Dale Naomi, Sakkalou Elena, Eriksson Maria H, Salt Alison
Great Ormond Street Hospital NHS Trust, Great Ormond Street, London, WC1 3JH, UK.
UCL Great Ormond Street Institute of Child Health, London, UK.
J Autism Dev Disord. 2024 Sep 9. doi: 10.1007/s10803-024-06514-z.
Children with visual impairment (VI) are at risk of autism spectrum disorder (ASD); however standard observational diagnostic assessments are not validated for this population. The primary objective of the study is to validate a modified version of the Autism Diagnostic Observation Schedule (ADOS-2, Module 3), for children with VI. A cross-sectional observational study was undertaken with 100 (mean 5½ years, SD 10.44 months, range 4-7 years; 59 (59%) males) children with congenital disorders of the peripheral visual system with moderate/severe-profound VI. As the primary objective, 83 (83%) who were 'verbally fluent' were assessed with the modified ADOS-2 (Module 3). Their scores were investigated for reliability, construct and criterion validity against expert clinician formulation and parent-rated social and communication questionnaires (Social Responsiveness Scale-2, SRS-2; Children's Communication Checklist-2). The secondary objective with the total sample was to report on frequency and distribution of ASD ratings in this VI population. The modified ADOS-2 (Module 3) was found to have strong internal coherence and construct validity (two factor model) and inter-rater reliability. A new VI diagnostic algorithm was established which showed high sensitivity and specificity against clinician formulation. Using the best cut-off threshold for 'High Risk for ASD', strong concurrent criterion validity was found according to parent-rated scores on the SRS-2. The modified ADOS-2 (Module 3) was shown to have promising reliability and validity in establishing children at 'High Risk of ASD' in this vulnerable population. Elevated rates of ASD were found across the sample, in line with previous estimates.
视力障碍（VI）儿童有患自闭症谱系障碍（ASD）的风险；然而，标准的观察性诊断评估方法尚未在该人群中得到验证。本研究的主要目的是验证针对视力障碍儿童的改良版自闭症诊断观察量表（ADOS-2，模块3）。对100名（平均5.5岁，标准差10.44个月，年龄范围4至7岁；59名（59%）为男性）患有中度/重度至极重度视力障碍的先天性周边视觉系统疾病儿童进行了横断面观察研究。作为主要目标，对83名（83%）“语言流畅”的儿童进行了改良版ADOS-2（模块3）评估。针对专家临床医生的诊断结果以及家长评定的社交和沟通问卷（社交反应量表-2，SRS-2；儿童沟通清单-2），对他们的得分进行了可靠性、结构效度和效标效度调查。对整个样本的次要目标是报告该视力障碍人群中ASD评定的频率和分布情况。结果发现，改良版ADOS-2（模块3）具有很强的内部一致性、结构效度（双因素模型）和评分者间信度。建立了一种新的视力障碍诊断算法，该算法针对临床医生的诊断结果显示出高敏感性和特异性。根据家长在SRS-2上评定的分数，使用“ASD高风险”的最佳临界阈值时，发现具有很强的同时效度。改良版ADOS-2（模块3）在确定这一弱势群体中“ASD高风险”儿童方面显示出有前景的可靠性和效度。在整个样本中发现ASD发病率升高，与先前的估计一致。
