Replication study for ADOS-2 cut-offs to assist evaluation of autism spectrum disorder.
Ji Su Hong, Vini Singh, Luke Kalb and 8 others
PMID 36054678WHAT IT FOUND
ADOS-2 cut-offs rarely miss autism but wrongly flag many non-autistic children.
Nearly one third of the non-ASD group were misclassified. Do not rely on ADOS-2 scores alone to diagnose. Combine them with clinical history and other assessments to avoid false positives.
Key findings
01The standard ADOS-2 autism spectrum cut-off was highly sensitive but had low specificity, leading to a high rate of false positives.
02Using the higher autism cut-off improved specificity but reduced sensitivity, showing a trade-off between missing cases and over-diagnosing.
03Children classified only as autism spectrum were almost equally likely to have ASD as not, meaning this score alone cannot confirm or rule out the diagnosis.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Diagnoses were not made independently of the ADOS-2 results, so clinicians may have been influenced by the test scores. The study did not have access to non-verbal mental age data, which can affect false positive rates in younger children. Most clinicians administering the test did not have research reliability training, though they were monitored for calibration. The sample came from a single specialty center, which may introduce selection and referral bias.
Declared interests
The authors have no conflicts of interest relevant to this article to disclose.
The easy way to misread this
Do not treat an ADOS-2 autism spectrum classification as a definitive diagnosis. Nearly half of the children with this classification did not actually have ASD, so relying on this score alone will lead to over-diagnosis.