Expediting clinician assessment in the diagnosis of autism spectrum disorder

Abstract

Aim To investigate a novel observational rating protocol designed to expedite clinical diagnosis of autism spectrum disorder (ASD). Method Two hundred and forty patients referred to a tertiary autism center (median age 8y 9mo, range 2y 6mo–34y 8mo; 188 males, 52 females) were rated using an adaptation of the Childhood Autism Rating Scale, Second Edition (CARS‐2) based exclusively on patient observation (CARS‐2obs). Scores were compared to expert diagnosis of ASD, parent‐reported Social Responsiveness Scale, Second Edition (SRS‐2) and, in a selected subset of patients, the Autism Diagnostic Observation Schedule, Second Edition (ADOS‐2). Results CARS‐2obs distinguished patients with a clinical diagnosis of ASD from those with non‐ASD neuropsychiatric disorders (mean score=18 vs 11.7, p<0.001). Severity ratings on the CARS‐2obs correlated with the ADOS‐2 (r=0.68, ρ=0.64) and SRS‐2 (r=0.31, ρ=0.32). A CARS‐2obs cutoff point equal to or greater than 16 demonstrated 95.8% specificity and 62.3% sensitivity in discriminating individuals with ASD from individuals without ASD in a specialty referral setting. Interpretation The CARS‐2obs allows the rapid acquisition of quantitative ratings of autistic severity by direct observation. Coupled with parent/teacher‐reported symptoms and developmental history, the measure may contribute to a low‐cost diagnostic paradigm in clinical and public health settings, where positive results might help reduce delays in diagnosis, and negative results could prompt further specialty assessment. What this paper adds The Childhood Autism Rating Scale, Second Edition based on patient observation distinguished individuals with versus without autism spectrum disorder (ASD). A score equal to or greater than 16 on this assessment showed high specificity for a diagnosis of ASD.

COVID-19 Pandemic and Impact on Patients with Autism Spectrum Disorder

“…Diagnostic assessment of autism through telehealth had been minimally researched pre-pandemic (Juárez et al, 2018 ). However, given the immediate need, many providers are now developing innovative adaptations to be able to conduct assessments via tele-health (Narzisi, 2020b ; Sanchez & Constantino, 2020 , Sutantio et al 2020 ; UCLA 2020 ; Wagner et al 2020 ). Though research on the validity of these assessment modifications is still emerging many professionals are working to adapt evidence-based tools to meet the healthcare constraints caused by the pandemic.…”

Neuropsychological Assessment in Autism Spectrum Disorder

“…Due to limitations to in-person assessment during the COVID-19 pandemic, the Brief Observation of Symptoms of Autism (BOSA [ 72 ]), an adaptation of the ADOS-2, was recently developed to assess ASD either remotely via telehealth or in-person with the parent leading the interaction with the child. Additionally, the CARS-2 was recently adapted to include only items scored based on a clinical observation in an effort to expedite the clinician’s ability to diagnose ASD [ 73 ]. The CARS-2 obs demonstrated the ability to differentiate individuals with ASD from those with non-ASD neuropsychiatric disorders with approximately 96% specificity and 62% sensitivity [ 73 ].…”

Proposed brief diagnostic observational scale for autism spectrum disorder

“…The new instrument for observing behavior in autism spectrum disorder (ASD) proposed by Sanchez and Constantino 1 could considerably speed up access to intervention for some children with the disorder. The Childhood Autism Rating Scale, Second Edition based exclusively on patient observation (CARS‐2 obs ) is derived from the first eight items of the original 15‐item CARS‐2 which tap into core symptoms of ASD (e.g.…”