Angelina Vernetti, Chelsea Morgan, Kelly Powell, Suzanne Macari, Katarzyna Chawarska
Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.
Autism Res. 2025 Jun;18(6):1279-1289. doi: 10.1002/aur.70050. Epub 2025 May 12.
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) constitutes one of the most widely used diagnostic instruments for autism and involves a direct face-to-face interaction between clinician and child. During the COVID-19 pandemic, administration of the ADOS-2 continued in several countries, with the requirement of face mask protection. It has been hypothesized that mask wearing may have disrupted the dynamic of child-clinician interaction and differentially affected toddlers with autism. We compared ADOS-2 algorithm scores between cohorts of toddlers evaluated before (pre-COVID-19, n = 232) and during the pandemic (COVID-19, n = 116). The COVID-19 cohort included 41 toddlers with autism spectrum disorders (AUT, Mage = 25.4, SD = 3.8), 34 toddlers with other neurodevelopmental conditions (NDC, Mage = 22.3, SD = 5.0), and 41 typically developing toddlers (TD, Mage = 20.4, SD = 3.6) recruited between September 2020 and April 2023. The pre-COVID-19 cohort was selected from 409 assessments conducted from January 2013 to March 2020. Propensity matching was used to match the pre- and COVID-19 cohorts on sex, chronological age, and verbal and nonverbal developmental quotient (DQ) scores. Ordered logistic regression analyses were computed for social affect (SA) and restricted and repetitive behaviors (RRB) algorithm total and item scores, with cohort (pre-COVID-19/COVID-19) as a fixed factor for each diagnostic group. The analyses revealed a limited impact of cohort on the algorithm scores in all three diagnostic groups. Item-level analysis revealed a significant cohort effect only on two out of 20 items: shared enjoyment and joint attention, with higher (more atypical) scores found in the COVID-19 than in the pre-COVID-19 cohorts. The resiliency of the algorithm and item-level scores to the effect of masking speaks to the strength of the diagnostic tool and its ability to capture a range of social, communication, and repetitive behaviors under both standard and nonstandard conditions.
《自闭症诊断观察量表第二版》（ADOS - 2）是最广泛使用的自闭症诊断工具之一，涉及临床医生与儿童之间直接的面对面互动。在新冠疫情期间，多个国家继续使用ADOS - 2进行诊断，但要求佩戴口罩。据推测，佩戴口罩可能扰乱了儿童与临床医生互动的动态过程，并对自闭症幼儿产生了不同程度的影响。我们比较了在新冠疫情之前（新冠疫情前，n = 232）和疫情期间（新冠疫情期间，n = 116）接受评估的幼儿队列的ADOS - 2算法得分。新冠疫情期间的队列包括2020年9月至2023年4月招募的41名自闭症谱系障碍幼儿（AUT，平均年龄 = 25.4，标准差 = 3.8）、34名患有其他神经发育障碍的幼儿（NDC，平均年龄 = 22.3，标准差 = 5.0）和41名发育正常的幼儿（TD，平均年龄 = 20.4，标准差 = 3.6）。新冠疫情前的队列选自2013年1月至2020年3月进行的409次评估。采用倾向匹配法，在性别、实际年龄以及语言和非语言发育商（DQ）得分方面对新冠疫情前和新冠疫情期间的队列进行匹配。对社交情感（SA）以及局限重复行为（RRB）算法的总分和分项得分进行有序逻辑回归分析，将队列（新冠疫情前/新冠疫情期间）作为每个诊断组的固定因素。分析显示，队列对所有三个诊断组的算法得分影响有限。分项分析显示，队列效应仅在20个项目中的两项上具有统计学意义：共同享受和共同注意，新冠疫情期间队列的得分高于（更不典型）新冠疫情前队列。算法和分项得分对口罩影响的弹性表明了该诊断工具的优势，以及它在标准和非标准条件下捕捉一系列社交、沟通和重复行为的能力。
