Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
Department of Psychology, University of Maryland, College Park, MD, USA.
J Child Psychol Psychiatry. 2017 Jul;58(7):829-839. doi: 10.1111/jcpp.12730. Epub 2017 Apr 27.
Discrepancy between informants (parents and teachers) in severity ratings of core symptoms commonly arise when assessing autism spectrum disorder (ASD). Whether such discrepancy yields unique information about the ASD phenotype and its clinical correlates has not been examined. We examined whether degree of discrepancy between parent and teacher ASD symptom ratings defines discrete, clinically meaningful subgroups of youth with ASD using an efficient, cost-effective procedure.
Children with ASD (N = 283; 82% boys; M = 10.5 years) were drawn from a specialty ASD clinic. Parents and teachers provided ratings of the three core DSM-IV-TR domains of ASD symptoms (communication, social, and perseverative behavior) with the Child and Adolescent Symptom Inventory-4R (CASI-4R). External validators included child psychotropic medication status, frequency of ASD-relevant school-based services, and the Autism Diagnostic Observation Schedule (ADOS-2).
Four distinct subgroups emerged that ranged from large between-informant discrepancy (informant-specific) to relative lack of discrepancy (i.e. informant agreement; cross-situational): Moderate Parent/Low Teacher or Low Parent/Moderate Teacher Severity (Discrepancy), and Moderate or High Symptom Severity (Agreement). Subgroups were highly distinct (mean probability of group assignment = 94%). Relative to Discrepancy subgroups, Agreement subgroups were more likely to receive psychotropic medication, school-based special education services, and an ADOS-2 diagnosis. These differential associations would not have been identified based solely on CASI-4R scores from one informant.
The degree of parent-teacher discrepancy about ASD symptom severity appears to provide more clinically useful information than reliance on a specific symptom domain or informant, and thus yields an innovative, cost-effective approach to assessing functional impairment. This conclusion stands in contrast to existing symptom clustering approaches in ASD, which treat within-informant patterns of symptom severity as generalizable across settings. Within-child variability in symptom expression across settings may yield uniquely useful information for characterizing the ASD phenotype.
在评估自闭症谱系障碍（ASD）时，通常会出现家长和教师对核心症状严重程度的报告存在差异。但是这种差异是否能提供关于 ASD 表型及其临床相关性的独特信息尚未得到检验。我们使用一种高效、经济有效的方法，来检验家长和教师 ASD 症状评定之间的差异程度是否可以确定具有临床意义的 ASD 青少年离散亚组。
从一家 ASD 专科诊所招募了 283 名 ASD 儿童（82%为男性；平均年龄为 10.5 岁）。家长和教师使用儿童青少年症状清单 4R（CASI-4R）对 ASD 症状的三个 DSM-IV-TR 核心领域（沟通、社交和固执行为）进行评定。外部验证指标包括儿童精神药物治疗状态、基于学校的 ASD 相关服务频率和自闭症诊断观察量表（ADOS-2）。
共出现了四个不同的亚组，范围从家长和教师之间的报告差异较大（特定于报告者）到相对缺乏差异（即报告者一致；跨情境）：中重度家长/轻度教师或轻中度家长/中重度教师严重程度（差异），以及中重度或高度症状严重程度（一致）。亚组之间差异显著（组分配的平均概率为 94%）。与差异亚组相比，一致亚组更有可能接受精神药物治疗、学校特殊教育服务和 ADOS-2 诊断。如果仅根据一个报告者的 CASI-4R 评分，这些差异关联将无法被识别。
家长和教师对 ASD 症状严重程度的差异程度似乎比依赖特定症状领域或报告者提供更有临床价值的信息，因此提供了一种创新、经济有效的评估功能障碍的方法。这一结论与 ASD 中现有的症状聚类方法形成了鲜明对比，后者将报告者内部的症状严重程度模式视为适用于所有情境。在不同情境下，症状表现的个体内变异性可能为描述 ASD 表型提供独特的有用信息。
