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Diagnostic Validity of the ADOS and ADI-R in Children Aged <48 Months: A European Perspective

Thursday, 2 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
E. Zander1,2, H. Sturm2 and S. Bölte1, (1)Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden, (2)Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
Background:   The diagnostic validity of the ADOS (revised algorithms) and the ADI-R (research algorithms) for ASD in young children with developmental difficulties has been studied in research settings in the USA (e.g. Kim & Lord, 2012). However, less is known about the validity of the gold standard in early childhood populations in clinical settings and in other countries.

Objectives:   To examine the diagnostic validity of the ADOS (revised algorithms) and ADI-R (research algorithms) in a clinical child psychiatric out-patient unit in Stockholm, Sweden.

Methods:   All children with unclear developmental problems (aged <48 months) assessed between 2007 and 2012 at the Neuropsychiatric Unit South East, Stockholm County ( were included in the study (N>200; ~25%girls; ~60% of Swedish origin, 30% of non-European origin). Aside from the ADOS and ADI-R the assessments included the Vineland-II, Merrill-Palmer-R/Mullen Early Learning Scales and observations in the children’s preschool. Diagnostic validity of the ADOS and ADI-R was investigated against a best estimate clinical consensus diagnosis made by an experienced clinical team (child psychiatrist, psychologist, social worker).

Results: About 70% of the referred children were diagnosed with ASD; the remainder primarily with ADHD and intellectual disability. The ADOS (sensitivity: 96%; specificity: 64%) had a higher diagnostic accuracy than the ADI-R (sensitivity: 58%; specificity: 78%).

Conclusions:   Both ADOS and ADI-R provide clinically valuable information in the assessment of young children with a suspected ASD. Overall, the ADOS showed a higher diagnostic validity than the ADI-R, although the interview yielded a somewhat higher specificity than the ADOS in a European clinical outpatient unit.

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