Validity of the Social Responsiveness Scale to Differentiate HF-ASD From ODD/CD

Thursday, May 17, 2012
Sheraton Hall (Sheraton Centre Toronto)
1:00 PM
H. Musch1 and C. M. Freitag2, (1)Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, JW Goethe University Frankfurt am Main, Frankfurt main, Germany, (2)Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, JW Goethe University Frankfurt am Main, Frankfurt am Main, Germany
Background:  

Autism spectrum disorders (ASD) are characterised by the presence of impairments in communication, reciprocal social interaction alongside with inflexible behaviour patterns, interests and activities (DSM-IV-TR; ICD-10). The international classification systems aim to establish the presence or absence of categorically defined symptoms, but research indicates, that autism is the extreme end of a continuously distributed trait. The Social Responsiveness Scale (SRS, Constantino & Gruber, 2005) is a 65-item questionnaire for parents and teacher that explicitly focuses on the measurement of autistic traits in children and adolescents which can also be used as a screening instrument. A factor analytic study resulted in a one factor solution (Constantino et al., 2004). A recent study in Germany reported a ROC of 98% when comparing ASD individuals with healthy typically developing controls. The ROC was much lower (81%), when compared to clinical controls who suffered from a mixture of child psychiatric disorders (Bölte et al., 2011).

Objectives:  

As no study has been performed to date on the validity of the SRS to differentiate between high-functioning ASD and other specific child psychiatric disorders, the present study aimed to assess its diagnostic validity in differentiating ASD from oppositional defiant disorder / conduct disorder (ODD/CD), which is also characterised by difficulties in reciprocal social interaction.

Methods:  

55 individuals with HFASD, 55 age, sex and IQ matched children with ODD / CD and 55 typically developing children were included in the study. Diagnosis was done by ADI-R / ADOS, K-DIPS (child psychiatric diagnostic interview), IQ-measurement, specific questionnaires and clinical observation.

Statistical analysis: Pairwise ROC-analysis between groups, cut-off values and sensitivity/specificity are calculated. The mean total SRS-score is compared between groups, influence of IQ, age, and gender are calculated by linear regression analysis. Correlation analysis will be done with algorithm scores of ADI-R, ADOS, and measures of general psychopathology (CBCL).

Results:  

ROC-values, sensitivity and specificity were high, when HF-ASD and typically developing controls were compared, but considerably lower, when HF-ASD had to be differentiated from ODD / CD. Mean SRS total scores of HF-ASD were highest, followed by ODD/CD, lowest in typically developing controls. Gender, but not IQ effects were observed. Correlation with ADI-R and ADOS algorithm scores was in the medium range, CBCL social problems and aggressive behavior scores also correlated with the SRS total score across groups.

Conclusions:  

The SRS has been developed as a measure of quantitative autism traits in the general population. Clinically, it is also used as a screening instrument for ASD. The current study replicates the good validity of the SRS to differentiate between ASD and typically developing controls, but alerts to the possibility of false-positive ASD diagnoses in children with ODD / CD by the SRS.

The study was supported by a grant of the JW Goethe University`s Medical Faculty Frankfurt am Main (Heinrich and Fritz Riese foundation).

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