Diagnostic observation schedule not necessary for autism diagnosis in children

The Autism Diagnostic Observation Schedule (ADOS) is not needed to diagnose autism spectrum disorder (ASD) in young children, according to a recent study published in JAMA Pediatrics.

ASD is a neurodevelopmental disorder with symptoms such as restricted and repetitive behaviors and difficulty interacting with others. The current prevalence of ASD is 1 in 44 children aged 8 years and has increased over time. 

Treatment for ASD is most effective when given earlier in life. In order to receive treatment, children must be given a diagnosis by a health care provider. Currently, criteria from the Diagnostic and Statistical Manual of Mental Disorders are followed when diagnosing ASD.

Certain professionals consider the ADOS, a semistructured observation of behaviors in ASD, to be a standard for ASD diagnosis. It is often necessary for both early and school-based intervention, along with intensive behavioral treatment. Administration takes 45 to 60 minutes, with specialized training required.

There is currently little research on ADOS in a clinical environment. As ADOS is often required for treatment, and ASD prevalence has risen, investigators saw a need to determine the accuracy and efficiency of diagnosis through ADOS compared to other methods. A multisite prospective diagnostic study on ADOS and ASD diagnosis was conducted.

Eight sites participated in the study and provided subspecialty assessments for children with ASD. Children aged 18 months to 5 years, 11 months and referred with ASD diagnosis between May 2019 and February 2020 were evaluated. Exclusion criteria included not speaking English and receiving an ASD diagnosis previously from a multidisciplinary team.

A demographic form detailed child’s date of visit, age, race and ethnicity, insurance type, main reason for referral, and the education level of the primary caregiver. Developmental-behavioral pediatricians (DBPs) evaluated this information along with clinical intake forms detailing presenting concerns, referring physicians’ questions, and prior assessments.

Clinical observations included ASD symptoms and visit characteristics. Behaviors were also recorded, focusing on hyperactive, inattentive, and aggressive behaviors.DBPs chose whether to diagnose patients with ASD at the end of phase 1.

In phase 2 of the trial, ADOS was used to diagnose patients with ASD. After diagnosis was given, DBPs made their diagnoses again, now having the ADOS results in mind alongside clinical data.

There were 349 children analyzed by over 40 DBPs in the study. When comparing clinical diagnoses with ADOS diagnoses, consistency was 90%. Of the 250 children who were diagnosed with ASD through ADOS, 232 were also diagnosed clinically.

As clinical diagnoses were consistent with ADOS diagnoses, investigators concluded that ADOS is not always necessary to diagnose children with ASD. Reducing the frequency of cases where ADOS is required for diagnosis could provide timely and costly ASD diagnoses.

Reference

Barbaresi W, Cacia J, Friedman S, Fussell J, Hansen R, Hofer J, et al. Clinician diagnostic certainty and the role of the autism diagnostic observation schedule in autism spectrum disorder diagnosis in young children. JAMA Pediatr. 2022;176(12):1233–1241. doi:10.1001/jamapediatrics.2022.3605