10.1 DIAGNOSIS OF AUTISM SPECTRUM D1SORDERS A COMPLEX CLINICAL PRESENTATION

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 10; p. S15
• Main Author: Grodberg, David
• Format: Journal Article
• Language: English
• Published: Baltimore Elsevier BV 01-10-2016
• Subjects: Accuracy; Attention deficit hyperactivity disorder; Autism; Autism Spectrum Disorders; Autistic adolescents; Autistic children; Child & adolescent psychiatry; Children; Children with disabilities; Clinical Diagnosis; Comorbidity; Developmental psychology; Diagnosis; Disability; Medical diagnosis; Mental disorders; Mental health; Pathophysiology; Physiological psychology; Psychometrics; Psychopathology; Quantitative psychology; Symptoms; Validity
• ISSN: 0890-8567; 1527-5418

Objectives: Social disability commonly seen in children with complex mental health disorders is often accounted for by the pathophysiology of the primary disorder. However, the developmental history and mental status exam often reveal comorbid ASD. This presentation will use the clinical presentation of ADHD with social disability as an example of such comorbidity and use the Autism Mental Status Exam (AMSE) to identify social and communicative impairments in the context of ADHD, report on psychometric properties of such an approach, and outline the reasons why it is important to identify such problems early. Methods: Our study sample group included 45 children ages 3-12 years, with signs and symptoms of ADHD, who were referred to our autism research center for an ASD diagnostic assessment. Subjects were first evaluated by a child and adolescent psychiatrist who administered the AMSE. Subjects then received an Autism Diagnostic Observation Schedule by an independent psychologist. A best estimate clinical diagnosis (BECD) protocol, independent of the AMSE, was then implemented to ascertain a DSM-5 diagnosis of ASD or non-ASD. Results: The AMSE is a brief diagnostic observational tool that structures the way clinicians observe and document eight signs and symptoms of ASD. The AMSE yields a score, and validation studies indicate excellent test performance when compared with the gold standard ASD diagnostic assessment protocol used in ASD research settings. Participants (62 percent) had met criteria for a clinical diagnosis of ASD. All had reported histories of ADHD signs and symptoms; 42 percent had formal medical diagnoses of ADHD. Diagnostic accuracy of the AMSE was assessed by the nonparametric measure of area under a receiver operating characteristic (ROC) curve. Area under the ROC curve was 0.90 [95% CI 0.809-0.997]. Conclusions: The AMSE demonstrates excellent sensitivity and specificity in detecting ASD in a population of children with ADHD symptomatology and suspected ASD. The AMSE holds promise to facilitate and standardize the diagnostic process of ASD in children with ADHD.