tag:blogger.com,1999:blog-1892134081049774386.post8901468122790585992..comments2023-12-02T09:37:08.472-05:00Comments on Autism Jabberwocky: Screening for Autism with the ASSQM.J.http://www.blogger.com/profile/12033918835169823548noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-1892134081049774386.post-49211482345075971692014-01-08T12:50:45.195-05:002014-01-08T12:50:45.195-05:00Do you know how to interpate the results of this A...Do you know how to interpate the results of this ASSQ ?martanoreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-34623735310752185662011-05-28T00:09:48.657-04:002011-05-28T00:09:48.657-04:00Hey, thanks for this explanation of the ASSQ --- I...Hey, thanks for this explanation of the ASSQ --- I had never heard of this particular measure before.<br /><br />(I am writing my own post about this study now, and am trying to figure out how on Earth they got from 0.36% of actual, confirmed autistic children to the 2.64% they think it implies).Lindsayhttps://www.blogger.com/profile/10860246538349067232noreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-75212295170323617882011-05-17T06:33:24.466-04:002011-05-17T06:33:24.466-04:00I think your comments about the ADI are pretty muc...I think your comments about the ADI are pretty much on target. We actually just did an ADI for our youngest daughter (who is 4) for a research study and it was hard answering some of the questions. <br /><br />This is in spite of the facts that we were paying very close attention to her development because of her sisters' history, that most of the questions address things that happened relatively recently, and that both my wife and I were answering the questions. <br /><br />I can't imagine that parents are going to be able to properly answer the questions as their children get older. Maybe up to the teenage years but certainly not into the adult years.<br /><br />This wasn't likely a factor in this study because the children were younger but it certainly could be a factor in others.M.J.https://www.blogger.com/profile/12033918835169823548noreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-31948146749291647692011-05-17T03:43:01.911-04:002011-05-17T03:43:01.911-04:00Thanks MJ.
The Kim study reported to use both ADO...Thanks MJ. <br />The Kim study reported to use both ADOS and ADI (alongside some measures of cognitive functioning). <br />ADI, despite being gold-standard, is perhaps the more 'flaky' of the instruments given its reliance on retrospective recall and report over direct observation and, particularly for those children older than 4-5 years old, where the so-called 'most abnormal' coding is used. Ask any parent of a 7-12 year old (irrespective of autism), what was your child like at 4-5 years old, and unless there is a good memory 'anchor', recall is going to be problematic at best. Cathy Lord and co recently talked about 'telescoping' based on the ADI-R data (Hus et al, 2011).<br />ADOS by contrast is pretty specific to autism, certainly when using the module 1 and 2, where there is a lot of interaction between assessor and child using the various testing toys, games and books. Having said that I would assume that most of the kids in the Kim study from the school group would have been assessed using module 3 (child/adolescent with fluent speech) where far less material are used and more conversation/questioning is required. <br />I've not actually seen anything discussing whether ADHD co-morbidity (or anything else) could affect the final outcome. I would perhaps be inclined to say that the criteria/algorithm is quite explicit when it comes to autism diagnostic criteria, and requires contribution from all clinical areas in order to reach cut-off points suggestive of a diagnosis.<br />The Kim study actually says that DSM-IV critera were used to determine autism or ASD.<br />As part of that diagnostic work-up, the data from ADI and ADOS were independently reviewed and diagnosis determined. This is perhaps where more detail is required from the study - did these reviewers use the video-taped ADI/ADOS sessions or merely use the notes taken when coming to a clinical judgement?Paul Whiteleyhttps://www.blogger.com/profile/14288851488012254897noreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-29009710695602149252011-05-16T19:45:58.717-04:002011-05-16T19:45:58.717-04:00Very interesting post, that raises all sorts of re...Very interesting post, that raises all sorts of related questions about diagnosis of a condition that is identified by observable symptoms, rather than (say) a blood test or brain scan. Though similar issues arise for "internal" (and not just external observational) tests for identifying autism, such as this one I came across a while ago: http://www.guardian.co.uk/science/blog/2010/aug/12/autism-brain-scan-statistics . This is an area I think about a lot - the question of in/correct diagnosis and the consequences of making errors, as well as the shifting criteria that then affect the numbers of diagnoses.Autism and Oughtismshttp://autismandoughtisms.wordpress.com/noreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-88468948489132061582011-05-16T18:40:45.611-04:002011-05-16T18:40:45.611-04:00Hi Paul,
Glad you liked the post.
I think you go...Hi Paul,<br /><br />Glad you liked the post.<br /><br />I think you got the point of where I am headed next. You can't really fault and autism diagnosis that was made using the ADOS but the extrapolation of the results back through the screening test to the general population is somewhat questionable. <br /><br />Especially since the the number of children who screened positive and then had an autism diagnosis does not line up with what we know about the screen. The low cut-offs make this problem even worse - there should have been an extremely high percentage of false positives but there don't seem to be.<br /><br />I am still playing with the numbers from the study but either I am missing something basic or something isn't quite adding up.<br /><br />The co-morbid conditions is a second problem of the extrapolation (I assume - perhaps wrongly - that the ADOS could distinguish between ADD/ADHD and the various forms of autism).M.J.https://www.blogger.com/profile/12033918835169823548noreply@blogger.comtag:blogger.com,1999:blog-1892134081049774386.post-85892189872571229432011-05-16T17:08:15.665-04:002011-05-16T17:08:15.665-04:00Enjoyed the post, many thanks. I think you touch o...Enjoyed the post, many thanks. I think you touch on some very relevant issues here, not least what do screening instruments screen for in autism? and also what about co-morbidity as a potential 'influencing' variable? (I dare say that this second issue of co-morbidity is also perhaps a question that should be asked of intervention, in terms of what intervention actually targets and what it is reported to target symptom-wise).<br />The Kim study is interesting when it comes to the ASSQ results: for the regular school group there was a response rate of 63% (23,234 out of 36,592). 7% (1,742) of these 23,234 screened positive on ASSQ but only 1,111 were sampled and then only 785 provided consent. <br />I hope I am not stealing any thunder when I say that the cut-off values for a positive result used in the study were: teachers =>10, parents =>14.<br />The paper makes no reference to ADHD or any other kind of co-morbidity (aside from telling us that Rett syndrome and Heller's syndrome were not detected in any cases).Paul Whiteleyhttps://www.blogger.com/profile/14288851488012254897noreply@blogger.com