Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community
Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community
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DOI：
10.1017/s0033291711001292
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发表时间：
2012-03-01
影响因子：
6.9
通讯作者：
Bankart, J.
中科院分区：
文献类型：
--
作者：
Brugha, T. S.;McManus, S.;Bankart, J.
背景。在成人普通人群样本中，尚无针对自闭症谱系障碍（ASD）进行流行病学研究的经检验的方法。我们检验了自闭症诊断观察量表第4版模块（ADOS - 4）和20项自闭症谱系商数（AQ - 20）的有效性。
方法。在英格兰各地对随机抽样的年龄≥16岁的成年人进行了一项普通人群多阶段调查访谈。在第1阶段，7353名成年人自行完成了AQ - 20。一个随机子集完成了第2阶段的ADOS - 4评估（n = 618）；被选中的概率随AQ - 20分数增加。在第3阶段，完成了基于知情人的社交和沟通障碍诊断访谈量表（DISCO）以及自闭症诊断访谈修订版（ADI - R）发育评估（n = 56）。将第1阶段和第2阶段的数据以案例形式呈现给6名经验丰富的临床医生（两人一组工作）。比较了三个调查阶段中受访者患有ASD的概率。
结果。临床共识诊断与ADOS - 4之间有中等程度的一致性。临床医生确定了一系列ADOS - 4病例判定阈值：5 +到13 +，曲线下面积（AUC）最大为5 +时（0.88）。使用56次DISCO评估对ASD存在情况进行建模表明，ADOS - 4阈值在10 +到13 +范围内，AUC最高为ADOS 10 +到11 +（0.93 - 0.94）。在ADOS为10 +时，敏感度为1[95%置信区间（CI）0.59 - 1.0]，特异度为0.86（95% CI 0.72 - 0.94）。AQ - 20只是ADOS - 4病例的一个较弱预测指标。
结论。临床推荐的ADOS - 4阈值也推荐用于社区病例：亚阈值为7 +，确诊病例为10 +。需要进一步开展关于成年人群体筛查方法的研究。
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.