Diagnostic Tests for Autism Spectrum Disorder (ASD) in Preschool Children
Cochrane Database of Systematic Reviews
Randall, M., Egberts, K. J., et al. (2018).
Cochrane Database of Systematic Reviews, 7, CD009044.
This systematic review investigates the accuracy of diagnostic tools compared to multi-disciplinary team clinical judgement to identify preschool-aged children on the autism spectrum.
The Cochrane Collaboration
Through July 2016
Cohort studies; cross-sectional studies; randomised test accuracy studies; case-control studies
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"Among the three tests with available diagnostic test accuracy data, ADOS [Autism Diagnostic Observation Scale] has the highest summary sensitivity and similar specificity to CARS [Childhood Autism Rating Scale] and ADI-R [Autism Diagnostic Interview - Revised]" (p. 25). <br />
"Sensitivity of CARS [Childhood Autism Rating Scale] ranged from 0.66 to 0.89, and specificity ranged from 0.21 to 1.00. The summary sensitivity for CARS was 0.80 (95% CI 0.61 to 0.91), and the summary specificity was 0.88 (95% CI 0.64 to 0.96)" (p. 2).<br />
"Current findings suggest that ADOS [Autism Diagnostic Observation Scale] is best for not missing children who have ASD and is similar to CARS [Childhood Autism Rating Scale] and ADI-R [Autism Diagnostic Interview - Revised] in not falsely diagnosing ASD in a child who does not have ASD. ADOS has acceptable accuracy in populations with a high prevalence of ASD. However, overdiagnosis is likely if the tool is used in populations with a lower prevalence of ASD. This finding supports current recommended practice for ASD diagnostic tools to be used as part of a multi-disciplinary assessment, rather than as stand- alone diagnostic instruments" (p. 4).<br />
"Sensitivity of ADOS [Autism Diagnostic Observation Scale] ranged from 0.76 to 0.98, and specificity ranged from 0.20 to 1.00. The summary sensitivity was 0.94 (95% confidence interval (CI) 0.89 to 0.97), and the summary specificity was 0.80 (95% CI 0.68 to 0.88)" (p. 2).<br />
"Sensitivity for ADI-R [Autism Diagnostic Interview - Revised] ranged from 0.19 to 0.75, and specificity ranged from 0.63 to 1.00. The summary sensitivity for the ADI-R was 0.52 (95% CI 0.32 to 0.71), and the summary specificity was 0.84 (95% CI 0.61 to 0.95" (p. 2).<br />
