Between a ROC and a hard place: decision making and making decisions about using the SCQ
Between a ROC and a hard place: decision making and making decisions about using the SCQ
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DOI：
10.1111/j.1469-7610.2007.01762.x
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发表时间：
2007-09-01
影响因子：
7.6
通讯作者：
Lord, Catherine
中科院分区：
文献类型：
--
作者：
Corsello, Christina;Hus, Vanessa;Lord, Catherine
背景：社会交往问卷（SCQ），前身为自闭症筛查问卷（ASQ），基于一种经过充分验证的家长访谈，即自闭症诊断访谈（ADI）。在一个由研究推荐的年龄较大的样本中，它作为自闭症谱系障碍（ASD）的一种筛查工具显示出了潜力，尽管近期对年幼儿童的研究报告称，当使用建议的≥15的临界值来区分自闭症谱系障碍儿童和非谱系障碍（NS）儿童时，其敏感性较低。
方法：在一个由590名儿童和青少年（2至16岁）组成的临床和研究推荐样本中，对SCQ的诊断区分能力进行了单独评估以及与自闭症诊断观察量表（ADOS）联合评估，这些样本具有自闭症、广泛性发育障碍（非特定型）（PDD - NOS）和非自闭症谱系障碍的最佳估计共识诊断。在大多数情况下，SCQ在评估之前完成。还将SCQ的表现与自闭症诊断访谈修订版（ADI - R）进行了比较。
结果：年幼儿童的绝对分数和敏感性以及所有组别的特异性均低于原始研究中所报告的水平。使用受试者工作特征曲线（ROC）来检查曲线下面积（AUC），在区分自闭症谱系障碍和非谱系障碍方面，SCQ在年龄较大（8 - 10岁、>11岁）的组中比在年龄较小（<5岁、5 - 7岁）的组中与ADI - R总分更为相似。降低两个较年轻组的临界分数提高了敏感性，但所有组的特异性仍然相对较低。将SCQ与ADOS联合使用提高了特异性。联合使用ADI - R和ADOS的诊断区分能力最佳。
结论：有兴趣使用SCQ的人员应考虑根据年龄和目的调整临界分数，并将其与另一种测量方法联合使用。根据目标不同，在研究或筛查中可能会优先考虑敏感性或特异性。
Background: The Social Communication Questionnaire (SCQ), formerly the Autism Screening Questionnaire (ASQ), is based on a well-validated parent interview, the Autism Diagnostic Interview (ADI). It has shown promise as a screening measure for autism spectrum disorders (ASDs) in a research-referred older sample, though recent studies with younger children reported lower sensitivities when using the suggested cutoff of >= 15 to differentiate ASDs from children with nonspectrum disorders (NS).Methods: Diagnostic discrimination of the SCQ was evaluated alone and in combination with the ADOS (Autism Diagnostic Observation Schedule) in a clinical and research-referred sample of 590 children and adolescents (2 to 16 years), with best estimate consensus diagnoses of autism, pervasive developmental disorder, not otherwise specified (PDD-NOS) and non-ASD disorders. The SCQ was completed before the evaluation in most cases. Performance of the SCQ was also compared with the Autism Diagnostic Interview - Revised (ADI-R).Results: Absolute scores and sensitivity in the younger children and specificity for all groups were lower than reported in the original study. Using receiver operating curves (ROC) to examine the area under the curve (AUC), the SCQ was more similar to the ADI-R total score in differentiating ASD from NS disorders in the older (8-10, > 11) than younger age groups (< 5, 5-7). Lowering the cutoff score in the 2 younger groups improved sensitivity, with specificity remaining relatively low in all groups. Using the SCQ in combination with the ADOS resulted in improved specificity. Diagnostic discrimination was best using the ADI-R and ADOS in combination.Conclusions: Those interested in using the SCQ should consider adjusting cutoff scores according to age and purpose, and using it in combination with another measure. Sensitivity or specificity may be prioritized for research or screening depending on goals.