Informant discrepancy defines discrete, clinically useful autism spectrum disorder subgroups

Area of Science:

• Child and Adolescent Psychiatry
• Developmental Psychology
• Behavioral Neuroscience

Background:

• Discrepancies between parent and teacher ratings of autism spectrum disorder (ASD) core symptoms are common.
• The clinical significance of these informant discrepancies in understanding the ASD phenotype and its correlates remains underexplored.

Purpose of the Study:

• To investigate whether the degree of discrepancy in ASD symptom severity ratings between parents and teachers identifies distinct, clinically meaningful subgroups of youth with ASD.
• To assess the utility of this approach as an efficient and cost-effective method for ASD assessment.

Main Methods:

• A cohort of 283 children diagnosed with ASD (82% boys, mean age 10.5 years) was recruited from a specialized ASD clinic.
• Parents and teachers completed the Child and Adolescent Symptom Inventory-4R (CASI-4R) to rate ASD symptoms across communication, social, and perseverative behavior domains.
• External validators included psychotropic medication status, school-based service utilization, and Autism Diagnostic Observation Schedule (ADOS-2) scores.

Main Results:

• Four distinct subgroups emerged based on parent-teacher symptom rating discrepancies: informant-specific (high discrepancy) and informant-agreement (low discrepancy).
• These subgroups, including Moderate Parent/Low Teacher, Low Parent/Moderate Teacher, Moderate Severity, and High Severity, were highly distinct (94% accurate group assignment).
• Informant-agreement subgroups showed higher rates of psychotropic medication, special education services, and a confirmed ADOS-2 diagnosis compared to discrepancy subgroups.

Conclusions:

• The degree of parent-teacher discrepancy in ASD symptom severity provides more clinically valuable information than relying on a single informant or symptom domain.
• This finding suggests that variability in symptom expression across different settings (home vs. school) offers unique insights into the ASD phenotype and functional impairment.
• This discrepancy-based approach represents an innovative, cost-effective method for assessing functional impairment in ASD, contrasting with traditional methods that assume symptom generalizability.