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Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community

Published online by Cambridge University Press:  29 July 2011

T. S. Brugha*
Affiliation:
Department of Health Sciences, University of Leicester, UK
S. McManus
Affiliation:
National Centre for Social Research (NatCen), London, UK
J. Smith
Affiliation:
Department of Health Sciences, University of Leicester, UK
F. J. Scott
Affiliation:
Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
H. Meltzer
Affiliation:
Department of Health Sciences, University of Leicester, UK
S. Purdon
Affiliation:
National Centre for Social Research (NatCen), London, UK
T. Berney
Affiliation:
Institute of Health and Society, Newcastle University, UK
D. Tantam
Affiliation:
School of Health and Related Research, University of Sheffield, UK
J. Robinson
Affiliation:
Cambridgeshire and Peterborough NHS Foundation Trust (CLASS Clinic), UK
J. Radley
Affiliation:
St Andrews Healthcare, Northampton, UK
J. Bankart
Affiliation:
Department of Health Sciences, University of Leicester, UK
*
*Address for correspondence: Professor T. S. Brugha, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK. (Email: tsb@le.ac.uk)

Abstract

Background

There are no tested methods for conducting epidemiological studies of autism spectrum disorders (ASDs) in adult general population samples. We tested the validity of the Autism Diagnostic Observation Schedule module-4 (ADOS-4) and the 20-item Autism-Spectrum Quotient (AQ-20).

Method

Randomly sampled adults aged ⩾16 years were interviewed throughout England in a general population multi-phase survey. The AQ-20 was self-completed by 7353 adults in phase 1. A random subset completed phase 2, ADOS-4 assessments (n=618); the probability of selection increased with AQ-20 score. In phase 3, informant-based Diagnostic Interview Schedule for Social and Communication Disorders (DISCO) and Autism Diagnostic Interview – Revised (ADI-R) developmental assessments were completed (n=56). Phase 1 and 2 data were presented as vignettes to six experienced clinicians (working in pairs). The probability of respondents having an ASD was compared across the three survey phases.

Results

There was moderate agreement between clinical consensus diagnoses and ADOS-4. A range of ADOS-4 caseness thresholds was identified by clinicians: 5+ to 13+ with greatest area under the curve (AUC) at 5+ (0.88). Modelling of the presence of ASD using 56 DISCO assessments suggested an ADOS-4 threshold in the range of 10+ to 13+ with the highest AUC at ADOS 10+ to 11+ (0.93–0.94). At ADOS 10+, the sensitivity was 1 [95% confidence interval (CI) 0.59–1.0] and the specificity 0.86 (95% CI 0.72–0.94). The AQ-20 was only a weak predictor of ADOS-4 cases.

