Chief, Child Neurology Division, Faculty in-Charge, Centre of Excellence & Advanced Research on Childhood Neurodevelopmental disorders, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India.
The INCLEN trust International, Phase-I, New Delhi, India.
PLoS One. 2019 Mar 13;14(3):e0213242. doi: 10.1371/journal.pone.0213242. eCollection 2019.
Diagnostic and Statistical Manual of mental disorder-IV (DSM-IV) TR based INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an established instrument for the diagnosis of ASD in Indian subcontinent and low-middle income countries (LMIC). The introduction of DSM-5 necessitated revision of existing INDT-ASD tool to incorporate the DSM-5 related changes. This study was undertaken to develop and validate the DSM-5 based All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool. The modifications were done using Delphi method and included: (a) rearrangement of questions from the previous tool; and (b) addition of new questions on sensory symptoms. The modified tool was validated against DSM-5 diagnostic criteria. In addition, receiver operating characteristic (ROC) curves were used to determine the cut-off for total score as compared to Childhood Autism Rating Scale (CARS) score to grade the severity of ASD. Two-hundred-twenty-five children (159 boys, median age = 47months) were enrolled. The modified tool demonstrated sensitivity of 98.4% and specificity of 91.7% to diagnose ASD. A score ≥14 on the tool was suggestive of severe ASD (CARS>36.5) with a sensitivity and specificity of 80% and 80.7% respectively [Area under the curve = 0.89]. AIIMS-Modified-INDT-ASD Tool is a simple and structured instrument based on DSM-5 criteria which can facilitate diagnosis of ASD with acceptable diagnostic accuracy.
《精神障碍诊断与统计手册》第四版修订本（DSM-IV-TR）基于 INCLEN 自闭症谱系障碍诊断工具（INDT-ASD）是一种已被确立的用于诊断印度次大陆和中低收入国家（LMIC）自闭症谱系障碍（ASD）的工具。DSM-5 的引入需要对现有的 INDT-ASD 工具进行修订，以纳入 DSM-5 相关的变化。本研究旨在开发和验证基于 DSM-5 的全印度医学科学院（AIIMS）-改良-INDT-ASD 工具。通过 Delphi 方法进行了修改，包括：（a）重新排列前一个工具中的问题；（b）在感官症状方面增加新问题。改良后的工具与 DSM-5 诊断标准进行了验证。此外，还使用受试者工作特征（ROC）曲线确定了总评分的截止值，与儿童自闭症评定量表（CARS）评分相比，用于评估 ASD 的严重程度。共纳入 225 名儿童（159 名男孩，中位数年龄=47 个月）。改良后的工具对 ASD 的诊断敏感性为 98.4%，特异性为 91.7%。工具得分≥14 分提示严重 ASD（CARS>36.5），敏感性和特异性分别为 80%和 80.7%[曲线下面积=0.89]。AIIMS-改良-INDT-ASD 工具是一种基于 DSM-5 标准的简单结构化工具，可通过可接受的诊断准确性促进 ASD 的诊断。
