Diagnosis of autism spectrum disorders in 2-year-olds: a study of community practice.

Longitudinal research studies have demonstrated that experienced clinicians using standardized assessment measures can make a reliable diagnosis of Autism Spectrum Disorders (ASDs) in children under age 3. Limited data are available regarding the sensitivity and specificity of these measures in community settings. The aims of this study were to determine how well a standardized diagnostic observational measure (Autism Diagnostic Observation Schedule; ADOS) functions alone, and with a brief parent measure within a community setting when administered by community clinicians. Clinical records for 138 children between the ages of 24 and 36 months of age who were evaluated for possible ASD or social/language concerns at a hospital based developmental evaluation clinic were examined. Evaluations were conducted by community based clinical psychologists. Classification results obtained from standardized diagnostic measures were compared with case reviewer diagnosis, by reviewers blind to scores on diagnostic measures, using The Records-based Methodology for ASD Case Definitionthat was developed by the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). When compared with case review diagnosis, the ADOS demonstrated strong sensitivity and specificity for both Autism vs. Not Autism and ASD vs. Non-spectrum (NS) diagnoses in this young sample. The Social Communication Questionnaire (SCQ), using the lower cut-off of ≥12, had adequate sensitivity when differentiating Autism from Not Autism, but weak sensitivity when differentiating ASD from NS, missing about 80% of the children with Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS). Using either the Modified Checklist for Autism in Toddlers(M-CHAT) or the SCQ in combination with the ADOS did not result in improved specificity over the ADOS alone and led to a drop in sensitivity when differentiating ASD from NS disorders. These results demonstrate that following best practice guidelines, the ADOS can be successfully incorporated into clinical practicewith relatively good sensitivity and specificity, and worked well with a referred sample of two-year-olds. A parent questionnaire did not lead to any improvement in diagnostic classification above the ADOS used in isolation.

纵向研究表明，经验丰富的临床医生使用标准化评估工具能够对3岁以下儿童的自闭症谱系障碍（ASD）做出可靠诊断。关于这些工具在社区环境中的敏感性和特异性，现有数据有限。本研究的目的是确定一种标准化的诊断观察工具（自闭症诊断观察量表；ADOS）单独使用时，以及由社区临床医生在社区环境中结合一份简短的家长问卷使用时的效果如何。 对138名年龄在24至36个月之间、因可能患有自闭症或社交/语言问题在一家医院的发育评估诊所接受评估的儿童的临床记录进行了检查。评估由社区临床心理学家进行。使用由亚特兰大都市发育障碍监测项目（MADDSP）开发的基于记录的自闭症病例定义方法，将标准化诊断工具得出的分类结果与病例评审员的诊断进行比较，评审员对诊断工具的分数不知情。 与病例评审诊断相比，在这个年幼的样本中，ADOS在自闭症与非自闭症以及自闭症谱系障碍与非谱系（NS）诊断方面都表现出较高的敏感性和特异性。社会沟通问卷（SCQ）采用≥12的较低临界值，在区分自闭症与非自闭症时有足够的敏感性，但在区分自闭症谱系障碍与非谱系障碍时敏感性较差，遗漏了约80%的广泛性发育障碍 - 未特定（PDD - NOS）儿童。使用幼儿自闭症改良检查表（M - CHAT）或SCQ与ADOS相结合，在特异性方面并没有比单独使用ADOS有所提高，并且在区分自闭症谱系障碍与非谱系障碍时敏感性有所下降。 这些结果表明，遵循最佳实践指南，ADOS能够以相对较好的敏感性和特异性成功地融入临床实践，并且在两岁儿童的转诊样本中效果良好。一份家长问卷并没有使诊断分类在单独使用ADOS的基础上有所改善。