The Reliability and Validity of a Clinical Observation Tool and Scoring Guide for the Diagnostic Evaluation of Autism Spectrum Disorder by Community Pediatricians - Abstract
Existing direct diagnostic tools for ASD tend not to be practical for use by most community paediatricians. We examined the potential of using selected activities modified from the Autism Diagnostic Observation Schedule (ADOS) to inform diagnostic decision-making.
Objectives: We evaluated the use of a unique, specially designed observation form and scoring guide (Pediatric Autism Early Diagnosis Tool; PAED), and then compared the diagnostic results with the validated ADOS Module 1. Completing a diagnostic assessment using this new method does not involve the complex scoring normally required with the ADOS, thus making it much more accessible for pediatricians to learn.
Methods: Twenty-eight pre-verbal children (mean age 33.6 months; SD=9.5m) referred to community clinics were assessed on the abbreviated process/PAED Tool and on the standard ADOS on separate visits. Both diagnostic methods included a detailed developmental history for ASD. A DSM-IV-TR diagnostic category was assigned for each approach. Videotaped sessions were scored by independent raters for PAED Tool reliability.
Results: PAED Tool inter-rater reliability was excellent using a video-scoring approach (ICC=0.86). Classification agreement between evaluation methods was excellent (weighted kappa=0.83), and sensitivity and specificity were both high (91%-100%).
Conclusions: When used with a detailed history and physical examination, the abbreviated battery and PAED Tool yielded good diagnostic accuracy. Further trials will involve DSM-5 modifications.