-SADS-PL)* (6-18 years) [73,74] • Strengths and Difficulties Questionnaire (SDQ) (2-17 years) [75] • The Development and Well-being Assessment (DAWBA) (5-17 years) [76,77] Autism-specific clinical interviews…”

The agreement between the referrer, practitioner and research diagnosis of autistic spectrum conditions among children attending child and adolescent mental health services

“…There is no test–retest reliability of the DAWBA as attenuation for such an in-depth assessment would be so great as to render any such assessment invalid [27]. The DAWBA has been shown to have high levels of sensitivity (0.88) and specificity (0.85) in detecting ASC in a population-based twin study, when it correlated highly ( ρ  =0.82, p  < 0.001) with the best estimate research diagnosis (revised Autism Diagnostic Interview combined with the Autism Diagnostic Observation Schedule) [23]. …”

“…Arguably, the Autism Diagnostic Interview combined with the Autism Diagnostic Observation Schedule is considered to be a reference standard to aspire to in research and clinical practise [23]. To access assessment, a child needs to be referred to a specialist service, which is frequently a CAMHS or community paediatrics.…”

Disentangling the autism−anxiety overlap: fMRI of reward processing in a community-based longitudinal study

“…The diagnostic algorithm derived from the DAWBA ASD module shows strong agreement with that from the Autism Diagnostic Interview—Revised 45 , 46 and has a high predictive value for ASD diagnoses in community settings. 47 In line with the newest characterization of ASD, 48 we classified participants as having ‘high' levels of ASD traits if their parents/carers reported three or more symptoms on the social difficulties subscale and three or more symptoms on the restricted and repetitive behaviors subscale of the DAWBA ASD section. Based on this criterion close to 5% of the sample had high ASD traits ( Table 1 ), consistent with the prevalence of clinically relevant autistic traits reported in previous population-based studies.…”