The influence of parental concern on the utility of autism diagnostic instruments.
Karoline Alexandra Havdahl, Somer L Bishop, Pål Surén and 14 others
PMID 28639396WHAT IT FOUND
ADOS cutoffs identified autism consistently.
ADI-R cutoffs missed 43% of toddlers diagnosed with autism when parents had not raised concern. A low ADI-R score should not rule out autism without direct observation and attention to parental concern.
Key findings
01ADOS cutoffs showed balanced accuracy (89% sensitivity, 83% specificity) and performed similarly whether or not parents had raised autism concern.
02ADI-R cutoffs were less sensitive and more specific among toddlers without parental autism concern; 43% of those diagnosed with autism scored below the ADI-R clinical cutoff.
03After accounting for parental concern, ADI-R scores still separated ASD from non-ASD (AUC = 0.85), but optimal cutoffs differed by concern group.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The clinical diagnosis team was not blinded to the ADI-R and ADOS information when assigning the consensus diagnosis, so agreement between instruments and diagnosis may be overestimated. Subgroup analyses were small when children were split by diagnosis and how they were identified, so confidence intervals matter. The sample was drawn from one country and culture, so results may not apply elsewhere. MoBa underrepresented young, single, and less educated mothers, and clinical participation may have involved self-selection. Children with severe sensory or motor impairments or nonverbal mental age below 10 months were excluded, so findings do not cover them. Diagnoses used DSM-IV-TR criteria, not DSM-5.
The easy way to misread this
Do not treat a below-cutoff ADI-R score as ruling out autism in toddlers whose parents have not expressed specific autism concern. In this study, 43% of toddlers diagnosed with autism in the no-concern group scored below the ADI-R clinical cutoff, even though the ADI-R scores themselves still helped distinguish autism from other diagnoses after adjustment.