Diagnosing Autism Spectrum Disorder in Children with Low Mental Age.
Lauren E Miller, Jeffrey D Burke, Diana L Robins and 1 others
PMID 30406437WHAT IT FOUND
In toddlers with autism functioning below a 12-month level, the ADOS often over-classified autism, while the CARS agreed more closely with clinical judgment.
Early social behaviors like eye contact, name response, and joint attention helped separate autism from global delay.
Key findings
01The ADOS agreed with clinical best estimate in 79.2% of low-mental-age cases, but 18.8% of children were over-classified as having ASD.
02The CARS agreed with clinical best estimate in 83.3% of cases, but it both over-classified 10.4% and under-classified 6.3% of children.
03Core early social behaviors such as eye contact, social smiling, facial expressions directed toward others, responsiveness to one's name, and spontaneous showing did not differ significantly between the two autism groups.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The diagnostic utility analyses used only 48 toddlers, including 16 with GDD, so they cannot settle how the tools perform for all children with very low mental age. Clinical best estimate was the reference standard, and it is subjective, so agreement with it may not equal true diagnosis. Children were diagnosed using DSM-IV-TR, so results may not transfer directly to DSM-5 settings. The ADOS was scored from Module 1 and brief clinic observation, so behaviors not seen in the session may have been missed. Six ADOS communication items were excluded because many children were too limited verbally for those items to be judged, so the study did not fully test communication symptoms. The groups differed in race/ethnicity, and sociocultural factors were not analyzed. All children were identified through autism screening or referral, so findings may not apply to children identified in other ways.
Declared interests
Diana Robins and Deborah Fein are part owners of M-CHAT, LLC, which receives royalties from companies that use the M-CHAT(-R) in commercial products. The study used the freely available paper version of the M-CHAT(-R). Lauren Miller and Jeffrey Burke declared no conflicts of interest.
The easy way to misread this
Do not conclude that the ADOS can diagnose autism by itself in toddlers with very low mental age. It often over-classified autism compared with clinical judgment, and the CARS also made errors.