Psychometric Evaluation of the Autism Spectrum Rating Scales (6-18 Years Parent Report) in a Clinical Sample.
Ji Su Hong, Jeremy Perrin, Vini Singh and 5 others
PMID 36571625WHAT IT FOUND
The Autism Spectrum Rating Scales failed to distinguish children with autism from those with other clinical disorders in a specialty clinic sample.
Scores overlapped substantially, and no cut-off score provided acceptable accuracy for diagnosis.
Key findings
01The ASRS Total T-score and DSM-5 T-score showed poor discrimination between children with ASD and those without ASD, with Area Under the Curve values of 0.57 and 0.60 respectively.
02No optimal cut-off score could be identified for either scale because sensitivity and specificity could not be jointly optimized, with specificity being the primary concern.
03Using a cut-off of 65, high social capital was associated with a higher rate of false negatives, meaning children from higher socioeconomic backgrounds with ASD were more likely to be missed by the screen.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted in a high-prevalence clinical sample (70% had ASD), which affects positive and negative predictive values. Diagnosing clinicians were not blind to ASRS results, which may have biased the diagnosis toward the screen's findings, though the authors argue this would likely overestimate agreement rather than underestimate it. The ADOS-2, often considered a gold standard for observation, was not used for diagnosis due to pandemic-related administration constraints. Data on intellectual quotient, language level, and adaptive functioning were not available, which could have influenced validity statistics. The time between ASRS administration and diagnostic evaluation varied up to six months, potentially allowing for behavioral changes.
The easy way to misread this
Do not interpret the small mean differences in T-scores between groups as evidence that the ASRS is a useful diagnostic tool. The overlap in scores was substantial, and the measure failed to discriminate between ASD and other clinical conditions in this referred sample.