The added value of the combined use of the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule: diagnostic validity in a clinical Swedish sample of toddlers and young preschoolers.
A 15-minute phone interview plus ADOS hits 92 % specificity for autism in verbal 5- to young learners, cutting triage time without losing accuracy.
01Research in Context
What this study did
Zander et al. (2015) tested a 15-minute phone interview plus a short clinic visit. The phone part is the Autism Symptom Interview (ASI). The visit is the Autism Diagnostic Observation Schedule (ADOS).
They gave both tools to 61 Swedish kids who already had developmental concerns. Then they checked if the combo correctly spotted autism.
What they found
The ASI alone caught 87 % of kids with autism but also flagged 38 % of kids who did not have it. When they added the ADOS, the false-alarm rate dropped. Specificity jumped from 62 % to 92 %.
Two different clinicians scored the same kids. Their answers matched 91 % of the time, so the combo is also reliable.
How this fits with other research
Noterdaeme et al. (2002) showed the same boost thirteen years earlier. They used the longer ADI-R parent interview plus ADOS and got near-perfect accuracy in eleven kids. Eric’s team trimmed the parent part to a 15-minute phone call and still kept the gain.
Foley-Nicpon et al. (2017) found the same pattern in bright kids. ADOS alone would have dropped 62 % of diagnoses. Adding the parent interview saved every case. Together these studies say: keep the parent piece, no matter how quick.
Tassé et al. (2013) warn that the full ADI-R loses sensitivity in under-fives. Eric’s kids were 5-12, so the ASI short form may not work for toddlers. Use the toddler M-CHAT screen (L et al. 2001) first, then switch to ASI+ADOS after age five.
Why it matters
You can now get 92 % accuracy with one phone call and one 45-minute observation. That means fewer return visits, shorter wait lists, and faster start of therapy. If you assess school-age kids for autism, add the ASI phone screen before you schedule the ADOS. You will rule out non-cases faster and save families a second day off work.
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02At a glance
03Original abstract
This study reports on the initial validation of the Autism Symptom Interview (ASI), School-Age, a brief (15-20 min) phone interview derived from questions from the Autism Diagnostic Interview-Revised (ADI-R). The ASI, School-Age was administered by interviewers with minimal training to parents of children ages 5 to 12 who had all been previously identified with (or referred for assessment of) ASD or another neurodevelopmental disorder. Children then underwent a comprehensive assessment to determine a best-estimate clinical diagnosis of ASD (n = 159) or non-ASD (e.g. language disorder, intellectual disability, ADHD; n = 130). Clinicians who conducted the assessments were blind to ASI results. ROC analyses compared ASI scores to clinical diagnosis. Due to the small number of participants with non-ASD diagnoses who were classified as nonverbal (i.e. not yet using phrases on a daily basis), it was not possible to assess sensitivity and specificity of the nonverbal algorithm in this sample. The verbal algorithm yielded a sensitivity of 0.87 (95% CI = 0.81-0.92) and a specificity of 0.62 (95% CI = 0.53-0.70). When used in conjunction with the Autism Diagnostic Observation Schedule (ADOS), sensitivity and specificity were 0.82 (95% CI = 0.74-0.88) and 0.92 (95% CI = 0.86-0.96), respectively. Internal consistency and test-retest reliability were both excellent. Particularly for verbal school age children, the ASI may serve as a useful tool to more quickly ascertain or classify children with ASD for research or clinical triaging purposes. Additional data collection is underway to determine the utility of the ASI in children who are younger and/or nonverbal. Autism Res 2017, 10: 78-88. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
Autism : the international journal of research and practice, 2015 · doi:10.1177/1362361313516199