Development and validation of a streamlined autism case confirmation approach for use in epidemiologic risk factor research in prospective cohorts
Development and validation of a streamlined autism case confirmation approach for use in epidemiologic risk factor research in prospective cohorts
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DOI：
10.1002/aur.1659
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发表时间：
2017-03-01
期刊：
影响因子：
4.7
通讯作者：
Warren, Zachary E.
中科院分区：
文献类型：
--
作者：
Newschaffer, Craig J.;Schriver, Emily;Warren, Zachary E.
在自闭症谱系障碍（ASD）危险因素的大规模流行病学研究中，将标准化观察评估和诊断访谈纳入其中的成本可能很高。确认ASD病例状态的简化方法将使这些研究受益。我们进行了一项多地点，横断面标准效度研究，在一个方便的样本382个三岁奥尔兹预定的神经发育评估。ASD病例分类由三种新的评估工具（早期视频引导自闭症筛查E-VAS;自闭症症状访谈，ASI;幼儿自闭症筛查工具扩展，STAT-E）确定，每种评估工具均设计为由外行人员在30分钟内进行管理，并与合格临床医生的ADOS评分和基于DSM的诊断评估进行比较。估计了每种仪器单独和组合的灵敏度和特异性。根据不同的标准确定了替代临界点，并使用两阶段交叉验证以避免过拟合。在一项大型前瞻性妊娠队列研究的背景下，采用两阶段方法进行病例识别，对结果进行了解释。在初始临界点下，灵敏度范围为0.63至0.92，特异性范围为0.35至0.70。对敏感性和特异性给予同等权重的临界点导致敏感性估计值范围为0.45至0.83，特异性范围为0.49至0.86。有几种策略非常适合作为第二阶段的病例确认。这些包括单独使用STAT-E以及E-VAS和ASI的平行给药。在ASD危险因素的大规模前瞻性队列流行病学调查中使用更简化的病例确认方法似乎是可行的。Autism Res2017，10：485-501. (c)2016年国际自闭症研究学会，Wiley Periodicals，Inc。
The cost associated with incorporating standardized observational assessments and diagnostic interviews in large-scale epidemiologic studies of autism spectrum disorders (ASD) risk factors can be substantial. Streamlined approaches for confirming ASD case status would benefit these studies. We conducted a multi-site, cross-sectional criterion validity study in a convenience sample of 382 three-year olds scheduled for neurodevelopmental evaluation. ASD case classification as determined by three novel assessment instruments (the Early Video-guided Autism Screener E-VAS; the Autism Symptom Interview, ASI; the Screening Tool for Autism in Toddlers Expanded, STAT-E) each designed to be administered in less than 30 minutes by lay staff, was compared to ADOS scores and DSM-based diagnostic assessment from a qualified clinician. Sensitivity and specificity of each instrument alone and in combination were estimated. Alternative cutpoints were identified under different criteria and two-stage cross validation was used to avoid overfitting. Findings were interpreted in the context of a large, prospective pregnancy cohort study utilizing a two-stage approach to case identification. Under initial cutpoints, sensitivity ranged from 0.63 to 0.92 and specificity from 0.35 to 0.70. Cutpoints giving equal weight to sensitivity and specificity resulted in sensitivity estimates ranging from 0.45 to 0.83 and specificity ranging from 0.49 to 0.86. Several strategies were well-suited for application as a second-stage case-confirmation. These included the STAT-E alone and the parallel administration of both the E-VAS and the ASI. Use of more streamlined methods of case-confirmation in large-scale prospective cohort epidemiologic investigations of ASD risk factors appears feasible. Autism Res2017, 10: 485-501. (c) 2016 International Society for Autism Research, Wiley Periodicals, Inc.