Diagnostic accuracy of the ADOS and ADOS-2 in clinical practice

Abstract

The Autism Diagnostic Observation Schedule is a semi-structured, standardized assessment tool for individuals with suspected autism spectrum disorders (ASD) and is deemed to be part of the gold standard for diagnostic evaluation. Good diagnostic accuracy and interpersonal objectivity have been demonstrated for the ADOS in research setting. The question arises whether this is also true for daily clinical practice and whether diagnostic accuracy depends on specialized experience in the diagnostic evaluation. The present study explores the diagnostic accuracy of the original and the revised version of the ADOS for Modules 1 through 4. Thus, seven cases of ADOS executions were recorded and coded by a group of experts of specialized outpatient clinics for ASD. In an extensive consensus process, including video analysis of every minute of the ADOS executions, a "gold standard" coding for every case was defined. The videos of the ADOS administration were presented to a large group of clinicians (from daily clinical routine care) and their codings (n = 189) were obtained and analysed. Variance of coding and congruence with the expert coding were determined. High variance was found in the codings. The accuracy of the coding depends on the experience of the coder with the ADOS as well as on characteristics of the cases and the quality of the administration of the ADOS. Specialization in the diagnostic of ASD has to be claimed. Specialized outpatient clinics for ASD are required which guarantee a qualified diagnostic/differential diagnostic and case management with the aim of demand-oriented supply of individual cases.

Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism

“…In support of this interpretation, 1 study found that children in Sweden aged 7 to 12 years who received a diagnosis of autism in 2014 had a 50% lower autism symptom score than did those diagnosed in 2004, whereas the prevalence of autism simultaneously increased 5-fold in this age group. 9 In parallel, the pool of individuals with autism diagnoses from which participants in research experiments are extracted generally satisfy Autism Diagnostic Interview and Autism Diagnostic Observation Schedule criteria, a set of criteria for which there can be problems with reliability 10 , 42 and specificity. 43 , 44 Regardless of the cause, the hypothesis of a broadening understanding of autism is consistent with the marked increase in the prevalence of autism that has been observed in recent decades and attributed, among other possibilities, to less stringent case ascertainment.…”

Music improves social communication and auditory–motor connectivity in children with autism

“…Recently, Bieleninik and colleagues 98 published a multicentre trial of improvisational music therapy for children aged 4–7 years and found no reductions in ASD symptoms on the ADOS Social Affect domain after 5 months of therapy, compared to standard care. The authors suggest that this could be due to variability across therapists, clinical assessors 99 and the choice of ADOS as outcome measure, particularly because no previous well-controlled and blinded intervention studies 3 have found treatment effects on the ADOS. While this trial demonstrates the global feasibility of implementing music therapy in large-scale international settings, it also indicates the importance of choosing appropriate outcome measures for psychosocial interventions in heterogeneous neurodevelopmental populations.…”

Plasmatic Levels of Neuropeptides, Including Oxytocin, in Children with Autism Spectrum Disorder, Correlate with the Disorder Severity

“…Obregia" Clinical Psychiatry Hospital. A certified child and adolescent psychiatrist established the diagnosis of ASD, based on clinical evaluation and diagnostic tests, among which ADOS (Autism Diagnostic Observation Schedule) (30).…”