Irarrázaval Matías, López Isabel, Figueroa Cecilia, Cabezas Marcia, Yáñez Cristián, Rodillo Eliana, Riesle Sofia, Rivera Tamara, Garcia Ricardo
Organización Mundial de la Salud, Suiza.
Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Andes Pediatr. 2023 Aug;94(4):475-484. doi: 10.32641/andespediatr.v94i4.4476.
Early detection of Autism is a challenge in Chile and Latin America. Gold-standard evaluations are expensive and difficult to access. The Autism Mental Status Exam (AMSE) is a brief, structured, observational instrument for clinical use with promising results.
To adapt and validate the AMSE in a sample of Spanish-speaking children and adolescents at risk of Autism Spectrum Disorder (ASD) using the ADOS-2 as a comparison.
Children and adolescents aged 15m-17yo consulting due to language and communication problems and/or suspected ASD. The AMSE was administered during clinical evaluation. The ADOS-2 was administered by independent evaluators, blinded to the study, which determined diagnostic categories as: Non-Autism Spectrum Disorder (Non-ASD), Autism Spectrum Disorder (ASD), or Autism (AUT). Psychometric characteristics of the AMSE were assessed and, using the ROC curve, a cut-off point was calculated, identifying sensitivity, specificity, positive, and negative predictive value.
Sixty-four children participated, 56 were males (87.5%), with a mean age of 6.6y (SD: 3.6). They were distributed as Non- ASD: 12 (18.8%), ASD: 19 (29.7%), and AUT: 33 (51.6%) according to the ADOS-2. The AMSE scores differed significantly among the three categories (p<0.0001). Internal consistency was moderate and Cronbach's alpha was 0.61. The cut-off point was ≥ 6 (Sensitivity 0.79, Specificity 0.92, AUC: 0.91). A second analysis according to language level suggests a greater diagnostic accuracy of the AMSE for the group with lower language development, maintaining the same optimal cut-off point (≥6).
The AMSE shows adequate psychometric properties, good capacity, and accuracy to support the diagnosis of ASD. Its brevity, low cost, and easy integration into clinical practice make it an alternative with great potential for timely recognition and referral of children with ASD.
在智利和拉丁美洲，早期发现自闭症是一项挑战。金标准评估费用高昂且难以获得。自闭症精神状态检查（AMSE）是一种简短、结构化的观察工具，用于临床，效果 promising。
以ADOS - 2作为对照，在有自闭症谱系障碍（ASD）风险的西班牙语儿童和青少年样本中对AMSE进行改编和验证。
因语言和沟通问题及/或疑似ASD前来咨询的15个月至17岁儿童和青少年。在临床评估期间进行AMSE测试。ADOS - 2由对研究不知情的独立评估人员进行测试，其确定的诊断类别为：非自闭症谱系障碍（非ASD）、自闭症谱系障碍（ASD）或自闭症（AUT）。评估了AMSE的心理测量特征，并使用ROC曲线计算临界点，确定敏感性、特异性、阳性和阴性预测值。
64名儿童参与，56名男性（87.5%），平均年龄6.6岁（标准差：3.6）。根据ADOS - 2，他们的分布情况为：非ASD：12名（18.8%），ASD：19名（29.7%），AUT：33名（51.6%）。AMSE得分在这三个类别之间存在显著差异（p<0.0001）。内部一致性为中等，Cronbach's alpha为0.61。临界点为≥6（敏感性0.79，特异性0.92，AUC：0.91）。根据语言水平进行的第二次分析表明，对于语言发展较低的组，AMSE具有更高的诊断准确性，且保持相同的最佳临界点（≥6）。
AMSE显示出足够的心理测量特性、良好的能力和准确性，可支持ASD的诊断。其简短性、低成本以及易于整合到临床实践中，使其成为及时识别和转诊ASD儿童的极具潜力的替代方法。
