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Journal of Autism and Developmental Disorders

, Volume 46, Issue 7, pp 2327–2339 | Cite as

Classifying Autism Spectrum Disorders by ADI-R: Subtypes or Severity Gradient?

  • Hannah CholemkeryEmail author
  • Juliane Medda
  • Thomas Lempp
  • Christine M. Freitag
Original Paper

Abstract

To reduce phenotypic heterogeneity of Autism spectrum disorders (ASD) and add to the current diagnostic discussion this study aimed at identifying clinically meaningful ASD subgroups. Cluster analyses were used to describe empirically derived groups based on the Autism Diagnostic Interview-revised (ADI-R) in a large sample of n = 463 individuals with ASD aged 3–21. Three clusters were observed. Most severely affected individuals regarding all core symptoms were allocated to cluster 2. Cluster 3 comprised moderate symptom severity of social communication impairments (SCI) and less stereotyped repetitive behavior (RRB). Minor SCI and relatively more RRB characterized cluster 1. This study offers support for both, a symptom profile, and a gradient model of ASD within the spectrum due to the sample included.

Keywords

Autism Diagnostic Interview-revised Psychometric assessment Diagnosis Autism spectrum disorder Cluster analysis DSM-5 

Notes

Acknowledgments

Our gratitude goes to the children, adolescents, and families we are allowed to work with, who took part in our study, and thus made our research possible. We are also indepted to our clinician colleagues who refer the families to our projects. The authors address special thanks to Heiko Zerlaut for data preparation, and Dana Probst for first working with parts of the data due to her diploma thesis. This work was supported by the European Union and the Bundesministerium für Bildung und Forschung (ERA-NET NEURON project: EUHF-AUTISM-01EW1105 to CMF), the Landes-Offensive zur Entwicklung wissenschaftlich ökonomischer Exzellenz (LOEWE): Neuronal Coordination Research Focus Frankfurt (NeFF to CMF), and the Deutsche Forschungsgemeinschaft DFG (FR2069/2-1 to CMF).

