Quantifying the Optimal Structure of the Autism Phenotype: A Comprehensive Comparison of Dimensional, Categorical, and Hybrid Models
Quantifying the Optimal Structure of the Autism Phenotype: A Comprehensive Comparison of Dimensional, Categorical, and Hybrid Models
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DOI：
10.1016/j.jaac.2018.09.431
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发表时间：
2019-09-01
影响因子：
13.3
通讯作者：
Gadow, Kenneth
中科院分区：
文献类型：
--
作者：
Kim, Hyunsik;Keifer, Cara;Gadow, Kenneth
目的：两个主要的-看似矛盾的-战略分类儿童精神综合征是分类和维度的概念模糊性似乎是最大的多元综合征，如自闭症谱系障碍（ASD）。最近，一个令人信服的替代方案已经出现，集成了分类和维度的方法（即，混合模型），由于分析程序的日益复杂。本研究旨在量化ASD的最佳表型结构，通过全面比较分类，尺寸，和混合models.Method：样本包括3,825名青年，谁是连续转介到一所大学的发育障碍或儿童精神科门诊。照顾者完成了儿童和青少年症状量表-4R（CASI-4 R），其中包括ASD症状评定量表。一系列的潜在类分析，探索性和验证性因素分析，以及因素混合分析。复制分析进行了一个独立的样本（N = 2,503）的儿童转介门诊evaluation.Results：基于44个不同的模型比较，结果表明，ASD症状表型是最好的概念化为多维与分类或分类维混合结构。ASD症状在CASI-4 R上最好分为沿着3个维度（即社会交往、交流和重复行为）。结论：研究结果揭示了一个最佳的结构，使用单一的父母报告测量来表征ASD表型，支持存在多个相关的症状维度，这些症状维度跨越正式的诊断边界并量化ASD的异质性。这些发现为理解神经发育障碍如何超越离散的发育类别提供了信息，并代表了人类行为范围内连续分布的特征。
Objective: The two primary-seemingly contradictory-strategies for classifying child psychiatric syndromes are categorical and dimensional; conceptual ambiguities appear to be greatest for polythetic syndromes such as autism spectrum disorder (ASD). Recently, a compelling alternative has emerged that integrates both categorical and dimensional approaches (ie, a hybrid model), thanks to the increasing sophistication of analytic procedures. This study aimed to quantify the optimal phenotypic structure of ASD by comprehensively comparing categorical, dimensional, and hybrid models.Method: The sample comprised 3,825 youth, who were consecutive referrals to a university developmental disabilities or child psychiatric outpatient clinic. Caregivers completed the Child and Adolescent Symptom Inventory - 4R (CASI-4R), which includes an ASD symptom rating scale. A series of latent class analyses, exploratory and confirmatory factor analyses, and factor mixture analyses was conducted. Replication analyses were conducted in an independent sample (N = 2,503) of children referred for outpatient evaluation.Results: Based on comparison of 44 different models, results indicated that the ASD symptom phenotype is best conceptualized as multidimensional versus a categorical or categorical-dimensional hybrid construct. ASD symptoms were best characterized as falling along three dimensions (ie, social interaction, communication, and repetitive behavior) on the CASI-4R.Conclusion: Findings reveal an optimal structure with which to characterize the ASD phenotype using a single, parent-report measure, supporting the presence of multiple correlated symptom dimensions that traverse formal diagnostic boundaries and quantify the heterogeneity of ASD. These findings inform understanding of how neurodevelopmental disorders can extend beyond discrete categories of development and represent continuously distributed traits across the range of human behaviors.