Rady Children's Hospital San Diego, San Diego, CA, USA.
J Child Psychol Psychiatry. 2013 Feb;54(2):178-85. doi: 10.1111/j.1469-7610.2012.02607.x. Epub 2012 Aug 20.
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 Definition that was developed by the Metropolitan Atlanta Developmental Disabilities Surveillance Program.
When compared with case review diagnosis, the ADOS demonstrated strong sensitivity and specificity for both Autism versus Not Autism and ASD versus Nonspectrum (NS) diagnoses in this young sample. The Social Communication Questionnaire (SCQ), using the lower cutoff 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. Using either the Modified Checklist for Autism in Toddlers 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 practice with relatively good sensitivity and specificity, and worked well with a referred sample of 2-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可以对 3 岁以下儿童的自闭症谱系障碍（ASD）做出可靠的诊断。关于这些工具在社区环境中的敏感性和特异性的数据有限。本研究的目的是确定在社区环境中由社区临床医生使用时，标准化诊断观察量表（ADOS）单独以及与简短的家长量表一起使用时的功能如何。
检查了在医院发育评估诊所接受可能患有 ASD 或社交/语言问题评估的 138 名 24 至 36 个月大的儿童的临床记录。评估由社区临床心理学家进行。使用由都市亚特兰大发育障碍监测计划开发的基于记录的 ASD 病例定义方法，将从标准化诊断工具获得的分类结果与评分盲法的病例审查诊断进行比较。
与病例审查诊断相比，ADOS 在这个年轻样本中对自闭症与非自闭症以及 ASD 与非谱系（NS）诊断均具有很强的敏感性和特异性。使用较低的 12 分作为 cutoff 的社会沟通问卷（SCQ）在区分自闭症与非自闭症方面具有足够的敏感性，但在区分 ASD 与 NS 方面敏感性较弱，漏诊了大约 80%的未特指的广泛性发育障碍儿童。使用改良幼儿自闭症检查表或 SCQ 与 ADOS 结合使用并没有提高 ADOS 单独使用的特异性，反而导致区分 ASD 与 NS 障碍的敏感性下降。
这些结果表明，遵循最佳实践指南，ADOS 可以成功地与相对较好的敏感性和特异性结合到临床实践中，并且在处理转诊的 2 岁儿童样本时效果良好。家长问卷在诊断分类方面没有比单独使用 ADOS 有任何改善。
