Wigham Sarah, Ingham Barry, Le Couteur Ann, Berney Tom, Ensum Ian, Parr Jeremy R
Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom.
Autism Adulthood. 2020 Mar 1;2(1):42-47. doi: 10.1089/aut.2019.0052. Epub 2020 Mar 11.
Clinicians use diagnostic interviews to help them gather and organize information collected in the assessment of autism. Most instruments are developed for children and few measures have been developed that are reliable, valid, and appropriate for use in adulthood. This is a significant barrier to providing a high-quality, timely service for adults. The aim of this development study was to assess the initial utility of the recently developed Autism Clinical Interview for Adults (ACIA) for use in autism diagnostic clinical services before further large-scale testing and evaluation.
We invited adults who had received an autism spectrum diagnosis through a U.K. National Health Service (NHS) multidisciplinary adult autism assessment to participate. Seventeen autistic adults (8 women and 9 men, mean age of 37 years) and four relatives agreed to an interview. The semistructured ACIA interview comprises subject and informant versions, and a self-report preinterview questionnaire. In combination, the ACIA components cover topics relevant to autism and co-occurring condition assessment. We evaluated clinical utility and content validity via comparison with the Diagnostic and Statistical Manual Fifth Edition (DSM-5) and NHS diagnostic reports.
Each interview took between 60 and 90 minutes to complete. Comparison with DSM-5 and the NHS autism diagnostic report demonstrated that the ACIA accurately identified information on core autism characteristics needed for a diagnosis, and identified co-occurring conditions. In response to participant suggestions we revised the interview.
These initial findings support the potential utility and validity of the ACIA for adult autism diagnostic clinical services. Further investigations of the acceptability, utility, and validity of this interview are planned.
Clinicians use diagnostic interviews during assessments to help gather and record information both from a person suspected to be on the autism spectrum and from an informant (someone who knows them well). However, most autism diagnostic interviews were originally developed for assessing autism in childhood, and few have been developed for use with adults. The lack of diagnostic interviews developed specifically for use with adults makes it difficult to provide a good-quality, consistent assessment. The study tested a new semistructured diagnostic interview called the Autism Clinical Interview for Adults (ACIA). The ACIA includes a questionnaire for people to complete before their interview. This is followed by an interview that can be conducted with the person themselves and a separate version to be used with someone who knows them well (if permitted). The interview covers autism traits, strengths and difficulties, and co-occurring physical and mental health conditions. We wanted to find out if the interview is useful for autism diagnostic services by comparing information collected using the ACIA with clinical diagnostic reports. We invited people who had received a diagnosis of autism from a U.K. National Health Service (NHS) assessment to take part in an interview. We asked them if we could also interview someone who knew them well, and if we could compare their NHS autism diagnostic report with information gathered using the ACIA. Seventeen autistic adults (average age 37 years; 8 women and 9 men) and 4 relatives/supporters (2 parents, a spouse, and a cohabiting partner) agreed to be interviewed. Each interview took 60 to 90 minutes to complete. A comparison with clinical reports showed the ACIA identified autism traits relevant for a diagnosis, as well as co-occurring conditions (e.g., depression). Participants suggested some ways to improve the interview, and revisions were made. There are few diagnostic interviews designed specifically for use with adults seeking a diagnosis of autism. The findings from this study show that the ACIA is a promising new interview. The study is small. However, it is important to run an initial test study before involving more people and resources in larger studies. Building on these results, we aim to undertake further studies on the acceptability and usefulness of the new interview with a larger number of people, including people from a range of backgrounds. The ACIA has potential for use in adult autism clinical assessment services and as a resource for research and training. The semistructured format helps gather important and relevant information, and the interview length supports feasibility in clinical and research settings. The ACIA has the potential to streamline autism assessments and speed up the process for adults who currently wait a long time for their diagnosis.
临床医生使用诊断访谈来帮助他们收集和整理在自闭症评估中收集到的信息。大多数工具是针对儿童开发的，很少有针对成年人开发的、可靠、有效且适用的测量方法。这是为成年人提供高质量、及时服务的一个重大障碍。这项开发研究的目的是在进一步大规模测试和评估之前，评估最近开发的成人自闭症临床访谈（ACIA）在自闭症诊断临床服务中的初步效用。
我们邀请了通过英国国家医疗服务体系（NHS）多学科成人自闭症评估获得自闭症谱系诊断的成年人参与。17名自闭症成年人（8名女性和9名男性，平均年龄37岁）和4名亲属同意接受访谈。半结构化的ACIA访谈包括主体版和知情者版，以及一份访谈前的自我报告问卷。ACIA的各个组成部分共同涵盖了与自闭症及共病状况评估相关的主题。我们通过与《精神疾病诊断与统计手册》第五版（DSM-5）和NHS诊断报告进行比较，评估了临床效用和内容效度。
每次访谈耗时60至90分钟完成。与DSM-5和NHS自闭症诊断报告的比较表明，ACIA准确识别了诊断所需的核心自闭症特征信息，并识别了共病状况。根据参与者的建议，我们对访谈进行了修订。
这些初步发现支持了ACIA在成人自闭症诊断临床服务中的潜在效用和效度。计划对该访谈的可接受性、效用和效度进行进一步调查。
临床医生在评估过程中使用诊断访谈，以帮助从疑似自闭症谱系的人及其知情者（非常了解他们的人）那里收集和记录信息。然而，大多数自闭症诊断访谈最初是为评估儿童自闭症而开发的，很少有专门为成年人开发的。缺乏专门为成年人开发的诊断访谈使得难以提供高质量、一致的评估。该研究测试了一种新的半结构化诊断访谈，称为成人自闭症临床访谈（ACIA）。ACIA包括一份让人们在访谈前完成的问卷。随后是可以与本人进行的访谈，以及一个供了解他们的人（如果允许）使用的单独版本。访谈涵盖自闭症特征、优势和困难，以及共病的身心健康状况。我们想通过将使用ACIA收集的信息与临床诊断报告进行比较，来了解该访谈对自闭症诊断服务是否有用。我们邀请了通过英国国家医疗服务体系（NHS）评估被诊断为自闭症的人参加访谈。我们询问他们我们是否也可以访谈一个非常了解他们并且与他们一起生活的人，以及我们是否可以将他们的NHS自闭症诊断报告与使用ACIA收集的信息进行比较。17名自闭症成年人（平均年龄37岁；8名女性和9名男性）和4名亲属/支持者（2名父母、1名配偶和1名同居伴侣）同意接受访谈。每次访谈耗时60至90分钟完成。与临床报告的比较表明，ACIA识别出了与诊断相关的自闭症特征以及共病状况（如抑郁症）。参与者提出了一些改进访谈的方法，并进行了修订。专门为寻求自闭症诊断的成年人设计的诊断访谈很少。这项研究的结果表明，ACIA是一种有前景的新访谈。该研究规模较小。然而，在将更多人员和资源投入到更大规模的研究之前，进行初步测试研究很重要。基于这些结果，我们旨在对更多人，包括来自不同背景的人，就新访谈的可接受性和有用性进行进一步研究。ACIA有潜力用于成人自闭症临床评估服务，并作为研究和培训的资源。半结构化格式有助于收集重要且相关的信息，访谈时长支持在临床和研究环境中的可行性。ACIA有潜力简化自闭症评估，并加快目前等待诊断时间较长的成年人的诊断过程。
