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The clinical utility of the ADI-R and ADOS in diagnosing autism

  • Michael Fitzgerald (a1)
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1 Larson, FV, Wagner, AP, Jones, PB, Tantam, D, Meng-Chuan, L, Baron-Cohen, S, et al. Psychosis in autism: comparison of the features of both conditions in a dually affected cohort. Br J Psychiatry 2017; 210: 269–75.
2 Fitzgerald, M. Schizophrenia and autism/Aspergers syndrome: overlap and difference. Clin Neuropsychiatry 2012; 9: 171–6.
3 Ventola, PE, Kleinman, J, Pandey, P, Barton, M, Allen, S, Greene, J, et al. Agreement among four diagnostic instruments for autism spectrum disorders in toddlers. J Autism Dev Disord 2006; 36: 839–47.
4 Baird, G, Simonoff, E, Pickles, A, Chandler, S, Loucast Meldrum, D, Charman, T. Prevalence of disorders of the autism spectrum disorder in a population cohort of children in South Thames: the Special Needs and Autism Project. Lancet 2006; 368: 210–5.
5 National Institute for Health and Care Excellence. Autism: Recognition, Referral, Diagnosis and Management of Adults on the Autism Spectrum. British Psychological Society & Royal College of Psychiatrists, 2012.
6 Feinstein, A. A History of Autism. Wiley-Blackwell, 2010.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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The clinical utility of the ADI-R and ADOS in diagnosing autism

  • Michael Fitzgerald (a1)
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Response to comments by Gary O’Reilly, (2017) on the Clinical Utility of the ADI-R and ADOS ...

michael fitzgerald, Psychiatrist, Trinity College, Dublin, Ireland
08 March 2018

Dear Editor,

I read, with interest, the comments by Gary O’Reilly, (2017) on the Clinical Utility of the ADI-R and ADOS in diagnosing autism. I would like to point out that the NICE Guideline No. 142 states that, “ADI-R is not the gold standard for diagnosis”, of autism. The broader autism phenotype is supported by the genetics of autism. Autism is one of the most genetic conditions in psychiatry. Psychiatrists and psychologists divide themselves into two groups; (1) the “splitters”, who observe narrow diagnosis and (2) the “lumpers”, who see Spectrums. Clearly at this stage in the development of psychiatry and psychology what we have are lumpers who see conditions like autism, ADHD, schizophrenia etc on Spectrums. This is a very accurate reflection of where psychiatry and clinical psychology is today. It is possible that in the future, we will have diagnosis based on biomarkers, diagnosis based on neuroimaging, neurophysiology, genetics etc. We are a very long way away from that yet. For clinicians who work with patients with the disorders mentioned above seen every day in the clinical practice are Spectrums. The so-called, “splitters diagnosis” in psychiatry is little more than pseudoscience. The ADI-R does not reflect the usual spectrum of autism seen in routine clinical

practice. Research using this instrument needs to be redone using a definition of autism that exists in the general population. What is the point in doing research on a narrow group of persons with autism, not reflecting the general population of persons with autism. The narrow diagnosis gives you a highly biased sample and a sample that does not reflect the general population which is critical for scientific research. Research using a narrow concept of autism needs to be re-done as it does not reflect autism in the general population.

Reilly G: The Clinical Utility of the ADI-R and ADOS in diagnosing autism. Br. J. Psychiatry 2017, 2011(2) 117.

National Institute for Health & Care Excellence: Autism. British Psychological Society and Royal College of Psychiatrists, 2012.

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Conflict of interest: None declared

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