How to use the ADI-R for classifying autism spectrum disorders? Psychometric properties of criteria from the literature in 1,204 Dutch children.
Choose ADI-R cut-offs based on your rule-in or rule-out goal, and always pair ADOS when testing bright, verbal kids.
01Research in Context
What this study did
The team looked at 1,204 Dutch children. Some had autism. Some had intellectual disability. Some had both.
They tested different ways to score the ADI-R. They wanted to know which rules catch autism best.
They also checked what happens when you add the ADOS to the mix.
What they found
The original ADI-R rules were best at keeping kids without autism out of the autism group.
Broader rule sets picked up more kids with autism, but also called more non-autistic kids autistic.
Adding ADOS helped keep the non-autistic group clean, yet it missed a few kids who really had autism.
How this fits with other research
Noterdaeme et al. (2002) first showed that ADI-R plus ADOS beats using either tool alone. The Dutch numbers now back that up in a huge sample.
Zander et al. (2015) found the same boost in Swedish toddlers. A short phone screen plus ADOS gave 92 % specificity, just like ADI-R plus ADOS in the Dutch study.
Foley-Nicpon et al. (2017) seems to clash: they say always use both tools, while the Dutch say adding ADOS can drop sensitivity. The gap is the kids studied. Megan looked at bright, verbal youth. The Dutch sample had many kids with intellectual disability. In high-IQ youth you need both tools; in mixed-IQ groups you may stick to ADI-R alone if you care most about avoiding false positives.
Why it matters
Pick your ADI-R cut-offs like a dial, not a switch. Need to rule autism in for a child without ID? Use the original strict rules. Need to rule it out? Try a broader set. If the child is bright and verbal, add ADOS so you do not miss the diagnosis. Monday morning, check which algorithm your software uses and match it to the question you are asking.
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02At a glance
03Original abstract
The algorithm of the Autism Diagnostic Interview-Revised provides criteria for autism versus non-autism according to DSM-IV. Criteria for the broader autism spectrum disorders are needed. This study investigated the validity of seven sets of criteria from the literature, in 1,204 Dutch children (aged 3-18 years) with and without mental retardation. The original criteria (Rutter et al. in ADI-R Autism Diagnostic Interview Revised. Manual. Western Psychological Services, Los Angeles, 2003) well discriminated ASD from non-ASD in MR. All other criteria (IMGSAC in Am Soc Hum Genet 69:570-581 2001; Sung et al. in Am J Hum Genet 76: 68-81, 2005; Risi et al. in J Am Acad Child Adolesc Psychiatry 45: 1094-1103, 2006) were sensitive at the cost of specificity, bearing the risk of overinclusiveness. In the group without MR, clinicians should decide whether sensitivity or specificity is aimed for, to choose the appropriate criteria. Including the Autism Diagnostic Observation Schedule revised algorithms in the classification, the specificity increases, at the cost of sensitivity. This study adds to a more valid judgment on which criteria to use for specific objectives.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-013-1783-1