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. 2013 Feb;18(1):52-63.
doi: 10.1111/j.1475-3588.2012.00664.x. Epub 2012 Apr 4.

Measurement Issues: Screening and diagnostic instruments for autism spectrum disorders - lessons from research and practise

Tony Charman  1 , Katherine Gotham  2
Affiliations

Measurement Issues: Screening and diagnostic instruments for autism spectrum disorders - lessons from research and practise

Tony Charman et al. Child Adolesc Ment Health. 2013 Feb.

Abstract

Background and scope: Significant progress has been made over the past two decades in the development of screening and diagnostic instruments for autism spectrum disorders (ASDs). This article reviews this progress, including recent innovations, focussing on those instruments for which the strongest research data on validity exists, and then addresses issues arising from their use in clinical settings.

Findings: Research studies have evaluated the ability of screens to prospectively identify cases of ASD in population-based and clinically referred samples, as well as the accuracy of diagnostic instruments to map onto 'gold standard' clinical best estimate diagnosis. However, extension of the findings to clinical services must be done with caution, with a full understanding that instrument properties are sample-specific. Furthermore, we are limited by the lack of a true test for ASD which remains a behaviourally defined disorder. In addition, screening and diagnostic instruments help clinicians least in the cases where they are most in want of direction, as their accuracy will always be lower for marginal cases.

Conclusion: Instruments help clinicians to collect detailed, structured information and increase accuracy and reliability of referral for in-depth assessment and recommendations for support, but further research is needed to refine their effective use in clinical settings.

Keywords: autism spectrum disorder (ASD); diagnosis; predictive value; screening; sensitivity; specificity.

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Conflict of interest statement

The authors have declared that they have no competing or potential conflicts of interest arising from the publication of this article. KG will be an author on the as-yet-unpublished Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2): royalties for this will be donated to charity

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