The Autism Mental Status Exam. Validation of a Spanish Version in Argentina

Background: In many areas of Argentina, as in other Latin-American countries, physicians and institutions typically do not have the resources to train in or to administer comprehensive diagnostic observational assessments for patients suspected of ASD. This fact leads frequently to under and misdiagnosing leaving a very important amount of the population underserved, and preventing researchers from selecting representative samples for clinical and epidemiological research. The autism mental status exam (AMSE) is a free and brief eight-item observation tool that addresses this gap. The AMSE, designed at the Seaver Autism Center for Research and Treatment at the Icahn School of Medicine at Mount Sinai, structures the observation and documentation of signs and symptoms of ASD and yields a score. Excellent sensitivity and specificity was demonstrated in a population of high-risk adults and recently, in a population of 45 young children with social and communication concerns.

Objectives: To provide with a short and free diagnostic tool feasible to be used in middle –income countries such as Argentina by investigating the validity and inter-rater reliability of the Spanish version of the AMSE in a sample of local children and adolescents. 

Methods: The AMSE was translated into Spanish, adapted to the local idiomatic expressions and back-translated into English. AMSE's test is now being performed in a population of 150 children and adolescents (age 18 months to 18 years) with social and communication concerns who are evaluated at four different autism centers in Argentina. The ADOS is to be used to estimate the most effective criterion cut-off on the AMSE for Argentine population. Each subject receives a developmental evaluation, including the AMSE followed by independent standardized assessment using the ADOS. Rapid Database Generator (RDG) toolset will be used to analyze the data, to determine cut off criteria, sensitivity and specificity of AMSE to predict the result from ADOS and DSM-5 diagnosis of ASD. 

Results: A summary of the results including cut off criteria, sensitivity, specificity and inter-rater reliability will be presented, and also an analysis of regional similarities and differences. Preliminary results show good sensitivity (>95%), specificity (>95%) (using a cut-off of 5 points in AMSE), and inter-rater reliability (>80%) in this high-risk Argentine sample. 

Conclusions: Preliminary findings suggest that the AMSE Spanish version provides a rapid and reliable observational assessment in high-risk Argentine population. This could have a direct impact in the care of patients with ASD by providing a free, standardized diagnostic tool for ASD. This project also addresses a research priority by reliably standardizing the phenotyping of children in under resourced international populations, since the use of the AMSE will lay the foundation for epidemiologic surveillance in populations that typically do not engage in research. Open-source and open access models also provide a way to facilitate global collaboration and training. Using tools like AMSE, the autism scientific community and clinicians worldwide should be able to deliver cost-effective services to everyone in need.