Evaluation of the revised algorithm of Autism Diagnostic Observation Schedule (ADOS) in the diagnostic investigation of high-functioning children and adolescents with autism spectrum disorders

Abstract

The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured, standardized assessment designed for use in diagnostic evaluation of individuals with suspected autism spectrum disorder (ASD). The ADOS has been effective in categorizing children who definitely have autism or not, but has lower specificity and sometimes sensitivity for distinguishing children with milder ASDs. Revised ADOS algorithms have been recently developed. The goals of this study were to analyze the predictive validity of different ADOS algorithms for module 3, in particular for high-functioning autism spectrum disorder. The participants were 252 children and adolescents aged between four and 16 years, with a full-scale IQ above 70 (126 with a diagnosis of ASD, 126 with a heterogeneous non-spectrum diagnosis). As a main finding, sensitivity was substantially higher for the newly developed 'revised algorithm', both for autism versus non-spectrum, as well as for the broader ASD versus non-spectrum, using the higher cut-off. The strength of the original algorithm lies in its positive predictive power, while the revised algorithm shows weaknesses in specificity for non-autism ASD. As the ADOS is valid and reliable even for higher functioning ASD, the findings of the present study have been used to make recommendations regarding the best use of ADOS algorithms in a high-functioning sample.

The genetic variability and commonality of neurodevelopmental disease

“…Despite seemingly distinct primary diagnoses, considerable clinical heterogeneity as well as overlap has been appreciated for many years. Individuals with autism, for example, can present with or without cognitive impairment or ID [Kaufman et al, 2008;Matson and Shoemaker, 2009]; this is also reflected in the observed effect of IQ on portions of the Autism Diagnostic Observation Schedule (ADOS) diagnostic criteria [Kamp-Becker et al, 2011]. Such clinical overlap has also been observed for psychiatric disorders, such as bipolar disorder and schizophrenia Malhotra et al, 2011].…”

Social and non-social deficits in children with high-functioning autism and their cooperative behaviors

“…Their IQs were between 70 and 141, with an average of 109.76 (SD = 18.85), confirming that they were children with HFA. Standardized clinical instruments, such as ADI-R or ADOS, were not adopted in this study because their clinical sensitivity is low for the diagnostic identification of individuals with higher-functioning autism (Hagenmuller, Rö ssler, Wittwer, & Haker, 2014) and they have small power to distinguish between children with milder forms of ASD (Kamp-Becker et al, 2013). Before participation parents and children signed informed consent forms.…”

Issues in Identification and Assessment of Children with Autism and a Proposed Resource Toolkit for Speech-Language Pathologists

“…For example, combined, they correctly identified ASD in a group of young children with developmental language delay [68]. Furthermore, ADOS with revised cutoff scores improved sensitivity so that it successfully identified mild ASD [69]. However, Lord [70] points out that although these are gold standard instruments, they were not validated on multicultural populations, and so may not adequately identify and diagnose culturally and linguistically diverse (CLD) children.…”

“…The region-culture-language-specific resources are meant to be compiled by SLPs collaboratively with other local stakeholders, and incorporate question and answer materials addressing parental concerns and explanations of treatment types and annotated lists of local resources for all stakeholders, for example, lists and contact information of professionals well-equipped to care for children and youth with ASD [67,69] such as pediatricians, psychologists, psychiatrists, and other similarly trained professionals. The lists should include dentists adept at treating children with ASD (especially those with challenging behaviors), SLPs specializing in children with ASD, occupational therapists, social services (these can provide a link to governmental funding agencies, and volunteer services such as respite resources and sitters), child care centers, and educational facilities and schools in their region.…”