Sensitivity and Specificity of the ADOS-2 Algorithm in a Large German Sample.
Juliane E Medda, Hannah Cholemkery, Christine M Freitag
PMID 30238180WHAT IT FOUND
ADOS-2 and ADOS performed similarly in most comparisons, but Module 1 had poor specificity.
Adding SCQ and SRS improved Module 4 autism versus non-ASD classification, not Module 3.
Key findings
01ADOS and ADOS-2 had similar accuracy in most comparisons; the only exception was the Module 2 younger-than-5 algorithm, based on 12 versus 4 participants.
02In Module 1, specificity was below 0.30 for both ADOS and ADOS-2 when separating non-ASD from autism or autism spectrum.
03For Module 4 autism versus non-ASD, adding SCQ and SRS raised correct classification from 83.6% to 87.3%; for Module 3, adding them did not increase correct classification.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Modules 1 and 2 had small subgroup sizes, producing wide confidence intervals and unstable estimates, especially for non-ASD children. All participants were referred for suspected ASD, so accuracy may not apply to unselected patients. IQ data were missing for many participants; IQ was obtained for 74% of patients, and Module 1 IQ data were missing for many young or severely affected children. Diagnostic groups differed in IQ and gender in some modules, so algorithm accuracy may be mixed with these differences. For Modules 3 and 4, only complete ADOS-2, SCQ and SRS datasets were used, reducing sample size. The reference diagnosis was a best-estimate clinical diagnosis made after ADOS and other assessments, so the test being evaluated was part of the diagnostic process. The authors note that future work should test accuracy against specific control groups, such as language impairment or social phobia.
Declared interests
Funded by Universität des Saarlandes, Deutsche Forschungsgemeinschaft, and Bundesministerium für Bildung und Forschung. The supplied text does not list author conflicts of interest.
The easy way to misread this
Do not assume ADOS-2 accuracy is the same across ages. Module 1 had poor accuracy and specificity below 0.30 for separating non-ASD from autism or autism spectrum.