Objectives: Many have hypothesized that caregivers exaggerate or understate autistic symptoms, based upon when in the child’s life they are asked to remember behaviors. Two studies determined whether caregivers anchor their perception of prior symptoms based upon the current functioning of the child as described on the ADI-R.
Methods: In the first study, a between subjects design, three formats of the ADI-R were administered to randomly chosen samples of caregivers whose children were matched on age, IQ and ASD diagnosis. 32 caregivers reported current symptoms on the ADI-R for all questions and then reported prior history of symptoms. 30 caregivers reported prior history of symptoms for all questions followed by current symptoms. 88 caregivers answered the ADI-R questions in the typical format, reporting current and prior history of behaviors together. Analyses were conducted comparing the two groups who received the ADI questions separated by time on algorithm totals for current and past behaviors and secondary analyses compared the three groups. In the second study, a within subjects design, data on the ADI-R was collected from 102 caregivers of children with suspected ASD or non-spectrum delay at 5 and 9 years of age. Analyses were conducted comparing how caregivers reported symptoms when the child was 4 -5 versus how caregivers reported symptoms about this same time period retrospectively when the child was 9 years of age.
Results: In the first study, caregivers who were first asked only current questions had higher totals for both current and prior history of symptoms compared to caregivers who were first asked only previous history of behaviors. Caregivers who were first asked only previous history of symptoms had lower totals of prior behaviors compared to caregivers who were first asked current behaviors and to those who were given the ADI-R in a typical format. In the second study, caregivers of children at age 9 retrospectively described their child’s symptoms from age 5 as more severe compared to when caregivers were reporting the current symptoms at age 5. Caregivers retrospectively described more severe behavior problems at age 5 in children who had more internalizing or externalizing behaviors on the Child Behavior Checklist at age 9.
Conclusions: Overall these findings highlight the importance of using both current and prior history symptom questions on the ADI-R and that the current functioning of a child should be considered when using this instrument as a diagnostic tool. How parents report symptoms is complicated and it is crucial to consider the influence of both prior and current symptoms from caregiver reports in diagnoses.
See more of: Clinical Phenotype
See more of: Symptoms, Diagnosis & Phenotype