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Characteristics of Young Children Associated with Diagnostic Utility of the Autism Diagnostic Observation Schedule: A
Jill J Fussell1, Ruth E K Stein2, Sandra Friedman3
1Division of Developmental Pediatrics, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR.
Insights
The Autism Diagnostic Observation Schedule (ADOS) is most beneficial for young children with autism spectrum disorder (ASD) who exhibit milder symptoms and less impaired language, as it can change initial diagnostic impressions. This tool aids in refining diagnoses for these specific cases.
Area of Science:
- Developmental Pediatrics
- Child Psychology
- Neurodevelopmental Disorders
Background:
- Developmental-behavioral pediatricians (DBPs) diagnose autism spectrum disorder (ASD) in young children.
- The Autism Diagnostic Observation Schedule (ADOS) is a tool used in ASD diagnosis.
- Understanding factors influencing diagnostic changes is crucial for accurate ASD assessment.
Purpose of the Study:
- To identify characteristics of children whose autism spectrum disorder (ASD) diagnosis by a developmental-behavioral pediatrician (DBP) was altered by Autism Diagnostic Observation Schedule (ADOS) results.
- To compare children whose diagnoses remained stable versus those whose diagnoses changed after ADOS administration.
- To elucidate the role of ADOS in refining ASD diagnoses in young children.
Main Methods:
- Prospective study of children aged 1.5 to <6 years referred for possible ASD.
- DBPs recorded diagnostic impressions and certainty pre- and post-ADOS.
- Comparison of 'Stable Group' (n=314) with 'Changed Group' (n=35) using matched samples.
Main Results:
- No significant differences in basic child demographics between groups.
- Lower diagnostic certainty in the 'Changed Group' pre- and post-ADOS.
- Diagnostic changes associated with milder ASD symptoms, less impaired language, and higher cognitive scores in the 'Changed Group'.
Conclusions:
- The ADOS appears most beneficial for young children with milder ASD symptoms and less impaired language.
- ADOS results can modify initial DBP diagnostic impressions in specific pediatric populations.
- Diagnostic certainty and symptom severity are key factors in ADOS-influenced diagnostic changes.
Objective:
The aim of this study is to identify characteristics of children for whom a developmental-behavioral pediatrician's (DBP) diagnostic impressions of autism spectrum disorder (ASD) or non-ASD were changed by Autism Diagnostic Observation Schedule (ADOS) results.
Method:
A prospective study of children 1½ to <6 years consecutively referred to 8 sites for possible ASD. Cognitive/developmental, language, and adaptive testing varied, as each site followed its usual clinical approach. DBPs documented diagnosis as ASD or non-ASD and their degree of diagnostic certainty (1-10) pre- and post-ADOS. Cases where DBP diagnostic impression did not change after ADOS administration ("Stable Group," n = 314) were compared with those for whom it did change ("Changed Group," n = 35), followed by matched random sample comparisons.
Results:
There were no significant differences in child characteristics (age, gender, race, ethnicity, insurance, caregiver education) between the Stable and Changed groups. DBPs' diagnostic certainty was significantly lower, both pre- and post-ADOS, in the Changed versus Stable group. Change was associated with milder symptoms of ASD and less impaired language. In an age- and gender-matched comparison, significant differences remained for diagnostic certainty and severity of social communication impairments. Cognitive scores were significantly higher in the Changed Group. Because of significantly higher caregiver education and a trend toward more privately insured children among the Changed Group, samples (n = 35 each) were then matched on those characteristics, revealing the same differences for diagnostic certainty, severity of ASD symptoms, and language skills.
Conclusion:
Young children with milder ASD symptoms and less impaired language may benefit most from the administration of the ADOS.
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