Psychometric Properties of Measuring Tools for Depression in Autistic Youths: A Systematic Review

While autistic individuals are 4 times more likely to have depression compared to non-autistic individuals, depression remained largely undetected in this group resulting in significant unmet needs. A systematic literature review was conducted to determine the psychometric properties of measuring tools for depressive symptoms in autistic children and adolescents. The review followed the PRISMA 2020 guideline (PROSPERO: CRD42023423377) based on the search of several databases from 1980 until November 2024. The COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) checklist was used to assess for each tool: internal consistency, reliability, measurement error, content validity, structural validity, hypothesis testing, criterion validity, responsiveness to change and cross-cultural validity. The review found 15 empirical studies evaluating the properties of twelve measuring tools for depression in autistic youths. The validities of standards screening scales were low, but better for questionnaires with items focusing on behavioral aspects of depression, i.e., the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). The evidence supporting the quality of the instrument was much better for those developed for subjects with neurodevelopmental divergences, such as The Evaluation of Depressive symptoms in Autism (EDA), with five domains of psychometric properties rated as strong or moderate. To determine the optimal approach for the use of consensual instruments, further research should include more individuals with co-occurring neurodevelopmental conditions, a risk factor for a more resistant form of depression, and examine the instruments' capacity to detect clinically significant changes during an intervention.