Abstract
Diagnosing autism spectrum disorder (ASD) in adulthood often represents a challenge in clinical practice. The aim of the present study was to evaluate the sensitivity and specificity of the ADOS and ADI-R in diagnosing ASD in adults. 113 subjects with an IQ of 70 or above were assessed through an extensive clinical evaluation. The ADOS-2 Module 4 and the ADI-R were separately administered by staff members blind to clinical judgment. Our results cautiously confirm the accuracy of ADOS-2 Module 4, while suggest that ADI-R might not be reliable in adults without intellectual disability. Clinicians’ training and experience remains of primary importance while assessing adults who could potentially belong to the autism spectrum.
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References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th edn.). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th edn.). Washington, DC: American Psychiatric Association.
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294.
Bastiaansen, J. A., Meffert, H., Hein, S., Huizinga, P., Ketelaars, C., Pijnenborg, M., et al. (2011). Diagnosing autism spectrum disorders in adults: The use of Autism Diagnostic Observation Schedule (ADOS) module 4. Journal of Autism and Developmental Disorders, 41(9), 1256–1266.
Bent, C. A., Barbaro, J., & Dissanayake, C. (2016). Change in autism diagnoses prior to and following the introduction of DSM-5. Journal of Autism and Developmental Disorders, 47(1), 163–171.
Centers of Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, DC: 2002), 63(2), 1.
De Bildt, A., Oosterling, I. J., van Lang, N. D. J., Kuijper, S., Dekker, V., Sytema, S., et al. (2013). How to use the ADI-R for classifying autism spectrum disorders? Psychometric properties of criteria from the literature in 1,204 Dutch children. Journal of Autism and Developmental Disorders, 43(10), 2280–2294.
De Bildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., et al. (2004). Interrelationship between autism diagnostic observation schedule-generic (ADOS-G), autism diagnostic interview-revised (ADI-R), and the diagnostic and statistical manual of mental disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. Journal of Autism and Developmental Disorders, 34(2), 129–137.
De Bildt, A., Sytema, S., Meffert, H., & Bastiaansen, J. A. C. J. (2015). The Autism Diagnostic Observation Schedule, Module 4: Application of the revised algorithms in an independent, well-defined, Dutch sample (n = 93). Journal of Autism and Developmental Disorders, 46(1), 21–30.
Esbensen, A. J., Seltzer, M. M., Lam, K. S., & Bodfish, J. W. (2009). Age-related differences in restricted repetitive behaviors in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 57–66.
Falkmer, T., Anderson, K., Falkmer, M., & Horlin, C. (2013). Diagnostic procedures in autism spectrum disorders: A systematic literature review. European Child &. Adolescent Psychiatry, 22(6), 329–340.
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Press, Inc.
Gray, K. M., Tonge, B. J., & Sweety, D. J. (2007). Using the autism diagnostic interview-revised and the autism diagnostic observation schedule with young children with developmental delay: Evaluating diagnostic validity. Journal of Autism and Developmental Disorders, 38(4), 657–667.
Hansen, S. N., Schendel, D. E., & Parner, E. T. (2015). Explaining the increase in the prevalence of autism spectrum disorders: The proportion attributable to changes in reporting practices. JAMA Pediatrics, 169(1), 56–62.
Happé, F. G., Mansour, H., Barrett, P., Brown, T., Abbott, P., & Charlton, R. A. (2016). Demographic and cognitive profile of individuals seeking a diagnosis of autism spectrum disorder in adulthood. Journal of Autism and Developmental Disorders, 46(11), 3469–3480.
Hosmer, D. W., & Lemeshow, S. (2004). Applied logistic regression. New York: John Wiley & Sons.
Howlin, P., & Moss, P. (2012). Adults with autism spectrum disorders. The Canadian Journal of Psychiatry, 57(5), 275–283.
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-017-3166-5.
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.
Interagency Autism Coordinating Committee (IACC). (2012). IACC strategic plan for autism spectrum disorder (ASD) research—2012 update. December 2012. Retrieved from the U.S. Department of Health and Human Services Interagency Autism Coordinating Committee website: http://iacc.hhs.gov/strategic-plan/2012/index.shtml.
Kamp-Becker, I., Ghahreman, M., Heinzel-Gutenbrunner, M., Peters, M., Remschmidt, H., & Becker, K. (2013). Evaluation of the revised algorithm of Autism Diagnostic Observation Schedule (ADOS) in the diagnostic investigation of high-functioning children and adolescents with autism spectrum disorders. Autism: The International Journal of Research and Practice, 17(1), 87–102.
Lai, M. C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
Langmann, A., Becker, J., Poustka, L., Becker, K., & Kamp-Becker, I. (2017). Diagnostic utility of the autism diagnostic observation schedule in a clinical sample of adolescents and adults. Research in Autism Spectrum Disorders, 34, 34–43.
Lord, C., DiLavore, P. C., & Gotham, K. (2012). Autism diagnostic observation schedule. Torrance, CA: Western Psychological Services.
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(5), 659–685.
Mazefsky, C. A., & Oswald, D. P. (2006). The discriminative ability and diagnostic utility of the ADOS-G, ADI-R, and GARS for children in a clinical setting. Autism: The International Journal of Research and Practice, 10(6), 533–549.
Molloy, C. A., Murray, D. S., Akers, R., Mitchell, T., & Manning-Courtney, P. (2011). Use of the Autism Diagnostic Observation Schedule (ADOS) in a clinical setting. Autism: The International Journal of Research and Practice, 15(2), 143–162.
