Identifying High Ability Children with DSM-5 Autism Spectrum or Social Communication Disorder: Performance on Autism Diagnostic Instruments.
Always give both ADOS and ADI-R for DSM-5 autism diagnosis in high-ability youth—ADOS alone misses over a third of cases.
01Research in Context
What this study did
The team looked at 37 bright kids who already had an autism label under the old DSM-IV rules.
Each child took two gold-standard tests: the ADOS (watching the child play) and the ADI-R (asking parents questions).
They asked: if we use only the new DSM-5 rules, how many kids lose the diagnosis?
What they found
ADOS alone dropped 62 % of the high-ability kids.
Adding the ADI-R parent interview saved every single diagnosis.
In short, skipping the parent part throws away over a third of bright children who need help.
How this fits with other research
Noterdaeme et al. (2002) first showed the pair beats either tool alone in young children.
Wilson et al. (2013) warned DSM-5 misses many able adults; Megan et al. now prove the same gap in youth.
Bao et al. (2017) saw new autism cases slow after DSM-5 arrived; this paper explains why—clinicians who rely only on ADOS leave kids out.
Why it matters
If you test bright clients with just the ADOS, you risk denying them services they qualify for.
Run the ADI-R every time. It takes an extra hour, but it keeps kids from falling through the cracks.
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02At a glance
03Original abstract
This study was a replication of Mazefsky et al.'s (Journal of Autism and Developmental Disabilities 43:1236-1242, 2013) investigation among a sample of 45 high ability children and adolescents diagnosed with ASD under DSM-IV-TR. Items from the ADOS and ADI-R were mapped onto DSM-5 diagnostic criteria for ASD and SCD to determine whether participants would meet either diagnosis under DSM-5. If the ADOS were administered alone, 62% of individuals diagnosed with ASD would no longer meet criteria under DSM-5; however, when the ADI-R and ADOS scores were combined, 100% of individuals would continue to meet ASD diagnosis. The ADOS was determined to be an insufficient measure for SCD due to the small number of algorithm items measuring SCD diagnostic criteria, suggesting the development of SCD measures is required.
Journal of autism and developmental disorders, 2017 · doi:10.1007/s10803-016-2973-4