Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania.
Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute.
J Clin Child Adolesc Psychol. 2020 Jul-Aug;49(4):469-475. doi: 10.1080/15374416.2019.1567345. Epub 2019 Mar 20.
States in the United States differ in how they determine special education eligibility for autism services. Few states include an autism-specific diagnostic tool in their evaluation. In research, the Autism Diagnostic Observation Schedule (ADOS for first edition, ADOS-2 for second edition) is considered the gold-standard autism assessment. The purpose of this study was to estimate the proportion of children with an educational classification of autism who exceed the ADOS/ADOS-2 threshold for autism spectrum (concordance rate). Data were drawn from 4 school-based studies across 2 sites (Philadelphia, Pennsylvania, and San Diego, California). Participants comprised 627 children (2-12 years of age; 83% male) with an autism educational classification. Analyses included (a) calculating the concordance rate between educational and ADOS/ADOS-2 classifications and (b) estimating the associations between concordance and child's cognitive ability, study site, and ADOS/ADOS-2 administration year using logistic regression. More San Diego participants (97.5%, all assessed with the ADOS-2) met ADOS/ADOS-2 classification than did Philadelphia participants assessed with the ADOS-2 (92.2%) or ADOS (82.9%). Children assessed more recently were assessed with the ADOS-2; this group was more likely to meet ADOS/ADOS-2 classification than the group assessed longer ago with the ADOS. Children with higher IQ were less likely to meet ADOS/ADOS-2 classification. Most children with an educational classification of autism meet ADOS/ADOS-2 criteria, but results differ by site and by ADOS version and/or recency of assessment. Educational classification may be a reasonable but imperfect measure to include children in community-based trials.
美国各州在确定自闭症服务的特殊教育资格方面存在差异。很少有州在其评估中使用自闭症专用诊断工具。在研究中，自闭症诊断观察量表（第一版的 ADOS，第二版的 ADOS-2）被认为是自闭症评估的黄金标准。本研究的目的是估计具有自闭症教育分类的儿童中，超过自闭症谱系障碍（ADOS/ADOS-2 阈值的比例）的比例（一致性率）。数据来自两个地点（宾夕法尼亚州费城和加利福尼亚州圣地亚哥）的 4 项基于学校的研究。参与者包括 627 名（2-12 岁；83%为男性）具有自闭症教育分类的儿童。分析包括（a）计算教育和 ADOS/ADOS-2 分类之间的一致性率，以及（b）使用逻辑回归估计一致性与儿童认知能力、研究地点和 ADOS/ADOS-2 管理年份之间的关联。与费城使用 ADOS-2 评估的参与者（92.2%）相比，圣地亚哥的更多参与者（97.5%，均使用 ADOS-2 进行评估）符合 ADOS/ADOS-2 分类标准。最近评估的儿童使用 ADOS-2 进行评估；与使用 ADOS 评估时间较长的组相比，该组更有可能符合 ADOS/ADOS-2 分类标准。智商较高的儿童不太可能符合 ADOS/ADOS-2 分类标准。大多数具有自闭症教育分类的儿童符合 ADOS/ADOS-2 标准，但结果因地点、ADOS 版本以及评估的及时性而异。教育分类可能是一种合理但不完美的方法，可以将儿童纳入基于社区的试验。
