Replication and Comparison of the Newly Proposed ADOS-2, Module 4 Algorithm in ASD Without ID: A Multi-site Study
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Recent updates have been proposed to the Autism Diagnostic Observation Schedule-2 Module 4 diagnostic algorithm. This new algorithm, however, has not yet been validated in an independent sample without intellectual disability (ID). This multi-site study compared the original and revised algorithms in individuals with ASD without ID. The revised algorithm demonstrated increased sensitivity, but lower specificity in the overall sample. Estimates were highest for females, individuals with a verbal IQ below 85 or above 115, and ages 16 and older. Best practice diagnostic procedures should include the Module 4 in conjunction with other assessment tools. Balancing needs for sensitivity and specificity depending on the purpose of assessment (e.g., clinical vs. research) and demographic characteristics mentioned above will enhance its utility.
KeywordsAutism spectrum disorder Adults Adolescents Diagnosis Autism diagnostic observation schedule Sensitivity Specificity
This work was supported in part by an award from the Isadore and Bertha Gudelsky Family Foundation and the Fredrick and Elizabeth Singer Foundation, and grants by the Organization for Autism Research, Autism Speaks (Dennis Weatherstone Predoctoral Fellowship), the Philadelphia Foundation, Pfizer, Shire Pharmaceuticals, Robert Wood Johnson Foundation (#6672), the Pennsylvania Department of Health (SAP #4100042728, SAP # 4100047863), and the National Institutes of Health and the Intramural Research Program at NIMH (1-ZIA-MH002920-05, P30HD040677, T32 HD046388-01A2, 1K01MH079945-01, K23MH086111, R21MH092615, RC1MH088791, and P30HD026979). We gratefully acknowledge Catherine Lord, PhD for contributing data for comparative analyses; those data were funded by R01MH081873 to CL.
Dr. Pugliese designed the study, conducted the statistical analyses, wrote the initial draft of the paper, and participated in revising the manuscript and addressing the reviewers’ comments. Dr. Anthony assisted in designing the study, guiding analyses, assisting with manuscript development, participated in revising the manuscript and addressing the reviewers’ comments. Drs. Kenworthy, Hus-Bal, Wallace, Yerys, Maddox, White, Miller, Herrington, Schultz, and Martin assisted with manuscript development, provided guidance on statistical analysis, and participated in revising the manuscript and addressing the reviewers’ comments. Ms Armour and Mr. Popal collected data, built the databases, and reviewed the manuscript.
Compliance with Ethical Standards
This project involved human subjects and was conducted in compliance with standards established by all institution’s IRB including procedures for informed consent. This research did not involve the use of animals.
Conflict of interest
There are no financial or non-financial conflicts of interest to declare.
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