Hidden Aspects of the Research-ADOS are Bound to Affect Autism Science

Abstract

The research-grade ADOS is a broadly used instrument that informs and steers 12 much of the science of Autism. Despite its broad use, little is known about the empirical 13 variability inherently present in the scores of the ADOS scale, or their appropriateness to 14 define change, to repeatedly use this test to characterize neurodevelopmental trajectories. 15Here we examine the empirical distributions of research-grade ADOS scores from 1,324 16 records in a cross-section of the population comprising participants with autism between 5-17 65 years of age. We find that these empirical distributions violate the theoretical 18 requirements of normality and homogeneous variance, essential for independence between 19 bias and sensitivity. Further, we assess a subset of 52 typical controls vs. those with autism 20 and find lack of proper elements to characterize neurodevelopmental trajectories in a coping 21 nervous system changing at non-uniform, non-linear rates. Lastly, longitudinally repeating 22 the assessments over 4 visits in a subset of the participants with autism for whom verbal 23 criteria kept the same appropriate ADOS modules over the timespan of the 4 visits, reveals 24 that switching the clinician, changes the cutoff scores, and consequently, influences the 25 diagnosis, despite maintaining fidelity in the same test's modules, room conditions and 26 tasks' fluidity per visit. Given the changes in probability distribution shape and dispersion 27of these ADOS scores, the lack of appropriate metric spaces, and the impact that these 28 elements have on sensitivity-bias co-dependencies, and on longitudinal tracking of autism, 29 we invite a discussion on the use of this test for scientific purposes. 30

Precision Autism: Genomic Stratification of Disorders Making Up the Broad Spectrum May Demystify its “Epidemic Rates”

“…Our overall conclusion from our results is twofold: (1) Autism prevalence rates are an artifact of current surveillance methods relying exclusively on the clinical (behavioral) diagnosis that welcomes other disorders, using fundamentally flawed statistics in the criteria, thus inflating false positives [8]; (2) The broad spectrum of Autism, as we know it today, i.e., inclusive of disorders and diseases of known etiology, share a common set of genes with those disorders and consequentially can be stratified into Autism subtypes. These genetically-based subtypes might be more manageable and less costly to treat and service, than forecasted by current epidemiological accounts relying only on the psychological construct of "appropriate" social behaviors [56].…”

“…Both receive the Autism diagnosis, and both will receive a form of behavioral modification to reshape social behaviors in compliance with a set of social norms. As mentioned, such norms were never informed, in any way, by the nervous systems physiology [8]. The accreditation programs enabling such behavioral diagnoses and interventions in fact lack training on basic neuroscience 1 .…”

“…Yet, motor features derived from endogenous neural signals in motor patterns, do identify the female phenotype [3][4][5][6]. This is the case even when digitizing the current clinical criteria that would otherwise miss females because of exclusive reliance on external observation [7,8]. Likewise, subtle cultural biases built into the socialappropriateness criteria of the current instruments skew identification of underserved populations [1].…”

Analysis and Real-Time Implementation of IoT in Autism

“…This data can transmit to further connected smart devices. In this way, parents can observe the stress levels of their children [31][32][33]. ASD melt-down issues can grow fast without any reason.…”