Adapting and validating the Autism Diagnostic Observation Schedule Version 2 for use with deaf children and young people.
Helen Phillips, Barry Wright, Victoria Allgar and 10 others
PMID 33761060WHAT IT FOUND
The ADOS-2 adapted for deaf children correctly identified 73% of children with autism and correctly ruled out 71% without autism when checked against clinical assessment, below the 85% target for finding autism.
Key findings
01The ADOS-2 Deaf adaptation had sensitivity of 73% and specificity of 71%, against pre-specified targets of 85% sensitivity and 60% specificity.
02For modules 1 to 3 combined, mean comparison scores were 6.6 in deaf children with autism and 2.9 in deaf children without autism, with a statistically significant difference (p < 0.001).
03The study was underpowered compared with the planned 65 children with autism and 65 without, and only 2 toddler module and 11 module 4 assessments were completed.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The validation was underpowered compared with the planned 65 children with autism and 65 without autism. Only 2 toddler module assessments and 11 module 4 assessments were completed, so these modules cannot be judged firmly from this study. The reference standard was a blinded NICE guideline standard clinical assessment, and 4 children were classified using parent report or a Social Communication Questionnaire score of 15 or more. The Delphi expert panel was mostly hearing (88%) and preferred spoken English (95%), although deaf lived experience was included. The validation was done in the UK using British Sign Language and spoken English, so it may not apply directly to other signed or spoken languages. Comorbidity information was based on parent report and needs caution. Sensitivity was 73%, below the pre-specified target of 85%.
Declared interests
The paper reports the Medical Research Council as the funder. It also states that the study was carried out with the agreement of the original ADOS-2 authors and permission from Western Psychological Services, the publisher of the ADOS-2.
The easy way to misread this
Do not treat the ADOS-2 Deaf adaptation as a stand-alone diagnostic test for autism in deaf children. Its sensitivity was 73%, below the pre-specified 85% target, and the study was underpowered, with only 2 toddler module and 11 module 4 assessments.