Author Contributions

HC and CMF designed and planned the study. JM and TL were involved in the study process. HC did the statistics and was together with CMF primarily responsible for the present article. All authors read and corrected the first draft, and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Achenbach, T. M. (1998). Elternfragebogen über das Verhalten von Kindern und Jugendlichen; Deutsche Bearbeitung der Child Behavior Checklist (CBCL/4-18). Köln: Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik.Google Scholar
  2. Aster, M., Neubauer, A., & Horn, R. (2006). Wechsler Intelligenztest für Erwachsene (WIE). Frankfurt a. Main: Harcourt Test Services.Google Scholar
  3. Bölte, S., Crecelius, K., & Poustka, F. (2000). Der Fragebogen über Verhalten und soziale Kommunikation: psychometrische Eigenschaften eines Autismus-Screening-Instruments für Forschung und Praxis. Diagnostica, 46, 149–155.CrossRefGoogle Scholar
  4. Bölte, S., & Poustka, F. (2006). Fragebogen zur Sozialen Kommunikation—Autismus Screening (FSK). Deutsche Fassung des Social Communication Questionnaire (SCQ). Bern: Hans Huber, Hogrefe AG.Google Scholar
  5. Bölte, S., & Poustka, F. (2008). Skala zur Erfassung Sozialer Reaktivität (SRS). Bern: Hans Huber, Hogrefe AG.Google Scholar
  6. Bölte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: Cross-cultural validation of the social responsiveness scale (SRS). Autism Research, 1, 354–363.CrossRefPubMedGoogle Scholar
  7. Bölte, S., Rühl, D., Schmötzer, G., & Poustka, F. (2006). Diagnostisches Interview für Autismus—Revidiert. Deutsche Fassung des Autism Diagnostic Interview—Revised von Michael Rutter, Ann LeCouteur und Catherine Lord; 1. Auflage. Bern: Hans Huber, Hogrefe AG.Google Scholar
  8. Brennan, L., Barton, M., Chen, C.-M., Green, J., & Fein, D. (2014). Detecting subgroups in children with pervasive developmental disorders—not otherwise specified. Journal of Autism Developmental Disorders, 45(5), 1329–1344.CrossRefGoogle Scholar
  9. Bulheller, S., & Häcker, H. O. (Eds.). (2002). Coloured progressive matrices (CPM). Deutsche Bearbeitung und Normierung nach J. C. Raven. Frankfurt: Pearson Assessment.Google Scholar
  10. Constantino, J. N., Gruber, C. P., Davis, S., Hayes, S., Passanante, N., & Przybeck, T. (2004). The factor structure of autistic traits. Journal of Child Psychology and Psychiatry, 45(4), 719–726.CrossRefPubMedGoogle Scholar
  11. Döpfner, M., Schmeck, K., & Berner, W. (1994). Handbuch: Elternfragebogen über das Verhalten von Kindern und Jugendlichen. Forschungsergebnisse zur deutschen Fassung der Child Behavior Checklist (CBCL/4-18). Köln: Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik (KJFD).Google Scholar
  12. Duku, E., Szatmari, P., Vaillancourt, T., Georgiades, S., Thompson, A., Liu, X.-Q., et al. (2013). Measurement equivalence of the autism symptom phenotype in children and youth. Journal of Child Psychology and Psychiatry, 54(12), 1346–1355.CrossRefPubMedGoogle Scholar
  13. Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test (4th ed.). Pearson Assessments: San Antonio, TX.Google Scholar
  14. Eaves, L. C., Ho, H. H., & Eaves, D. M. (1994). Subtypes of autism by cluster analysis. Journal of Autism Developmental Disorders, 24(1), 3–22.CrossRefPubMedGoogle Scholar
  15. Fein, D., Stevens, M., Dunn, M., Waterhouse, L., Allen, D., & Rapin, I. (1999). Subtypes of pervasive developmental disorder: Clinical characteristics. Child Neuropsychology, 5, 1–23.CrossRefGoogle Scholar
  16. Georgiades, S., Szatmari, P., Zwaigenbaum, L., Bryson, S., Brian, J., Roberts, W., et al. (2013). A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorders. JAMA Psychiatry, 70(1), 42–48.CrossRefPubMedGoogle Scholar
  17. Gotham, K., Pickles, A., & Lord, C. (2009). Standardized ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism Developmental Disorders, 39(5), 693–705.CrossRefPubMedGoogle Scholar
  18. Greaves-Lord, K., Eussen, M. L., Verhulst, F. C., Minderaa, R. B., Mandy, W., Hudziak, J. J., et al. (2012). Empirically based phenotypic profiles of children with pervasive developmental disorders: Interpretation in the light of the DSM-5. Journal of Autism Developmental Disorders, 43(8), 1784–1797.CrossRefGoogle Scholar
