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The Autism Mental Status Exam: Psychometric Validity of a Brief Screening Tool

Friday, May 15, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)
B. Lewis1, J. M. Jamison2, C. Farrell3 and D. Grodberg4, (1)Yale Child Study Center, New Haven, CT, (2)Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, (3)Developmental and Behavioral Pediatrics, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, (4)Box #1230, Icahn School of Medicine at Mount Sinai, New York, NY
Background:   The American Academy of Pediatrics (AAP) recommends screening for autism spectrum disorder (ASD) at 18-month well-child visits, but implementation in pediatric settings is slow with fewer than 10% of pediatricians integrating an ASD-specific screen (Barton et al., 2012; Dosreis, Weiner, Johnson, & Newschaffer, 2006).  A multitude of screening tools exist; however, some lack sound psychometric properties, others are cumbersome to integrate into pediatric settings, and the majority are parent-report questionnaires.

The Autism Mental Status Exam (Grodberg, 2011) is an 8-item observational assessment requiring clinician rating of highly predictive ASD symptoms resulting in a global risk score. The AMSE is not intended to add extra work to a clinician’s exam, but rather structures the way that data are observed and documented; thus it carries minimal clinical burden. It is intended for use by a variety of health professionals and proposed for many functions, including rapid assessment of ASD profiles for clinical and research purposes, supplement to ASD diagnostic evaluations, and potentially use as a screening tool. An initial validation study indicated the AMSE had high classification accuracy when compared to the Autism Diagnostic Observation Schedule (Grodberg, Weinger, Kolevzon, Soorya, & Buxbaum, 2012).

Objectives:   The current study contributes to the psychometric investigation of the AMSE as a tool to assess autism symptomatology in children seen in diverse settings.  Specifically, the AMSE’s convergent validity will be verified with comparisons to an empirically validated measure of ASD symptoms.

Methods: The study includes children presenting for an initial visit in three community settings: developmental behavior pediatric clinic, an autism clinic, and a preschool program.  Participants included were those whose health care provider completed the AMSE during the initial assessment and whose parents completed the Social Responsiveness Scale, 2nd Edition (SRS-2, Constantino & Gruber, 2012).  The sample (n=59) was predominantly male (70%), racially diverse (22% Hispanic, 22% Caucasian, 14% African American, and 8% multi-racial), with a median age of 61 months.

Results: AMSE Total Score was significantly correlated with the SRS-2 Total Score (r(56) = .61, p < .01).  Furthermore, the AMSE’s classification of risk for ASD was significantly related to classification of risk on the SRS-2 (X2 (1, N = 59) = 18.88, p < .01).  Construct validity of specific items on the AMSE was supported through significant relationships with related subdomains on the SRS-2.  Specifically, Interest in Others on the AMSE was significantly related to SRS-2 subdomain Social Awareness (r(57) = .34, p = .01), Pragmatics of Language was significantly correlated with Social Communication subdomain on the SRS-2 (r(57) = .35, p = .01), and the SRS-2 subdomain Restricted Interests and Repetitive Behavior was significantly correlated with both Repetitive Behaviors/Stereotypy (r(56) = .49, p < .01) and Unusual or Encompassing Preoccupations (r(55) = .40, p < .01) items on the AMSE.

Conclusions: The AMSE demonstrated strong convergent and construct validity with the SRS-2 within a diverse sample.  Based on continued evidence of sound psychometrics, further research is recommended to explore its validity and clinical utility as a brief ASD-screening tool in pediatric settings.