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Friday, May 8, 2009
Boulevard (Chicago Hilton)
Background: The Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Scale (ADOS) have strong psychometric properties and are the current gold-standard assessment tools for autism. However, these instruments have several problematic features: 1) they both require training and extensive practice for a rater to develop proficiency; 2) the ADI-R relies on a combination of a caregiver’s interpretation of behavior, her ability to clearly articulate descriptions of behavior, and a rater’s ability to probe effectively; 3) an interview can take between 1.5 to 3 hours to complete; 4) the ADOS provides 30 minutes to observe behavior and relies on structured probes; and 5) while the ADOS can classify a subject with autism or autism spectrum disorder (ASD) based on atypical behaviors related to socialization and communication, no repetitive behaviors are considered in the process. Excluding one required behavioral domain can lead to an incomplete clinical profile for the individual. An improved diagnostic measure would rely on observed behavioral examples that occur during routine natural settings and provide sufficient information to diagnose autism. This procedure would provide a more accurate clinical profile for the individual.
Objectives: To design a reliable and valid diagnostic procedure for classifying individuals with autism based on observation of typical and autism-related behaviors that occur in naturalistic settings and requires significantly less time than the ADI-R and ADOS.
Methods: Participants were five children with autism, age four and under, and their caregivers. ADI-R and ADOS assessments were previosuly completed. Parents were asked to: 1) record their child for 8 to 10 minutes in four settings: mealtime, play with peers, unstructured play, and problem time, on two separate days, with an inconspicuous Flip Video™ camera; 2) interact with their children as they would normally do in each setting; and 3) upload videos from their home to B.I. (Behavior Imaging) Care’s platform for rater review. Three ADI-R and ADOS reliable raters reviewed each of the videos online from multiple locations. The raters used B.I. Care’s video tagging and annotations tools to comment on typical behaviors as well as autism related behaviors. The tagged autism related behaviors were then used to support DSM IV criteria for autistic disorder.
Results: Each child assessed through this method met full DSM IV criteria for autistic disorder. Previously, five children met criteria for ADI-R autism, three met criteria for autism on the ADOS, and two met criteria for ASD.
Conclusions: This procedure relies on direct behavioral observation that occurs in the naturalistic setting, permits for behaviors to be observed over time, was completed in <60 minutes, and was concordant with ADI-R diagnosis. Additionally, this method provides an opportunity to quantify the amount and type of typical behavior that is exhibited by the child, which, combined with the measure of autistic behavior may translate into a measure of severity for the disorder in each child. Work on this project is continuing as we collect a larger sample of subjects and we plan to measure the reliability of raters who are untrained on the ADI-R and ADOS.
Objectives: To design a reliable and valid diagnostic procedure for classifying individuals with autism based on observation of typical and autism-related behaviors that occur in naturalistic settings and requires significantly less time than the ADI-R and ADOS.
Methods: Participants were five children with autism, age four and under, and their caregivers. ADI-R and ADOS assessments were previosuly completed. Parents were asked to: 1) record their child for 8 to 10 minutes in four settings: mealtime, play with peers, unstructured play, and problem time, on two separate days, with an inconspicuous Flip Video™ camera; 2) interact with their children as they would normally do in each setting; and 3) upload videos from their home to B.I. (Behavior Imaging) Care’s platform for rater review. Three ADI-R and ADOS reliable raters reviewed each of the videos online from multiple locations. The raters used B.I. Care’s video tagging and annotations tools to comment on typical behaviors as well as autism related behaviors. The tagged autism related behaviors were then used to support DSM IV criteria for autistic disorder.
Results: Each child assessed through this method met full DSM IV criteria for autistic disorder. Previously, five children met criteria for ADI-R autism, three met criteria for autism on the ADOS, and two met criteria for ASD.
Conclusions: This procedure relies on direct behavioral observation that occurs in the naturalistic setting, permits for behaviors to be observed over time, was completed in <60 minutes, and was concordant with ADI-R diagnosis. Additionally, this method provides an opportunity to quantify the amount and type of typical behavior that is exhibited by the child, which, combined with the measure of autistic behavior may translate into a measure of severity for the disorder in each child. Work on this project is continuing as we collect a larger sample of subjects and we plan to measure the reliability of raters who are untrained on the ADI-R and ADOS.