PARTICIPANTS Children

Yes

Adults Yes - provided the interviewee can recall childhood behaviour.

AU but primarily aimed at the more severely disabled child - more able participants require lifespan dataE.

Level of mental retardation

OTHER DATA IN SCHEDULE/OTHER INFORMATION/COMMENTS

The overall classification only requires 34 of the items7 or even one4. The five subscales have not been independently validated7 and have variable internal consistency5. Correlation with the Childhood Autism Rating Scale is only moderate’ and it is less specific than the Autism Diagnostic Interview’?. There is a significant misclassification rate, making it ineffectual as an instrument for clinical diagnosis6. It is not always clear whether, in practice, users have rated current or lifespan symptomatology.

References Eaves RC, Milner B. (1993) The criterion-related validity of the Childhood Autism Rating Scale and the Autism Behavior Checklist. Journal of Abnormal Cbild Psycbology 21: 481-91. Krug DA, Arick J, Almond F! (1980) Behaviour checklist for identifying severely handicapped individuals with high levels of autistic behaviour. Journal of Cbild Psycbology and Psycbiaty 6 Allied Dfsdplines 21: 221-9. Krug DA, Arick JR, Almond PJ. (1988) Tbe Autfsm Bebavior Cbecklist. Portland, Oregon: ASIEP Education Company. Oswald DP, V o h a r FR. (1991) Signal detection analysis of items from the Autism Behavior Checklist. Journal of Autism and Developmental Disorders 21: 543-9. Stunney P, Matson JL, Sevin JA. (1992) Analysis of the internal consistency of three autism scales. Journal of Autism and Developmental Dtsorders 22 321-8. Volkmar FR, Cicchetti D. (1988) An evaluation of the Autism Behaviour Checklist. Journal of Autism and Developmental Disorders 18 81-97. Wadden NI: Bryson SE, Rodger RS. (1991) A closer look at the Autism Behavior Checklist: Discriminant validity and factor structure. Journal of Autism and Developmental Dfsorders 21: 529-41. Ymiya N, Sigman M, Freeman BJ. (1994) Comparison between diagnostic instruments for identlfying high- functioning children with autism. Journal of Autism and Developmental Disorders 24: 281-91.

4. Autism Diagnostic Interview - Revised (ADI-R) The ADI-R is a modified version of the AD12. It has been subject to revision4, partly due to the increasing ability to diagnose autism at an early age and the importance in differentiating autism when it is accompanied by profound mental retardation. The ADI-R is specifically tailored to these issues as the ADI-R has been modified for use with children with a mental age of from approximately 18 months. Some of the schedule items are directly related to specific age periods and allow comparisons to be made in order to judge severity and abnormality of behaviours. A number of items have been modified. In the section on communication, items are in the direction of autism specific

impairments. Other items, such as sensitivity to noise level, have been given a broader definition to include sensitivity to other specific noises, not just loudness. Repetitive behaviour has been differentiated from compulsions and rituals.

The ADI-R focuses upon developmental deviance rather than developmental delay. The schedule measures behaviour across three areas: communication, social skills and restricted, repetitive and stereotyped behaviour. It is a semi- structured interview with primary caregivers. Behaviour is rated by the clinician on a 4-point scale: (0) ‘no definite behaviour of the type is specified; (1) ‘behaviour of the type specified probably present but defining criteria not fully met’; (2) ‘definite abnormal behaviour of the type described in the definition and coding’; and (3) ‘extreme severity’. The ADI-R uses a scoring algorithm based on DSM-N and ICD-10 criteria. In the communication section, a cut-off score of 8 is needed for verbal participants and a score of 7 is required for non-verbal participants. Within the social domain, a minimum score of 10 is the proposed cut-off score for all participants. A cut-off score of 3 is required for restricted and repetitive behaviours. To reach a diagnosis of autism that is conducive to DSM-IV and ICD- 10 guidelines, the participant must meet criteria in all three areas, and the symptomology must be present in at least one area by the age of 36 months.

CONTENTS What does the schedule try to measure?

Lifetime history focused on the symptoms associated with autism.

Does the schedule measure psychiatric symptoms?

Does it give a clinical diagnosis? Yes, it includes an algorithm.

Does the schedule measure behaviour disorder? Yes

Does the schedule contain a widelnarrow range of behaviours?

No

Autism specific.

N o Does the schedule measure temperament?

PURPOSE Is the schedule treatment-orientated?

Is it intended as a research tool for behaviour disorder?

Is it appropriate for epidemiological use?

Yes

Yes

Yes, but it is a diagnostic rather than a screening instrument.

Is it an appropriate screening instrument for behaviour disorder?

No

INFORMANT

Person with close and long-standing knowledge of the individual, particularly in early childhood.

