Leekam Susan R, Libby Sarah J, Wing Lorna, Gould Judith, Taylor Colin
Department of Psychology, University of Durham, UK.
J Child Psychol Psychiatry. 2002 Mar;43(3):327-42. doi: 10.1111/1469-7610.00024.
The Diagnostic Interview for Social and Communication Disorders (DISCO) is an interviewer-based schedule for use with parents and carers. In addition to its primary clinical purpose of helping the clinician to obtain a developmental history and description of the child or adult concerned, it can also be used to assist in providing a formal diagnostic category.
In this study we compared two algorithms based on the ninth revision of the schedule (DISCO 9). The algorithm for ICD-10 childhood autism comprised 91 individual, operationally defined items covering the behaviour outlined in the ICD-10 research criteria. The algorithm for the autistic spectrum disorder, as defined by Wing and Gould (1979), was based on 5 DISCO items that represented overarching categories of behaviour crucial for the diagnosis of autistic disorders. The aim of the study was to examine the implications for clinical diagnosis of these two different approaches. Parents of 36 children with clinical diagnoses of autistic disorder, 17 children with learning disability and 14 children with language disorders were interviewed by two interviewers. Algorithm diagnoses were applied to interview items in order to analyse the relationship between clinical and algorithm diagnoses and the inter-rater reliability between interviewers.
Clinical diagnosis was significantly related to the diagnostic outputs for both algorithms. Inter-rater reliability was also high for both algorithms. The ICD childhood disorder algorithm produced more discrepant diagnoses than the Wing and Gould autistic spectrum algorithm. Analysis of the ICD-10 algorithm items and combination of items helped to explain the reason for these discrepancies.
The results indicate that the DISCO is a reliable instrument for diagnosis when sources of information are used from the whole interview. It is particularly effective for diagnosing disorders of the broader autistic spectrum.
社交与沟通障碍诊断访谈（DISCO）是一种基于访谈者的工具，供家长和照顾者使用。除了其主要临床用途，即帮助临床医生获取有关儿童或成人的发育史及描述外，它还可用于协助给出正式的诊断类别。
在本研究中，我们比较了基于该工具第九版（DISCO 9）的两种算法。国际疾病分类第十版（ICD - 10）儿童自闭症算法包含91个单独的、操作性定义的项目，涵盖了ICD - 10研究标准中概述的行为。由温格和古尔德（1979年）定义的自闭症谱系障碍算法基于5个DISCO项目，这些项目代表了对自闭症障碍诊断至关重要的总体行为类别。本研究的目的是检验这两种不同方法对临床诊断的影响。两位访谈者对36名临床诊断为自闭症障碍的儿童、17名有学习障碍的儿童和14名有语言障碍的儿童的家长进行了访谈。将算法诊断应用于访谈项目，以分析临床诊断与算法诊断之间的关系以及访谈者之间的评分者间信度。
临床诊断与两种算法的诊断输出均显著相关。两种算法的评分者间信度也都很高。ICD儿童障碍算法产生的差异诊断比温格和古尔德自闭症谱系算法更多。对ICD - 10算法项目及项目组合的分析有助于解释这些差异的原因。
结果表明，当从整个访谈中获取信息来源时，DISCO是一种可靠的诊断工具。它在诊断更广泛的自闭症谱系障碍方面特别有效。
