Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Sci Rep. 2022 Nov 5;12(1):18744. doi: 10.1038/s41598-022-21719-x.
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two frequently co-occurring neurodevelopmental conditions that share certain symptomatology, including social difficulties. This presents practitioners with challenging (differential) diagnostic considerations, particularly in clinically more complex cases with co-occurring ASD and ADHD. Therefore, the primary aim of the current study was to apply a data-driven machine learning approach (support vector machine) to determine whether and which items from the best-practice clinical instruments for diagnosing ASD (ADOS, ADI-R) would best differentiate between four groups of individuals referred to specialized ASD clinics (i.e., ASD, ADHD, ASD + ADHD, ND = no diagnosis). We found that a subset of five features from both ADOS (clinical observation) and ADI-R (parental interview) reliably differentiated between ASD groups (ASD & ASD + ADHD) and non-ASD groups (ADHD & ND), and these features corresponded to the social-communication but also restrictive and repetitive behavior domains. In conclusion, the results of the current study support the idea that detecting ASD in individuals with suspected signs of the diagnosis, including those with co-occurring ADHD, is possible with considerably fewer items relative to the original ADOS/2 and ADI-R algorithms (i.e., 92% item reduction) while preserving relatively high diagnostic accuracy. Clinical implications and study limitations are discussed.
自闭症谱系障碍(ASD)和注意缺陷多动障碍(ADHD)是两种经常同时发生的神经发育障碍,它们具有某些共同的症状,包括社交困难。这给从业者带来了具有挑战性的(鉴别)诊断考虑,特别是在同时患有 ASD 和 ADHD 的临床情况更复杂的情况下。因此,本研究的主要目的是应用基于数据的机器学习方法(支持向量机)来确定最佳临床诊断 ASD 工具(ADOS、ADI-R)中的哪些项目可以最好地区分四个被转诊到专门 ASD 诊所的个体群体(即 ASD、ADHD、ASD+ADHD、ND=无诊断)。我们发现,ADOS(临床观察)和 ADI-R(家长访谈)中的五个特征子集可靠地区分了 ASD 组(ASD 和 ASD+ADHD)和非 ASD 组(ADHD 和 ND),这些特征与社交沟通以及受限和重复行为领域相对应。总之,本研究的结果支持这样一种观点,即在存在疑似诊断迹象的个体中,包括那些同时患有 ADHD 的个体中,通过相对较少的项目(相对于原始 ADOS/2 和 ADI-R 算法减少了 92%)来检测 ASD 是可能的,同时保持相对较高的诊断准确性。讨论了临床意义和研究限制。