Stony Brook University, NY.
Stony Brook University, NY.
J Am Acad Child Adolesc Psychiatry. 2019 Sep;58(9):876-886.e2. doi: 10.1016/j.jaac.2018.09.431. Epub 2018 Oct 29.
The two primary-seemingly contradictory-strategies for classifying child psychiatric syndromes are categorical and dimensional; conceptual ambiguities appear to be greatest for polythetic syndromes such as autism spectrum disorder (ASD). Recently, a compelling alternative has emerged that integrates both categorical and dimensional approaches (ie, a hybrid model), thanks to the increasing sophistication of analytic procedures. This study aimed to quantify the optimal phenotypic structure of ASD by comprehensively comparing categorical, dimensional, and hybrid models.
The sample comprised 3,825 youth, who were consecutive referrals to a university developmental disabilities or child psychiatric outpatient clinic. Caregivers completed the Child and Adolescent Symptom Inventory-4R (CASI-4R), which includes an ASD symptom rating scale. A series of latent class analyses, exploratory and confirmatory factor analyses, and factor mixture analyses was conducted. Replication analyses were conducted in an independent sample (N = 2,503) of children referred for outpatient evaluation.
Based on comparison of 44 different models, results indicated that the ASD symptom phenotype is best conceptualized as multidimensional versus a categorical or categorical-dimensional hybrid construct. ASD symptoms were best characterized as falling along three dimensions (ie, social interaction, communication, and repetitive behavior) on the CASI-4R.
Findings reveal an optimal structure with which to characterize the ASD phenotype using a single, parent-report measure, supporting the presence of multiple correlated symptom dimensions that traverse formal diagnostic boundaries and quantify the heterogeneity of ASD. These findings inform understanding of how neurodevelopmental disorders can extend beyond discrete categories of development and represent continuously distributed traits across the range of human behaviors.
儿童精神障碍综合征分类的两个主要策略似乎是相互矛盾的，即分类法和维度法；多维度综合征（如自闭症谱系障碍 (ASD)）的概念似乎存在最大的歧义。最近，由于分析程序的日益复杂，出现了一种引人注目的替代方法，即整合分类法和维度法（即混合模型）。本研究旨在通过综合比较分类法、维度法和混合模型来量化 ASD 的最佳表型结构。
该样本包括 3825 名连续转诊到大学发育障碍或儿童精神科门诊的青少年。照顾者完成了儿童和青少年症状清单-4R（CASI-4R），其中包括 ASD 症状评定量表。进行了一系列潜在类别分析、探索性和验证性因素分析以及因子混合分析。在另一个独立的样本（N=2503）中进行了复制分析，该样本为门诊评估的儿童。
基于对 44 个不同模型的比较，结果表明，ASD 症状表型最好被概念化为多维，而不是分类或分类-维度混合结构。ASD 症状在 CASI-4R 上最好用三个维度（即社会互动、沟通和重复行为）来描述。
研究结果揭示了一种使用单一父母报告测量来描述 ASD 表型的最佳结构，支持存在多个相关症状维度，这些维度跨越正式的诊断边界，并量化了 ASD 的异质性。这些发现为理解神经发育障碍如何超越离散的发展类别，以及如何代表人类行为范围内连续分布的特征提供了信息。