  19. Hair, J. F., & Black, W. C. (2000). Cluster analysis. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and understanding more multivariate statistics (pp. 147–205). Washington, DC: American Psychological Association.Google Scholar
  20. Horn, R. (Ed.). (2009). Standard progressive matrices (SPM). Deutsche Bearbeitung und Normierung nach J. C. Raven (2nd ed.). Frankfurt: Pearson Assessment.Google Scholar
  21. Hu, V. W., & Lai, Y. (2013). Developing a predictive gene classifier for autism spectrum disorders based upon differential gene expression profiles of phenotypic subgroups. North American Journal of Medicine and science,. doi: 10.7156/najms.2013.0603107.PubMedPubMedCentralGoogle Scholar
  22. Hu, V. W., & Steinberg, M. E. (2009). Novel clustering of items form the Autism diagnostic interview-revised to define phenotypes within autism spectrum disorders. Autism Research, 2(2), 67–77.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Hus, V., Gotham, K., & Lord, C. (2014). Standardizing ADOS domain scores: separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders, 44(10), 2400–2412.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Hus, V., & Lord, C. (2013). Effects of child characteristics on the autism diagnostic interview-revised: Implications as a measure of ASD severity. Journal of Autism and Developmental Disorders, 43(2), 371–381.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Hus, V., & Lord, C. (2014). The autism diagnostic observation schedule, module 4: Revised algorithm and standardized severity scores. Journal of Autism and Developmental Disorders, 44(8), 1996–2012.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Hus, V., Pickles, A., Cook, E. H., Risi, S., & Lord, C. (2007). Using the autism diagnostic interview-revised to increase phenotypic homogeneity in genetic studies of autism. Biological Psychiatry, 61, 438–448.CrossRefPubMedGoogle Scholar
  27. Jansen, R., Ceulemans, E., Grauwels, J., Maljaars, J., Zink, I., Steyaert, J., & Noens, I. (2013). Young children with language difficulties: A dimensional approach of subgrouping. Research in Developmental Disabilities, 34(11), 4115–4124.CrossRefPubMedGoogle Scholar
  28. Kim, S. H., & Lord, C. (2012). Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. Journal of Child Psychology and Psychiatry, 53(2), 143–151.CrossRefPubMedGoogle Scholar
  29. Kim, S. H., Thurm, A., Shumway, S., & Lord, C. (2013). Multisite study of new autism diagnostic interview-revised (ADI-R) algorithms for toddlers and young preschoolers. Journal of Autism Developmental Disorders, 43(7), 1527–1538.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Lord, C., & Bishop, S. L. (2015). Recent advances in autism research as reflected in DSM-5 criteria for autism spectrum disorder. Annual Review of Clinical Psychology, 11, 53–70.CrossRefPubMedGoogle Scholar
  31. Lord, C., Petkova, E., Hus, V., & Risi, S. (2012). A multi-site study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry, 69(3), 306–313.CrossRefPubMedGoogle Scholar
  32. Mandy, W., Charman, T., Gilmour, J., & Skuse, D. (2011). Toward specifying pervasive developmental disorders-not otherwise specified. Autism Research, 4(2), 121–131.CrossRefPubMedGoogle Scholar
  33. Melchers, P., & Preuß, U. (2009). Kaufman Assessment Battery for Children, dt. Version (K-ABC). Frankfurt/M: Pearson Assessment.Google Scholar
  34. Obafemi-Ajayi, T., Miles, J. H., Takahashi, T. N., Qi, W., Aldridge, K., Zhang, M., et al. (2014). Facial structure analysis separates autism spectrum disorders into meaningful clinical subgroups. Journal of Autism Developmental Disorders, 45(5), 1302–1317.CrossRefGoogle Scholar
  35. Pearson, D. A., Loveland, K. A., Lachar, D., Lane, D. M., Reddoch, S. L., Mansour, R., & Cleveland, L. A. (2006). A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS. Child Neuropsychology, 12(4–5), 321–333.CrossRefPubMedGoogle Scholar
  36. Petermann, F., & Petermann, U. (2010). Hamburg-Wechsler-Intelligenztest für Kinder-IV. Bern: Hans Huber.Google Scholar
  37. Ring, H., Woodbury-Smith, M., Watson, P., Wheelwright, S., & Baron-Cohen, S. (2008). Clinical heterogeneity among people with high functioning autism spectrum conditions: evidence favouring a continuous severity gradient. Behavioral and Brain Functions, 4(11), 1–6.CrossRefGoogle Scholar