Conclusions

Clinically recommended ADOS-4 thresholds are also recommended for community cases: 7+ for subthreshold and 10+ for definite cases. Further work on adult population screening methods is needed.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Asperger, H (1991). ‘Autistic psychopathy’ in childhood. In Autism and Asperger Syndrome (ed. Frith, U.), pp. 3792. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Baird, G, Simonoff, E, Pickles, A, Chandler, S, Loucas, T, Meldrum, D, Charman, T (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 368, 210215.CrossRefGoogle Scholar
Baron-Cohen, S, Scott, FJ, Allison, C, Williams, J, Bolton, P, Matthews, FE, Brayne, C (2009). Prevalence of autism-spectrum conditions: UK school-based population study. British Journal of Psychiatry 194, 500509.CrossRefGoogle ScholarPubMed
Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J, Clubley, E (2001). The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders 31, 5–17.CrossRefGoogle ScholarPubMed
Brugha, TS, Bebbington, PE, Jenkins, R (1999). A difference that matters: comparisons of structured and semi-structured diagnostic interviews of adults in the general population. Psychological Medicine 29, 10131020.CrossRefGoogle Scholar
Brugha, TS, McManus, S, Bankart, J, Scott, F, Purdon, S, Smith, J, Bebbington, P, Jenkins, R, Meltzer, H (2011). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry 68, 459466.CrossRefGoogle ScholarPubMed
Brugha, TS, McManus, S, Meltzer, H, Smith, J, Scott, F, Purdon, S, Harris, J, Meltzer, H (2009). Autism Spectrum Disorders in adults living in households throughout England – report from the Adult Psychiatric Morbidity Survey 2007. The NHS Information Centre: Leeds.Google Scholar
Brugha, TS, Meltzer, H (2008). Measurement of psychiatric and psychological disorders and outcomes in populations. In International Encyclopedia of Public Health (ed. Heggenhougen, K. and Quah, S.), pp. 261272. Academic Press: San Diego.CrossRefGoogle Scholar
Brugha, TS, Nienhuis, FJ (1998). SCAN-SF. A Survey Form of the Present State Examination and SCAN: Supplementary schedule for lay interviewers. World Health Organization: Geneva.Google Scholar
Cichon, S, Craddock, N, Daly, M, Faraone, SV, Gejman, PV, Kelsoe, J, Lehner, T, Levinson, DF, Moran, A, Sklar, P, Sullivan, PF (2009). Genomewide association studies: history, rationale, and prospects for psychiatric disorders. American Journal of Psychiatry 166, 540556.Google ScholarPubMed
Cohen, J (1960). A coefficient of agreement for nominal scale. Educational and Psychological Measurement 20, 3746.CrossRefGoogle Scholar
Elashoff, J (1997). nQuery Advisor® Release 2.0. Statistical Solutions: Boston, MA.Google Scholar
Fombonne, E (2003). Epidemiological surveys of autism and other pervasive developmental disorders: an update. Journal of Autism and Developmental Disorders 33, 365382.CrossRefGoogle ScholarPubMed
Fombonne, E (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry 66 (Suppl. 10), 38.Google ScholarPubMed
Frith, U (1991). Autism and Asperger Syndrome. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research 15, 167180.CrossRefGoogle ScholarPubMed
Howlin, P, Goode, S, Hutton, J, Rutter, M (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry 45, 212229.CrossRefGoogle ScholarPubMed
Jenkins, R, Meltzer, H, Bebbington, P, Brugha, T, Farrell, M, McManus, S, Singleton, N (2009). The British Mental Health Survey Programme: achievements and latest findings. Social Psychiatry and Psychiatric Epidemiology 44, 899904.CrossRefGoogle ScholarPubMed
Kanner, L (1943). Autistic disturbance of affective contact. Nervous Child 2, 217250.Google Scholar
Knapp, M, Romeo, R, Beecham, J (2007). Economic Consequences of Autism in the UK. Mental Health Foundation and Autism Speaks: London.Google Scholar
Lord, C, Rutter, M, DiLavore, PC, Risi, S (2002). Autism Diagnostic Observation Schedule. ADOS Manual. Western Psychological Services: Los Angeles.Google Scholar
Lord, C, Rutter, M, Le Couteur, A (1994). Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders 24, 659685.CrossRefGoogle ScholarPubMed
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey. The NHS Information Centre for Health and Social Care: London.Google Scholar
McNamee, R (2002). Optimal designs of two-stage studies for estimation of sensitivity, specificity and positive predictive value. Statistics in Medicine 21, 36093625.CrossRefGoogle ScholarPubMed
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar
Williams, JB, Gibbon, M, First, MB, Spitzer, RL, Davies, M, Borus, J, Howes, MJ, Kane, J, Pope, HGJ, Rounsaville, B (1992). The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Archives of General Psychiatry 49, 630636.CrossRefGoogle ScholarPubMed
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablensky, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.CrossRefGoogle ScholarPubMed
Wing, L (1997). The autistic spectrum. Lancet 350, 17611766.CrossRefGoogle ScholarPubMed
Wing, L, Gould, J (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism and Developmental Disorders 9, 1129.CrossRefGoogle ScholarPubMed
Wing, L, Leekam, SR, Libby, SJ, Gould, J, Larcombe, M (2002). The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry 43, 307325.CrossRefGoogle ScholarPubMed
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