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Systematic Review and Meta-Analysis of the Clinical Utility of the ADOS-2 and the ADI-R in Diagnosing Autism Spectrum Disorders in Children

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Abstract

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and the Autism Diagnostic Interview, Revised (ADI-R) have high accuracy as diagnostic instruments in research settings, while evidence of accuracy in clinical settings is less robust. This meta-analysis focused on efficacy of these measures in research versus clinical settings. Articles (n = 22) were analyzed using a hierarchical summary receiver operating characteristics (HSROC) model. ADOS-2 performance was stronger than the ADI-R. ADOS-2 sensitivity and specificity ranged from .89-.92 and .81-.85, respectively. ADOS-2 accuracy in research compared with clinical settings was mixed. ADI-R sensitivity and specificity were .75 and .82, respectively, with higher specificity in research samples (Research = .85, Clinical = .72). A small number of clinical studies were identified, indicating ongoing need for investigation outside research settings.

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Acknowledgements

The authors would like to thank the UAB Libraries Reference Department for their support in formalizing and improving the search strategy for this project, Sarah Ryan, Ph.D. and Cassandra Newsom, Ph.D. for serving as article reviewers, and Dustin Long, Ph.D. for assistance with biostatistical analyses. This research was supported in part by the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCH) Leadership Education in Neurodevelopmental and Related Disabilities (LEND; PI: Biasini), UAB Civitan International Science Center and Foundation for Children with Intellectual and Developmental Disabilities McNulty Scientist Award (O’Kelley), and the UAB Civitan-Sparks Clinics.

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  1. University of Alabama at Birmingham, 1720 7th Ave S, Birmingham, AL, 35233, USA

    Jenna B. Lebersfeld, Marissa Swanson, Christian D. Clesi & Sarah E. O’Kelley

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JL designed the project and wrote the protocol supervised by SO. JL and MS conducted the literature searches and determined article eligibility. JL and CD completed data extraction, and JL conducted the statistical analysis. JL wrote the first draft of the manuscript and SO provided substantial edits and guidance. All authors have approved the final manuscript.

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Correspondence to Jenna B. Lebersfeld.

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Lebersfeld, J.B., Swanson, M., Clesi, C.D. et al. Systematic Review and Meta-Analysis of the Clinical Utility of the ADOS-2 and the ADI-R in Diagnosing Autism Spectrum Disorders in Children. J Autism Dev Disord 51, 4101–4114 (2021). https://doi.org/10.1007/s10803-020-04839-z

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