Agreement among four diagnostic instruments for autism spectrum disorders in toddlers.
The classic ADI-R misses many toddlers who lack repetitive behaviors—add ADOS-G or use the newer toddler algorithm.
01Research in Context
What this study did
The team compared four ways to spot autism in toddlers. They used the ADOS-G, CARS, ADI-R, and a clinician’s best judgment.
All four tools were given to the same group of very young children. The goal was to see which tests agreed and which ones missed kids.
What they found
ADOS-G, CARS, and the clinician agreed most of the time. ADI-R often said “no autism” when the other three said “yes.”
The toddlers who were missed usually had not yet shown clear repetitive behaviors. Without those behaviors, the ADI-R scored them as non-autistic.
How this fits with other research
Kim et al. (2012) fixed the problem. They wrote new toddler rules for the ADI-R that catch more early cases.
Hedley et al. (2015) added a quick 10-minute screen called ADEC. It matched the ADOS well and can be used while you wait for the full team.
Allison et al. (2008) gave us the Q-CHAT, a short parent checklist for 18- to 24-month-olds. It adds a cheap first step before the long interviews.
Why it matters
If you test toddlers, do not rely on the old ADI-R alone. Pair it with ADOS-G or CARS, or use the updated toddler algorithm. A fast screen like Q-CHAT or ADEC can flag kids early and cut wait time for full evaluations.
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02At a glance
03Original abstract
Autistic spectrum disorders (ASD) can be difficult to diagnose in toddlers. This study compared diagnostic measures (ADOS-G, ADI-R, CARS, and clinical judgment using DSM-IV criteria) applied to toddlers. Results indicated that the ADOS-G, CARS, and clinical judgment agreed with each other but not with the ADI-R. Many of the children classified with ASD by the other measures were not classified with autism by the ADI-R because they did not display enough repetitive behaviors and stereotyped interests. These results indicate that young children with ASD may not display repetitive behaviors and stereotyped interests, and for toddlers, the ADI-R would have a higher sensitivity if revised to include a diagnosis of PDD-NOS, for which the requirement of repetitive behaviors is less stringent.
Journal of autism and developmental disorders, 2006 · doi:10.1007/s10803-006-0128-8