Moss, J., Magiati, I., Charman, T., & Howlin, P. (2008). Stability of the autism diagnostic interview—Revised from pre-school to elementary school age in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1081–1091.
Mukaetova-Ladinska, E. B., Perry, E., Baron, M., & Povey, C. (2012). Ageing in people with autistic spectrum disorder. International Journal of Geriatric Psychiatry, 27(2), 109–118.
National Institute of Clinical Excellence (2012). Autism: Recognition, referral, diagnosis, and management of adults on the autism spectrum. Manchester: NICE Clinical Guideline.
Nicolaidis, C., Kripke, C. C., & Raymaker, D. (2014). Primary care for adults on the autism spectrum. The Medical Clinics of North America, 98(5), 1169–1191.
Ozonoff, S. (2005). Evidence-based assessment of autism spectrum disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 34(3), 523–540.
Papanikolaou, K., Paliokosta, E., Houliaras, G., Vgenopoulou, S., Giouroukou, E., Pehlivanidis, A., et al. (2008). Using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic for the diagnosis of autism spectrum disorders in a Greek sample with a wide range of intellectual abilities. Journal of Autism and Developmental Disorders, 39(3), 414–420.
Piven, J., Harper, J., Palmer, P., & Arndt, S. (1996). Course of behavioral change in autism: A retrospective study of high-IQ adolescents and adults. Journal of the American Academy of Child & Adolescent Psychiatry, 35(4), 523–529.
Pugliese, C. E., Kenworthy, L., Bal, V. H., Wallace, G. L., Yerys, B. E., Maddox, B. B, et al. (2015). Replication and comparison of the newly proposed ADOS-2, module 4 algorithm in ASD without ID: A multi-site study. Journal of Autism and Developmental Disorders, 45(12), 3919–3931.
Raven, J. C. (1941). Standardization of progressive matrices, 1938. British Journal of Medical Psychology, 19(1), 137–150.
Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information from multiple sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(9), 1094–1103.
Rutter, M. (2005). Incidence of autism spectrum disorders: Changes over time and their meaning. Acta Paediatrica, 94(1), 2–15.
Rynkiewicz, A., Schuller, B., Marchi, E., Piana, S., Camurri, A., Lassalle, A., et al. (2016). An investigation of the ‘female camouflage effect’ in autism using a computerized ADOS-2 and a test of sex/gender differences. Molecular Autism, 7(1), 1.
Sappok, T., Diefenbacher, A., Budczies, J., Schade, C., Grubich, C., Bergmann, T., et al. (2013). Diagnosing autism in a clinical sample of adults with intellectual disabilities: How useful are the ADOS and the ADI-R? Research in Developmental Disabilities, 34(5), 1642–1655.
Seltzer, M. M., Krauss, M. W., Shattuck, P. T., Orsmond, G., Swe, A., & Lord, C. (2003). The symptoms of autism spectrum disorders in adolescence and adulthood. Journal of Autism and Developmental Disorders, 33(6), 565–581.
Soke, G. N., Philofsky, A., Diguiseppi, C., Lezotte, D., Rogers, S., & Hepburn, S. (2011). Longitudinal changes in scores on the Autism Diagnostic Interview—Revised (ADI-R) in pre-school children with autism Implications for diagnostic classification and symptom stability. Autism: The International Journal of Research and Practice, 15(5), 545–562.
Ventola, P., Kleinman, J., Pandei, J., Barton, M., Allen, S., Green, J., et al. (2006). Agreement among four diagnostic instruments for autism spectrum disorders in toddlers. Journal of Autism and Developmental Disorders, 36, 839–847.
Wechsler, D. (1981). WAIS-R manual: Wechsler adult intelligence scale-revised. New York: Psychological Corporation.
Wolf, J. M., & Ventola, P. (2014). Assessment and treatment planning in adults with autism spectrum disorders. In F. R. Volkmar et al. (Eds.), Adolescents and adults with autism spectrum disorders (pp. 283–298). New York: Springer.
Zander, E., Sturm, H., & Bölte, S. (2015). The added value of the combined use of the Autism Diagnostic Interview–Revised and the Autism Diagnostic Observation Schedule: Diagnostic validity in a clinical Swedish sample of toddlers and young preschoolers. Autism: The International Journal of Research and Practice, 19(2), 187–199.
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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors would like to thank all the patients of Laboratorio Autismo and their families.
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LF and NB conceived of the study, participated in its design and coordination, performed the evaluations, analyzed the data, and drafted the manuscript; MR and CP participated in the design and interpretation of the data, performed the evaluations, and helped to draft the manuscript; UP and SD participated in the interpretation of the data and helped to write the manuscript; PP conceived of the study, participated in its design and coordination, performed the evaluations, and helped to draft the manuscript. All authors read and approved the final manuscript.
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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
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Informed consent was obtained from all individuals included in this study.
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Laura Fusar-Poli and Natascia Brondino are joint first authors.
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Fusar-Poli, L., Brondino, N., Rocchetti, M. et al. Diagnosing ASD in Adults Without ID: Accuracy of the ADOS-2 and the ADI-R. J Autism Dev Disord 47, 3370–3379 (2017). https://doi.org/10.1007/s10803-017-3258-2
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DOI: https://doi.org/10.1007/s10803-017-3258-2