Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Autism Res. 2021 Jun;14(6):1284-1295. doi: 10.1002/aur.2496. Epub 2021 Mar 8.
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) has been regarded as the gold standard assessment of autism spectrum disorder (ASD). While clinical validity of ADOS-2 Modules 1-4 have been extensively studied, there has been very limited research examining the clinical validity of ADOS-2 Toddler Module. The goal of this study was to examine alignment of the ADOS-2 Toddler Module classification with clinicians' determination of ASD, with assessing cut-off scores for diagnosing ASD in toddlers. A total of 412 toddlers ages 12-30 months who received ADOS-2 Toddler Module as well as a best estimate clinical (BEC) diagnosis, were included in this study. ADOS-2 Toddler Module cut-off scores were determined using the appropriate algorithms (Algorithm 1 for toddlers aged 12-20 months and those aged 21-30 months with <5 words, Algorithm 2 for toddlers aged 21-30 months with 5 words or more). Receiver operating characteristic (ROC) curves were used to assess cut-off scores that optimized sensitivity and specificity when compared against BEC diagnosis. The selected cut-off scores were examined using frequency tables to compare ADOS-2 classification against BEC diagnosis. For Algorithm 1, classification statistics were optimized at the cut-off score of 12 with an area under the curve (AUC) of 0.92. For Algorithm 2, classification statistics were optimized at the cut-off score of 10 with an AUC of 0.96. The ADOS-2 Toddler Module classification is strongly aligned with BEC diagnosis. The optimal cut-off scores identified in the current study reflect the same results configured by the prior study. LAY SUMMARY: ADOS-2 Toddler Module has been widely used for the ASD assessment, but there have been limited research on its clinical validity. This study is the first replication of the ADOS-2 Toddler Module with a large independent sample. We examined alignment of the ADOS-2 Toddler Module classification with clinicians' determination of ASD, with assessing cut-off scores, and confirmed the clinical validity of ADOS-2 Toddler Module. Cut-off scores of ADOS-2 Toddler Module cited in the manual yielded best clinical utility for diagnosing ASD in toddlers.
自闭症诊断观察量表第二版（ADOS-2）被认为是自闭症谱系障碍（ASD）的金标准评估工具。虽然 ADOS-2 模块 1-4 的临床效度已经得到了广泛研究，但对 ADOS-2 幼儿模块的临床效度的研究非常有限。本研究的目的是检验 ADOS-2 幼儿模块的分类与临床医生确定 ASD 的一致性，并评估用于诊断幼儿 ASD 的截断分数。共有 412 名 12-30 个月大的幼儿接受了 ADOS-2 幼儿模块以及最佳估计临床（BEC）诊断，包括在这项研究中。ADOS-2 幼儿模块的截断分数是使用适当的算法确定的（适用于 12-20 个月大的幼儿的算法 1 和 21-30 个月大且词汇量少于 5 个的幼儿的算法 2，适用于 21-30 个月大且词汇量为 5 个或更多的幼儿的算法 2）。接收者操作特征（ROC）曲线用于评估与 BEC 诊断相比，灵敏度和特异性最佳的截断分数。使用频率表检查选定的截断分数，以比较 ADOS-2 分类与 BEC 诊断。对于算法 1，在截断分数为 12 时分类统计数据得到优化，曲线下面积（AUC）为 0.92。对于算法 2，在截断分数为 10 时分类统计数据得到优化，AUC 为 0.96。ADOS-2 幼儿模块的分类与 BEC 诊断高度一致。本研究确定的最佳截断分数反映了先前研究中确定的相同结果。
摘要：ADOS-2 幼儿模块已广泛用于 ASD 评估，但对其临床有效性的研究有限。本研究是首次使用大型独立样本对 ADOS-2 幼儿模块进行复制。我们检验了 ADOS-2 幼儿模块的分类与临床医生确定 ASD 的一致性，评估了截断分数，并证实了 ADOS-2 幼儿模块的临床有效性。手册中引用的 ADOS-2 幼儿模块的截断分数为诊断幼儿 ASD 提供了最佳的临床效用。
