Clinical algorithm for identifying adult autism

描述（由申请人提供）：该R34申请寻求支持，以完善和测试用于在接受门诊治疗的成人中识别自闭症谱系障碍（ASD）的临床算法 精神病治疗有证据表明，在接受精神病治疗的人中，患有ASD的成年人比例过高，诊断不足。患有ASD的成年人可能会因他们没有的疾病而接受药物治疗，这些药物对治疗ASD无效。他们也可能受益于ASD特异性干预，因为诊断不准确，他们没有得到。ASD诊断工具很长，大多数仅在儿童中得到验证，并且需要相当多的培训才能正确使用。因此，它们不适合使用 在社区心理健康机构中的成年人。为了制定适合这种情况的筛查策略，我们将在住院治疗的基础上，与宾夕法尼亚州一家大型社区精神卫生组织Horizon House合作，识别出患有ASD的成人。然后，我们将完善和验证我们的算法，用于识别接受精神病治疗的成年人中的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，在社区心理健康环境中准确识别成人ASD，然后进行进一步的诊断评估。该研究的具体目的是：1）估计社区门诊中未诊断的ASD的患病率~ 2）比较ASD成年人与其他精神疾病成年人的临床特征，治疗和指定诊断~ 3）开发和测试社区心理健康实践的简要工具，以筛查成人ASD。为了确定ASD病例，Horizon House工作人员将为6个月内与他们有面对面接触的成年客户完成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）（n H 2000）。然后，研究人员将对按SRS评分分层的450名受试者样本进行：1）图表审查，以使用检查表提取信息，该检查表包括在先前研究中发现的区分患有ASD和其他精神疾病的成年人的特征（发育史，神经问题，物质使用和犯罪活动~附录B）~ 2）使用自闭症诊断观察表，模块4，和DSM疾病的结构化临床访谈和3）家庭访谈，使用社会沟通问卷，关于早期发展的半结构化问题，以及修改后的遗传研究家庭访谈。将对所有受试者进行病例会议，以最终确定ASD。一旦确定病例状态，将使用受试者工作特征曲线和决策树分析比较ASD和非ASD受试者的所有变量，以确定最简约的筛选策略。如果成功的话，这项拟议的研究将提供美国第一个在门诊人群中对ASD的估计，并将大大提高社区临床医生识别ASD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.