Clinical diagnoses of autism spectrum disorder mostly consistent with, without Autism Diagnostic Observation Schedule

Clinical diagnoses of autism spectrum disorder (ASD) with and without the reference standard Autism Diagnostic Observation Schedule (ADOS) are consistent in 90.0 percent of cases, according to a study published online Oct. 17 in JAMA Pediatrics.

William Barbaresi, M.D., from Boston Children's Hospital, and colleagues examined consistency between clinical diagnosis and diagnosis incorporating the ADOS in a prospective study conducted between May 2019 and February 2020. Developmental-behavioral pediatricians (DBPs) made a diagnosis based on clinical assessment; the ADOS was administered and then a DBP made a second diagnosis (index diagnosis and reference standard diagnosis). A total of 349 children completed the study.

The researchers found that index diagnoses and reference standard diagnoses were consistent for 314 children (90 percent) and changed for 35 children. The most sensitive and specific predictor of diagnostic consistency was clinician diagnostic certainty (area under curve, 0.860). No child or clinician factors improved prediction of diagnostic consistency based solely on clinician diagnostic certainty at the time of index diagnosis in a multilevel logistic regression.

"ASD diagnostic assessments that do not include the ADOS are less time consuming and costly, potentially leading to more streamlined assessments that could improve access to timely diagnosis by more children," the authors write. "Additionally, this study suggests that results from the ADOS should not be required by insurers, early intervention programs, or schools for children to access intervention and treatment for ASD."

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