低收入和中等收入国家中自闭症及自闭症谱系障碍的诊断：来自牙买加的经验。
The diagnosis of autism and autism spectrum disorder in low- and middle-income countries: Experience from Jamaica.
作者信息
Samms-Vaughan Maureen, Rahbar Mohammad H, Dickerson Aisha S, Loveland Katherine A, Hessabi Manouchehr, Pearson Deborah A, Bressler Jan, Shakespeare-Pellington Sydonnie, Grove Megan L, Coore-Desai Charlene, Reece Jody, Boerwinkle Eric
机构信息
1 The University of the West Indies, Jamaica.
2 The University of Texas Health Science Center at Houston, USA.
出版信息
Autism. 2017 Jul;21(5):564-572. doi: 10.1177/1362361317698938. Epub 2017 Apr 1.
The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have resulted in its use in both high-income countries and low- and middle-income countries. This study examines the agreement between assessments using the Childhood Autism Rating Scale with those using the Autism Diagnostic Observation Schedule or Autism Diagnostic Observation Schedule, Second Edition and Autism Diagnostic Interview-Revised in Jamaica. Children aged 2-8 years (n = 149) diagnosed with autism by an experienced clinician using the Childhood Autism Rating Scale were re-evaluated using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The proportion diagnosed with autism spectrum disorder using the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised was determined and mean domain scores compared using analysis of variance (ANOVA). The mean age was 64.4 (standard deviation = 21.6) months; the male:female ratio was 6:1. The diagnostic agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule and Autism Diagnostic Observation Schedule, Second Edition was 100.0% and 98.0%, respectively. Agreement with the Autism Diagnostic Interview-Revised was 94.6%. Domain scores were highest for children with more severe symptoms (p < 0.01). Despite a high level of agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale should be evaluated further with a broader range of autism spectrum disorder symptomatology, and by clinicians with varying experience before recommendation for use in low- and middle-income countries.
《自闭症诊断观察量表》和《自闭症诊断访谈修订版》在高收入国家广泛使用，但其管理要求使其在低收入和中等收入国家用于自闭症谱系障碍的诊断时可行性较低。《儿童自闭症评定量表》灵活的管理要求使其在高收入国家以及低收入和中等收入国家均有使用。本研究考察了在牙买加使用《儿童自闭症评定量表》与使用《自闭症诊断观察量表》或《自闭症诊断观察量表第二版》及《自闭症诊断访谈修订版》进行评估之间的一致性。由经验丰富的临床医生使用《儿童自闭症评定量表》诊断为自闭症的2至8岁儿童（n = 149），使用《自闭症诊断观察量表》和《自闭症诊断访谈修订版》进行重新评估。确定使用《自闭症诊断观察量表》、《自闭症诊断观察量表第二版》和《自闭症诊断访谈修订版》诊断为自闭症谱系障碍的比例，并使用方差分析（ANOVA）比较平均领域得分。平均年龄为64.4（标准差 = 21.6）个月；男女比例为6:1。《儿童自闭症评定量表》与《自闭症诊断观察量表》和《自闭症诊断观察量表第二版》的诊断一致性分别为100.0%和98.0%。与《自闭症诊断访谈修订版》的一致性为94.6%。症状较严重的儿童领域得分最高（p < 0.01）。尽管《儿童自闭症评定量表》与《自闭症诊断观察量表》、《自闭症诊断观察量表第二版》和《自闭症诊断访谈修订版》的一致性较高，但在推荐其用于低收入和中等收入国家之前，应通过更广泛的自闭症谱系障碍症状学以及不同经验的临床医生对《儿童自闭症评定量表》进行进一步评估。
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