Autism Diagnostic Interview-Revised and the Childhood Autism Rating Scale: Convergence and Discrepancy in Diagnosing Autism

  • Evald Saemundsen
  • Páll Magnússon
  • Jakob Smári
  • Solveig Sigurdardóttir
Article

Abstract

The agreement between the Autism Diagnostic Interview–Revised (ADI-R) and the Childhood Autism Rating Scale (CARS) was investigated in the diagnostic assessment of 54 children aged 22–114 months referred for possible autism. The observed agreement between the two systems was 66.7% (Cohen's kappa = .40) when the ADI-R definition for autism was applied (i.e., scores reaching cutoff in three domains on the ADI-R), but increased considerably with less stringent criteria; that is, scores reaching cutoffs in two domains and in one domain on the ADI-R. As predicted, the CARS identified more cases of autism than the ADI-R. Children classified as autistic according to both instruments had significantly lower IQ/DQ and more severe autistic symptomatology than those classified with the CARS only.

Autism diagnosis Autism Diagnostic Interview–Revised Childhood Autism Rating Scale 

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References

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.) Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  3. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  4. Arthur, G. (1952). Manual for the Arthur Adaptation of the Leiter International Performance Scale. Washington, DC: The Psychological Service Center Press.Google Scholar
  5. Bailey, A., Philips, W., & Rutter, M. (1996). Autism: Towards an integration of clinical, genetic, neuropsychological and neurobiological perspectives. Journal of Child Psychology and Psychiatry, 37, 89-126.PubMedGoogle Scholar
  6. Barton, M., & Volkmar, F. (1998). How commonly are known medical conditions associated with autism? Journal of Autism and Developmental Disorders, 28, 273-278.PubMedGoogle Scholar
  7. Bayley, N. (1969). Manual for the Bayley Scales of Infant Development. New York: Psychological Corporation.Google Scholar
  8. Bayley, N. (1993). Manual for the Bayley Scales of Infant Development (2nd ed.). New York: Psychological Corporation.Google Scholar
  9. Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444-451.Google Scholar
  10. Cox, A., Klein, K., Charman, T., Baird, G., Baron-Cohen, S., Swettenham, J., Drew, A., & Wheelwright, S. (1999). Autism spectrum disorders at 20 and 42 months of age: Stability of clinical and ADI-R diagnosis. Journal of Child Psychology and Psychiatry, 40, 719-732.PubMedGoogle Scholar
  11. DiLalla, D. L., & Rogers, S. J. (1994). Domains of the Childhood Autism Rating Scale: Relevance for diagnosis and treatment. Journal of Autism and Developmental Disorders, 24, 115-128.PubMedGoogle Scholar
  12. Eaves, R. C., & Milner, B. (1993). The criterion-related validity of the Childhood Autism Rating Scale and the Autism Behavior Checklist. Journal of Abnormal Child Psychology, 21, 481-491.PubMedGoogle Scholar
  13. Einarsdóttir, A. V., & Haraldsdóttir, G. (1992). Réttmætis-og áreiôanleikaathugun á Greiningarkvarôa fyrir barnaeinhverfu (CARS). [Study of the reliability and validity of the Childhood Autism Rating Scale (CARS)]. Unpublished B. A. thesis, University of Iceland, Reykjavík, Iceland.Google Scholar
  14. Fombonne, E. (1998). Epidemiological surveys of autism. In F. R. Volkmar (Ed.), Autism and pervasive developmental disorders (pp. 32-63). Cambridge: Cambridge University Press.Google Scholar
  15. Garfin, D. G., McCallon, D., & Cox, R. (1988). Validity and reliability of the Childhood Autism Rating Scale with autistic adolescents. Journal of Autism and Developmental Disorders, 18, 367-378.PubMedGoogle Scholar
  16. Hannibalsson, A. (1971). Greindarpróf Wechslers handa börnum. [Wechsler Intelligence Scale for Children]. Reykjavik, Iceland: Reykjavik Primary Health Care Center.Google Scholar
  17. Howell, D. C. (1992). Statistical Methods in Psychology (3rd ed.). Belmont, CA: Duxbury Press.Google Scholar
  18. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. (1989). Autism Diagnostic Interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders 19, 363-387.PubMedGoogle Scholar
  19. Levine, M. N. (1982). Leiter International Performance Scale: A handbook. Los Angeles: Western Psychological Services.Google Scholar
  20. Lilienfeld, D. E., & Stolley, P. D. (1994). Foundations of Epidemiology. New York: Oxford University Press.Google Scholar
  21. Lord, C. (1991). Methods and measures of behavior in the diagnosis of autism and related disorders. Psychiatric Clinics of North America, 14, 69-80.PubMedGoogle Scholar
  22. Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36, 1365-1382.PubMedGoogle Scholar
  23. Lord, C. (1997). Diagnostic instruments in autism spectrum disorders. In D. J. Cohen, & F. R. Volkmar (Eds.), Autism and pervasive developmental disorders (pp. 460-483). New York: Wiley.Google Scholar
