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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 ,
S. McManus ,
J. Smith ,
F. J. Scott ,
H. Meltzer ,
S. Purdon ,
T. Berney ,
D. Tantam ,
J. Robinson  and
J. Radley
...Show all authors
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: [email protected])
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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.

Keywords

Adultautistic disorderepidemiologic methodsinstrumentationvalidity and reliability
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 647 - 656
Copyright
Copyright © Cambridge University Press 2011

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