Clinical algorithm for identifying adult autism

描述(由申请人提供)：此R34应用程序寻求支持，以改进和测试在接受门诊治疗的成年人中识别自闭症谱系障碍(ASD)的临床算法 精神科护理。有证据表明，在接受精神护理的个人中，患有自闭症的成年人比例过高，而诊断不足。患有ASD的成年人可能会用治疗ASD无效的药物来治疗他们没有的疾病。他们还可能受益于ASD的特定干预措施，但由于诊断不准确，他们没有得到这些干预措施。ASD诊断工具很长，大多数只在儿童中得到验证，而且它们需要大量培训才能正确使用。因此，它们的使用是不可行的 社区心理健康环境中的成年人。为了开发一种适合这种情况的筛查策略，我们将在住院环境中先前工作的基础上，与宾夕法尼亚州的大型社区精神卫生组织Horizon House合作，识别在他们护理下患有自闭症的成年人。然后，我们将改进和验证我们的算法，用于在接受精神治疗的成年人中识别ASD。我们的目标是使用临床医生容易获得的项目，结合简短的筛查工具，在社区精神卫生环境中准确地识别成年人的ASD，这将导致进一步的诊断评估。这项研究的具体目的是：1)估计社区门诊中未诊断的ASD的患病率；2)比较成人ASD与其他精神疾病成人的临床特征、治疗和指定的诊断；3)开发和测试社区精神卫生实践中筛查成人ASD的简单工具。为了确定自闭症的病例，Horizon House的工作人员将为在6个月内与他们有面对面接触的成年客户填写SRS和成人自闭症谱系障碍筛查问卷(类似研究中使用的较短工具)(2000年8月)。然后，研究人员将对450名按SRS分数分层的受试者进行图表回顾，以提取信息，检查表包括先前研究(发展史、神经问题、药物使用和犯罪活动)中发现的区分患有自闭症和其他精神疾病的成年人的特征~2)使用自闭症诊断观察计划模块4和DSM障碍的结构化临床访谈~)和3)家庭访谈，使用社交沟通问卷、关于早期发展的半结构化问题和修改后的遗传学家庭访谈。将举行个案会议，让所有受试者就自闭症作出最终决定。一旦病例状态被确定，患有和不患有ASD的受试者将使用接收器操作特征曲线和决策树分析在所有变量上进行比较，以确定最简约的筛选策略。如果成功，这项拟议的研究将提供美国对门诊人群ASD的第一次估计，并将极大地提高社区临床医生识别患有ASD的成年人的能力。

DESCRIPTION (provided by applicant): This R34 application seeks support to refine and test a clinical algorithm for identifying autism spectrum disorders (ASD) in adults receiving outpatient psychiatric care. Evidence suggests that adults with ASD are overrepresented and underdiagnosed among individuals receiving psychiatric care. Adults with ASD may be medicated for disorders they do not have with medications that are not effective for treating ASD. They also may benefit from ASD-specific interventions that they do not get because of inaccurate diagnosis. ASD diagnostic tools are lengthy, most are validated only in children, and they require considerable training to administer correctly. Therefore they are not feasible for use with adults in community mental health settings. To develop a screening strategy appropriate for this setting, we will build upon our prior work in inpatient settings by partnering with Horizon House, a large community mental health organization in Pennsylvania, to identify adults with ASD in their care. We then will refine and validate our algorithm for identifying ASD in adults presenting for psychiatric treatment. Our goal is to use items readily available to clinicians, in combination with a brief screening tool, to accurately identify ASD in adults in community mental health settings, which would then lead to further diagnostic assessment. The specific aims of the proposed study are to: 1) Estimate the prevalence of undiagnosed ASD in community outpatient settings~ 2) Compare clinical characteristics, treatment and assigned diagnoses of adults with ASD with those of adults with other psychiatric disorders~ and 3) Develop and test a brief tool for community mental health practice to screen for ASD in adults. To determine cases of ASD, Horizon House staff will complete the SRS and the Autism Spectrum Disorders in Adults Screening Questionnaire (a shorter instrument used in similar studies) for adult clients with whom they have in-person contact during a 6-month period (n H 2000). Researchers then will conduct, on a sample of 450 subjects stratified by SRS score: 1) chart reviews to extract information using a checklist comprising the characteristics found to discriminate between adults with ASD and other psychiatric disorders in prior studies (developmental history, neurological problems, substance use and criminal activity~ Appendix B)~ 2) structured clinical interviews using the Autism Diagnostic Observation Schedule, Module 4, and the Structured Clinical Interview for DSM Disorders~ and 3) family interviews, using the Social Communication Questionnaire, semi-structured questions about early development, and the modified Family Interview for Genetic Studies. Case conferences will be conducted for all subjects to make a final determination of ASD. Once case status is determined, subjects with and without ASD will be compared on all variables using receiver operating characteristic curves and decision tree analyses to determine the most parsimonious creening strategies. If successful, the proposed study will provide the first US estimates of ASD in an outpatient population and will greatly enhance community clinicians' ability to identify adults with ASD.