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Expediting clinician assessment in the diagnosis of autism spectrum disorder.

ABSTRACT: AIM:To investigate a novel observational rating protocol designed to expedite clinical diagnosis of autism spectrum disorder (ASD). METHOD:Two hundred and forty patients referred to a tertiary autism center (median age 8y 9mo, range 2y 6mo-34y 8mo; 188 males, 52 females) were rated using an adaptation of the Childhood Autism Rating Scale, Second Edition (CARS-2) based exclusively on patient observation (CARS-2obs ). Scores were compared to expert diagnosis of ASD, parent-reported Social Responsiveness Scale, Second Edition (SRS-2) and, in a selected subset of patients, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). RESULTS:CARS-2obs distinguished patients with a clinical diagnosis of ASD from those with non-ASD neuropsychiatric disorders (mean score=18 vs 11.7, p<0.001). Severity ratings on the CARS-2obs correlated with the ADOS-2 (r=0.68, ?=0.64) and SRS-2 (r=0.31, ?=0.32). A CARS-2obs cutoff point equal to or greater than 16 demonstrated 95.8% specificity and 62.3% sensitivity in discriminating individuals with ASD from individuals without ASD in a specialty referral setting. INTERPRETATION:The CARS-2obs allows the rapid acquisition of quantitative ratings of autistic severity by direct observation. Coupled with parent/teacher-reported symptoms and developmental history, the measure may contribute to a low-cost diagnostic paradigm in clinical and public health settings, where positive results might help reduce delays in diagnosis, and negative results could prompt further specialty assessment. WHAT THIS PAPER ADDS:The Childhood Autism Rating Scale, Second Edition based on patient observation distinguished individuals with versus without autism spectrum disorder (ASD). A score equal to or greater than 16 on this assessment showed high specificity for a diagnosis of ASD.

SUBMITTER: Sanchez MJ

PROVIDER: S-EPMC7540056 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Expediting clinician assessment in the diagnosis of autism spectrum disorder.

Sanchez Matthew J MJ Constantino John N JN

Developmental medicine and child neurology 20200402 7

<h4>Aim</h4>To investigate a novel observational rating protocol designed to expedite clinical diagnosis of autism spectrum disorder (ASD).<h4>Method</h4>Two hundred and forty patients referred to a tertiary autism center (median age 8y 9mo, range 2y 6mo-34y 8mo; 188 males, 52 females) were rated using an adaptation of the Childhood Autism Rating Scale, Second Edition (CARS-2) based exclusively on patient observation (CARS-2<sup>obs</sup> ). Scores were compared to expert diagnosis of ASD, paren ...[more]

PMID: 32239502

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Project description:BACKGROUND: Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the 'sub domain' level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels. METHODS: A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190). RESULTS: Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level. CONCLUSIONS: This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level.

Dataset Information

Expediting clinician assessment in the diagnosis of autism spectrum disorder.

Publications

Expediting clinician assessment in the diagnosis of autism spectrum disorder.

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