Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research

Karoline Alexandra Havdahl; Vanessa Hus Bal; Marisela Huerta; Andrew Pickles; Anne Siri Øyen; Camilla Stoltenberg; Catherine Lord; Somer L. Bishop

doi:10.1016/j.jaac.2016.09.490

Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research

Karoline Alexandra Havdahl, Vanessa Hus Bal, Marisela Huerta, Andrew Pickles, Anne Siri Øyen, Camilla Stoltenberg, Catherine Lord, Somer L. Bishop^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

102 Citations (Scopus)

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Abstract

Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors. Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview–Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS). Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27–42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36–59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures. Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.

Original language	English
Pages (from-to)	1054-1063.e3
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	55
Issue number	12
Early online date	28 Sept 2016
DOIs	https://doi.org/10.1016/j.jaac.2016.09.490
Publication status	Published - 1 Dec 2016

Keywords

Autism Diagnostic Interview–Revised
Autism Diagnostic Observation Schedule
discriminative ability
measurement
Social Responsiveness Scale

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jaac.2016.09.490

Multidimensional Influences on Autism_HAVDAHL_Publishedonline28September2016_GREEN AAMAccepted author manuscript, 548 KBLicence: CC BY-NC-ND

Cite this

@article{63a3c25ff37a47878c68502686332c65,

title = "Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research",

abstract = "Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors. Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview–Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS). Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27–42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36–59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures. Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.",

keywords = "Autism Diagnostic Interview–Revised, Autism Diagnostic Observation Schedule, discriminative ability, measurement, Social Responsiveness Scale",

author = "Havdahl, {Karoline Alexandra} and {Hus Bal}, Vanessa and Marisela Huerta and Andrew Pickles and {\O}yen, {Anne Siri} and Camilla Stoltenberg and Catherine Lord and Bishop, {Somer L.}",

year = "2016",

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doi = "10.1016/j.jaac.2016.09.490",

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T2 - Implications for Use in Etiological Research

AU - Havdahl, Karoline Alexandra

AU - Hus Bal, Vanessa

AU - Huerta, Marisela

AU - Pickles, Andrew

AU - Øyen, Anne Siri

AU - Stoltenberg, Camilla

AU - Lord, Catherine

AU - Bishop, Somer L.

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N2 - Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors. Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview–Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS). Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27–42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36–59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures. Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.

AB - Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors. Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview–Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS). Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27–42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36–59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures. Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.

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