  24. Lord, C., Pickles, A., McLennan, J., Rutter, M., Bregman, J., Folstein, S., Fombonne, E., Leboyer, M., & Minshew, N. (1997). Diagnosing autism: Analyses of data from the Autism Diagnostic Interview. Journal of Autism and Developmental Disorders, 27, 501-517.PubMedGoogle Scholar
  25. Lord, C., & Risi, S. (1998). Frameworks and methods in diagnosing autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Review, 4, 90-96.Google Scholar
  26. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview–Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659-685.PubMedGoogle Scholar
  27. Lord, C., Storoschuck, S., Rutter, M., & Pickles, A. (1993). Using the ADI-R to diagnose autism in preschool children. Infant Mental Health Journal, 14, 234-252.Google Scholar
  28. Nordin, V., Gillberg, C., & Nydén, A. (1998). The Swedish version of the Childhood Autism Rating Scale in a clinical setting. Journal of Autism and Developmental Disorders, 28, 69-75.PubMedGoogle Scholar
  29. Pilowsky, T., Yirmiya, N., Shulman, C., & Dover, R. (1998). The Autism Diagnostic Interview–Revised and the Childhood Autism Rating Scale: Differences between diagnostic systems and comparison between genders. Journal of Autism and Developmental Disorders, 28, 143-151.PubMedGoogle Scholar
  30. Prizant, B. (1992). Review of the Childhood Autism Rating Scale. In J. J. Kramer, J. C. Conoley, & L. L. Murphy (Eds.), The Eleventh Mental Measurements Yearbook (pp. 170-171). Lincoln: University of Nebraska Press.Google Scholar
  31. Rutter, M., Lord, C., & Le Couteur, A. (1990) Autism Diagnostic Interview–Revised research protocol (3rd. ed.), corrected 11 September 1991. London: Institute of Psychiatry.Google Scholar
  32. Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The Childhood Autism Rating Scale (CARS). Los Angeles: Western Psychological Services.Google Scholar
  33. Sevin, J. A., Matson, J. L., Coe, D. A., Fee, V. E., & Sevin, B. M. (1991). A comparison and evaluation of three commonly used autism scales. Journal of Autism and Developmental Disorders, 21, 415-432.Google Scholar
  34. Sponheim, E. (1996). Changing criteria of autistic disorders: A comparison of the ICD-10 research criteria and DSM-IV with DSMIII-R, CARS, and ABC. Journal of Autism and Developmental Disorders, 26, 513-525.PubMedGoogle Scholar
  35. Stella, J., Mundy, P., & Tuchman, R. (1999). Social and nonsocial factors in the Childhood Autism Rating Scale. Journal of Autism and Developmental Disorders, 29, 307-317.PubMedGoogle Scholar
  36. Tanguay, P. E., Robertson, J., & Derrick, A. (1998). A dimensional classification of autism spectrum disorder by social communication domains. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 271-277.PubMedGoogle Scholar
  37. Van Bourgondien, M., Marcus, M., & Schopler, E. (1992). Comparison of DSM-III-R and Childhood Autism Rating Scale diagnoses of autism. Journal of Autism and Developmental Disorders, 22, 493-506.PubMedGoogle Scholar
  38. Volkmar, F. R., Cicchetti, D. V., Bregman, J., & Cohen, D. J. (1992). Three diagnostic systems for autism: DSM-III, DSM-III-R and ICD-10. Journal of Autism and Developmental Disorders, 22, 483-492.PubMedGoogle Scholar
  39. Volkmar, F. R., Klin, A., Siegel, B., Szatmari, P., Lord, C., Campbell, M., Freeman, B. J., Cicchetti, D. V., Rutter, M., Kline, W., Buitelaar, J., Hattab, Y., Fombonne, E., Fuentes, J., Werry, J., Stone, W., Kerbeshian, J., Hoshino, Y., Bregman, J., Loveland, K., Szymanski, L., & Towbin, K. (1994). Field trial for autistic disorder in DSM-IV. American Journal of Psychiatry, 151, 1361-1367.PubMedGoogle Scholar
  40. Waterhouse, L., Morris, R., Allen, D., Dunn, M., Fein, D., Feinstein, C., Rapin, I., & Wing, L. (1996). Diagnosis and classification in autism. Journal of Autism and Developmental Disorders, 26, 59-86.PubMedGoogle Scholar
  41. Wechsler, D. (1949). Manual for the Wechsler Intelligence Scale for Children. New York: Psychological Corporation.Google Scholar
  42. Wechsler, D. (1989). Manual for the Wechsler Preschool and Primary Scale of Intelligence–Revised. San Antonio, TX: The Psychological Corporation.Google Scholar
  43. Wing, L. (1993). The definition and prevalence of autism: A review. European Child and Adolescent Psychiatry, 2, 61-74.Google Scholar
  44. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva, Switzerland: Author.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Evald Saemundsen
    • 1
  • Páll Magnússon
    • 2
  • Jakob Smári
    • 3
  • Solveig Sigurdardóttir
    • 1
  1. 1.State Diagnostic and Counseling CenterKópavogurIceland
  2. 2.Department of Child and Adolescent PsychiatryNational University HospitalIceland
  3. 3.Department of Social SciencesUniversity of IcelandReykjavíkIceland

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