Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research
Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research
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DOI：
10.1016/j.jaac.2016.09.490
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发表时间：
2016-12-01
影响因子：
13.3
通讯作者：
Bishop, Somer L.
中科院分区：
文献类型：
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作者：
Havdahl, Karoline Alexandra;Bal, Vanessa Hus;Bishop, Somer L.
目的：人们日益认识到自闭症谱系障碍（ASD）的症状跨越多个诊断类别，并且在识别与ASD相关的遗传综合征方面取得了重大进展，这导致在神经发育障碍的病因学研究中广泛使用ASD症状测量方法。对认知能力或行为问题等潜在混杂因素考虑不足，可能会对研究结果的解释产生重要的负面影响，包括对ASD与病因因素之间关联的错误估计。
方法：参与者为388名2至13岁的儿童，他们被诊断患有ASD或其他非ASD的神经发育障碍。采用受试者工作特征方法评估智商以及情绪和行为问题对3种广泛使用的ASD症状测量方法的判别能力的影响，这3种方法分别是：社会反应量表（SRS）、自闭症诊断访谈修订版（ADI - R）和自闭症诊断观察量表（ADOS）。
结果：智商影响了SRS和ADI - R的判别阈值，情绪和行为问题影响了SRS、ADI - R和ADOS的判别阈值。这导致对于无ASD的智力残疾儿童，SRS和ADI - R上ASD临界值的特异性较低（27% - 42%），对于有情绪和行为问题增加的非ASD儿童，所有3种工具的特异性都较低（36% - 59%）。对这些特征进行调整后，所有ASD测量方法的判别能力都得到了提高。
结论：研究结果表明，ASD症状测量的分数所反映的远不止ASD症状。要对这些测量的分数进行有效解释，需要采取措施考虑智商以及情绪和行为问题的影响。
Objective: Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors.Method: Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS).Results: IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27-42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36-59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures.Conclusion: The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.