Sensitivity and Specificity of Common Autism Diagnostic Instruments for Early School-Aged Children

Area of Science:

• Child Psychology
• Neurodevelopmental Disorders
• Diagnostic Accuracy Studies

Background:

• Autism spectrum disorder (ASD) diagnosis relies on standardized instruments.
• The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) are widely used for ASD assessment.
• Comparing the diagnostic accuracy of these instruments is crucial for research and clinical practice.

Purpose of the Study:

• To evaluate the diagnostic accuracy of ADOS-2 and ADI-R against a best-estimate (BE) diagnosis for autism spectrum disorder (ASD).
• To compare the performance of ADOS-2 and ADI-R using sensitivity, specificity, and receiver operating characteristic (ROC) curves.

Main Methods:

• A cohort of 213 children aged 5-7 years underwent comprehensive diagnostic assessments for ASD.
• ADOS-2 and ADI-R results were compared to a gold-standard best-estimate (BE) diagnosis determined by a research psychologist.
• Statistical analyses included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROC curve analysis.

Main Results:

• ADOS-2 Spectrum Criterion scoring showed excellent accuracy (sensitivity=96.2%, specificity=97.5%).
• ADOS-2 Autism Criterion scoring also demonstrated high accuracy (sensitivity=82.0%, specificity=100%).
• ADI-R exhibited good accuracy (sensitivity=78.6%, specificity=83.5%), with ADOS-2 outperforming ADI-R in ROC analyses.

Conclusions:

• Both ADOS-2 and ADI-R offer good to excellent classification accuracy for ASD diagnosis.
• ADOS-2 demonstrated superior diagnostic performance compared to ADI-R.
• The choice of diagnostic instrument for ASD research may involve considering factors beyond classification accuracy.