8 Measurfng Bebavfour in Developmental Disability: A review of existing scbedules

TYPE OF SCHEDULE

Semi-structured, open-ended interview based on a detailed questionnaire. The items cover the symptoms of autism as defined in the ICD-10 criteria with an emphasis on achieving a threshold on three subscales. The responses, descriptions of actual behaviour, are coded on a tightly defined rating system.

Lifespan history with a particular emphasis on the 4-5 year age period. An algorithm is available for research diagnostic purposes.

L O N G ~ H O R T

Rvo to three hours to administer 111 items. A shortened version of 40 items takes 90-120 minutes.

DERIVATION

Research interview for British twin studies.

PUBLISHED MATERIAL Author/Otber

Both

Usejidness Gold standard diagnostic instrument for research and now being used clinically for equivocal cases. It has not been designed to measure change.

Construct - ICD-10. Comparable rate of diagnosis to Childhood Autism Rating Scale but, although accurate by 3 years, both instruments tend to have less specificity for 2-year- olds3v7. The schedule has good convergent validity with the Autistic Diagnostic Observation Schedule.

Validated

Reliability Interrater and test-retest - high for total and individual scores - requires training to develop and maintain reliability. Internal consistency is reported to be high for subscales. 1.23435

Additional statistical analysis Factor analysis of social communication domains.

Inter-vdrome usekross-syndrome use/syndrome use N o information identified.

PARTICIPANTS Children

Adults Yes

Level of mental retardation Yes - most valid for children of normal abilityhild mental retardation.

Yes - most valid in late childhood.

OTHER DATA I N SCHEDULE/OTHER INFORMATION/COMMENTS

Purely a history-taking instrument, it is complemented by the ADOS. A lengthy interview and extensive training is required to use the instrument effectively. The instrument is still subject to the informants’ perception of the person’s behaviour although bias is minimised as far as possible by an emphasis throughout on concrete examples.

References Cox A, Charman T, Baron-Cohen S, Drew A, Klein K, Baird G, Swettenham J, Wheelwright S. (1999) Autism spectrum disorders at 20 and 42 months of age: Stability of the Clinical and ADI-R diagnosis. Journal of Child Psychology and Psychiatry 40: 719-32. le Couteur A, Rutter M, Lord C, Rios r: Robertson S, Holdgrafer M, McLennan J. (1989) Autism Diagnostic Interview: A standardised investigator-based instrument. Journal of Autism and Developmental Disorders 19: 363-87. Lord C. (1995) Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry 36 1365-82. Lord C, Browder DM, le Couteur A. (1994) Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive develop- mental disorders. Journal of Autism and Developmental Disorders 24: 659-85. Lord C, Pickles A, McLennan J, Rutter M, Bregman J, Folstein S, Fombonne E, Leboyer M, Minshew N. (1997) Diagnosing autism: analyses of data from the Autism Diagnostic Interview. Journal of Autism and Developmental Disorders 27: 501-17. Lord C, Rutter M, Goode S, Heemsbergen J, Jordan H, Mawhood L, Schopler E. (1989) Autism Diagnostic Observation Schedule: A standardised observation of communicative and social behaviour. Journal of Autism and Developmental Disorders 19: 185-212. Pilowsky T, Yiiiya N, Shulman C, Dover R. (1998) The Autism Diagnostic Interview-Revised and the Childhood Autism Rating Scale: Differences between diagnostic systems and comparison between genders. Journal of Autism and Developmental Disorders 2 8 143-5 1.

5. Autism Diagnostic Observation Schedule - Generic

The ADOS measures the presence of symptoms and deficits associated with autism. The schedule consists of four modules, each one being appropriate to the developmental level of the participant. In order to determine which module to use, it may be advisable to carry out a cognitive assessment of the individual before administration of the ADOS-G. Module 1 is for use with participants that are ‘preverbal or have single words’. Module 2 can be used in individuals with phrase speech’. Module 3 is suitable for use with a ‘child/adolescent with fluent speech’ and Module 4 is for use with ‘adolescentsladults with fluent speech’. Each module consists of standard situations (either task-based or social-based) in which the individual is assessed according to three broad areas: communication, social interaction and playhaginative use of objects. These situations use ‘presses’ that are designed to elicit specific behaviours. To administer the ADOS-G, the experimenter should have extensive training in its use’.

Administration time of the ADOS-G is 3045 minutes2, after which the clinician’s observations must be scored using standardised coding procedures. These scores can then be used to produce an algorithm. The psychometric properties are well researched and established.

CONTENTS What does the schedule try to measure?

The presence of symptoms and deficits associated with autism.

Measuring Behaviour in Developmental Disability: A review of existing schedules 9