The influence of parental concern on the utility of autism diagnostic instruments

Karoline Alexandra Havdahl; Somer L. Bishop; Pål Surén; Anne Siri Øyen; Catherine Lord; Andrew Pickles; Stephen von Tetzchner; Synnve Schjølberg; Nina Gunnes; Mady Hornig; W. Ian Lipkin; Ezra Susser; Michaeline Bresnahan; Per Magnus; Nina Stenberg; Ted Reichborn-Kjennerud; Camilla Stoltenberg

doi:10.1002/aur.1817

The influence of parental concern on the utility of autism diagnostic instruments

Karoline Alexandra Havdahl^*, Somer L. Bishop, Pål Surén, Anne Siri Øyen, Catherine Lord, Andrew Pickles, Stephen von Tetzchner, Synnve Schjølberg, Nina Gunnes, Mady Hornig, W. Ian Lipkin, Ezra Susser, Michaeline Bresnahan, Per Magnus, Nina Stenberg, Ted Reichborn-Kjennerud, Camilla Stoltenberg

^*Corresponding author for this work

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

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Abstract

The parental report-based Autism Diagnostic Interview-Revised (ADI-R) and the clinician observation-based Autism Diagnostic Observation Schedule (ADOS) have been validated primarily in U.S. clinics specialized in autism spectrum disorder (ASD), in which most children are referred by their parents because of ASD concern. This study assessed diagnostic agreement of the ADOS-2 and ADI-R toddler algorithms in a more broadly based sample of 679 toddlers (age 35-47 months) from the Norwegian Mother and Child Cohort. We also examined whether parental concern about ASD influenced instrument performance, comparing toddlers identified based on parental ASD concern (n=48) and parent-reported signs of developmental problems (screening) without a specific concern about ASD (n=400). The ADOS cutoffs showed consistently well-balanced sensitivity and specificity. The ADI-R cutoffs demonstrated good specificity, but reduced sensitivity, missing 43% of toddlers whose parents were not specifically concerned about ASD. The ADI-R and ADOS dimensional scores agreed well with clinical diagnoses (area under the curve≥0.85), contributing additively to their prediction. On the ADI-R, different cutoffs were needed according to presence or absence of parental ASD concern, in order to achieve comparable balance of sensitivity and specificity. These results highlight the importance of taking parental concern about ASD into account when interpreting scores from parental report-based instruments such as the ADI-R. While the ADOS cutoffs performed consistently well, the additive contributions of ADI-R and ADOS scores to the prediction of ASD diagnosis underscore the value of combining instruments based on parent accounts and clinician observation in evaluation of ASD.

Original language	English
Journal	Autism research
Early online date	22 Jun 2017
DOIs	https://doi.org/10.1002/aur.1817
Publication status	E-pub ahead of print - 22 Jun 2017

Keywords

Autism Diagnostic Interview-Revised
Autism Diagnostic Observation Schedule
Early diagnosis
Screening

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The influence of parental concern_HAVDAHL_Publishedonline22June2017 GREEN AAMAccepted author manuscript, 1.07 MB

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Havdahl, K. A., Bishop, S. L., Surén, P., Øyen, A. S., Lord, C., Pickles, A., von Tetzchner, S., Schjølberg, S., Gunnes, N., Hornig, M., Lipkin, W. I., Susser, E., Bresnahan, M., Magnus, P., Stenberg, N., Reichborn-Kjennerud, T., & Stoltenberg, C. (2017). The influence of parental concern on the utility of autism diagnostic instruments. Autism research. Advance online publication. https://doi.org/10.1002/aur.1817

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abstract = "The parental report-based Autism Diagnostic Interview-Revised (ADI-R) and the clinician observation-based Autism Diagnostic Observation Schedule (ADOS) have been validated primarily in U.S. clinics specialized in autism spectrum disorder (ASD), in which most children are referred by their parents because of ASD concern. This study assessed diagnostic agreement of the ADOS-2 and ADI-R toddler algorithms in a more broadly based sample of 679 toddlers (age 35-47 months) from the Norwegian Mother and Child Cohort. We also examined whether parental concern about ASD influenced instrument performance, comparing toddlers identified based on parental ASD concern (n=48) and parent-reported signs of developmental problems (screening) without a specific concern about ASD (n=400). The ADOS cutoffs showed consistently well-balanced sensitivity and specificity. The ADI-R cutoffs demonstrated good specificity, but reduced sensitivity, missing 43% of toddlers whose parents were not specifically concerned about ASD. The ADI-R and ADOS dimensional scores agreed well with clinical diagnoses (area under the curve≥0.85), contributing additively to their prediction. On the ADI-R, different cutoffs were needed according to presence or absence of parental ASD concern, in order to achieve comparable balance of sensitivity and specificity. These results highlight the importance of taking parental concern about ASD into account when interpreting scores from parental report-based instruments such as the ADI-R. While the ADOS cutoffs performed consistently well, the additive contributions of ADI-R and ADOS scores to the prediction of ASD diagnosis underscore the value of combining instruments based on parent accounts and clinician observation in evaluation of ASD.",

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AU - Havdahl, Karoline Alexandra

AU - Bishop, Somer L.

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AU - Øyen, Anne Siri

AU - Lord, Catherine

AU - Pickles, Andrew

AU - von Tetzchner, Stephen

AU - Schjølberg, Synnve

AU - Gunnes, Nina

AU - Hornig, Mady

AU - Lipkin, W. Ian

AU - Susser, Ezra

AU - Bresnahan, Michaeline

AU - Magnus, Per

AU - Stenberg, Nina

AU - Reichborn-Kjennerud, Ted

AU - Stoltenberg, Camilla

PY - 2017/6/22

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KW - Autism Diagnostic Observation Schedule

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AN - SCOPUS:85021207962

SN - 1939-3792

JO - Autism research

JF - Autism research

ER -

The influence of parental concern on the utility of autism diagnostic instruments

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Keywords

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