  38. Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information of multiple sources in the diagnosis of autism spectrum disorders. Journal of American Academy of Child and Adolescent Psychiatry, 45(9), 1094–1103.CrossRefGoogle Scholar
  39. Rühl, D., Bölte, S., Feineis-Matthews, S., & Poustka, F. (2004). Diagnostische Beobachtungsskala für Autistische Störungen. Deutsche Fassung der Autism Diagnostic Observation Schedule. Bern: Hans Huber, Hogrefe AG.Google Scholar
  40. Rutter, M., Bailey, A., & Lord, C. (2001). Social communication questionnaire (SCQ). Los Angeles, CA: Western Psychological Services.Google Scholar
  41. Rutter, M., LeCouteur, A., & Lord, C. (2003). Autism diagnostic interview-revised (ADI-R). Los Angeles, CA: Western Psychological Services.Google Scholar
  42. Schopler, E., Reichler, R., & Rochen, Renner B. (1988). The childhood autism rating scale. Los Angeles, CA: Western Psychological Services.Google Scholar
  43. Sevin, J., Matson, J., Coe, D., Love, S., Matese, M., & Benavidez, D. (1995). Empirically derived subtypes of pervasive developmental disorders: A cluster analytic study. Journal of Autism Developmental Disorders, 25, 561–578.CrossRefPubMedGoogle Scholar
  44. Siegel, B., Anders, T., Ciaranello, R., Bienenstock, B., & Kramer, H. (1986). Empirically derived sub-classification of the autistic syndrome. Journal of Autism Developmental Disorders, 16, 275–294.CrossRefPubMedGoogle Scholar
  45. Snow, A. V., & Lecavalier, L. (2011). Comparing autism, PDD-NOS, and other developmental disabilities on parent-reported behavior problems: Little evidence for ASD subtype validity. Journal of Autism Developmental Disorders, 41, 302–310.CrossRefPubMedGoogle Scholar
  46. Snow, A. V., Lecavalier, L., & Houts, C. (2008). The structure of the Autism Diagnostic Interview-Revised: Diagnostic and phenotypic implications. Journal of Child Psychology and Psychiatry, 50(6), 734–742. http://www.ncbi.nlm.nih.gov/pubmed/?term=Snow%2CLecavalier%2C+Houts%282008%29.CrossRefPubMedGoogle Scholar
  47. Spiker, D., Lotspeich, L. J., Dimiceli, S., Myers, R. M., & Risch, N. (2002). Behavioral phenotypic variation in autism multiplex families: Evidence for a continuous severity gradient. American Journal of Medical Genetics, 114, 129–136.CrossRefPubMedGoogle Scholar
  48. Steinhausen, D., & Langer, K. (1977). Clusteranalyse: Einführung in Methoden und Verfahren der automatischen Klassifikation. Berlin: Walter de Gruyter.CrossRefGoogle Scholar
  49. Stevens, M. C., Fein, D. A., Dunn, M., Allen, D., Waterhouse, L. H., Feinstein, C., & Rapin, I. (2000). Subgroups of children with autism by cluster analysis: A longitudinal examination. Journal of the American Academy of Child and Adolescent Psychiatry, 39(3), 346–352.CrossRefPubMedGoogle Scholar
  50. Veatch, O. J., Veenstra-Vanderweele, J., Potter, M., Pericak-Vance, M. A., & Haines, J. L. (2014). Genetically meaningful phenotypic subgroups in autism spectrum disorders. Genes Brain Behavior, 13(3), 276–285.CrossRefGoogle Scholar
  51. Verté, S., Geurts, H. M., Roeyers, H., Rosseel, Y., Oosterlaan, J., & Sergeant, J. A. (2006). Can the children’s communication checklist differentiate autism spectrum disorders? Autism, 10(3), 266–287.CrossRefPubMedGoogle Scholar
  52. Weiss, R. H. (2006). CFT 20-R: Grundintelligenz Skala 2-Revision. Göttingen: Hogrefe.Google Scholar
  53. Wiggins, L. D., Robins, D. L., Adamson, L. B., Bakeman, R., & Henrich, C. C. (2012). Support for a dimensional view of autism spectrum disorders in toddlers. Journal of Autism Developmental Disorders, 42(2), 191–200.CrossRefPubMedPubMedCentralGoogle Scholar
  54. World Health Organisation. (1992). International statistical classification of diseases and related health problems Rev. 10. Geneva: World Health Organisation.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Hannah Cholemkery
    • 1
    Email author
  • Juliane Medda
    • 1
  • Thomas Lempp
    • 1
  • Christine M. Freitag
    • 1
  1. 1.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyJW Goethe University HospitalFrankfurt Am MainGermany

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