Child and family characteristics moderate agreement between caregiver and clinician report of autism symptoms.

The sample was made up of children who already met strict research diagnostic criteria on both the ADI-R and ADOS, so this does not tell clinicians how to make an initial ASD diagnosis. The sample was mostly White (78.5%) and came from families with only one child with ASD, so findings may not apply to more diverse or multiplex families. The ADI-R and ADOS are specialized research and clinical tools, not universal clinical measures, so agreement patterns may differ with common questionnaires or shorter assessments. Caregiver-clinician differences could reflect real changes in behavior across settings, not only reporter perception; the study could not tell these apart. Higher ADI-R or ADOS algorithm scores may reflect a broader range of symptoms rather than greater severity. For older children, the combined model did not identify a single significant moderator, so the older-group moderators should be read as exploratory.

The supplied text does not include an author conflict-of-interest declaration. The publication types list NIH extramural research support and non-U.S. government research support.

Do not read these associations as evidence that higher IQ, stronger adaptive skills, more behavior problems, African American race, or lower income cause disagreement or misdiagnosis. The study compared reports at one assessment point and used a research sample already diagnosed on both measures, so it cannot establish causes or apply directly to initial diagnosis.