ADOS testing is not required for ASD diagnosis by developmental-behavioral pediatricians

ADOS testing is not required for ASD diagnosis by developmental-behavioral pediatricians

Trained developmental and behavioral pediatricians can generally diagnose autism spectrum disorder (ASD) in young children without the need for additional Autism Diagnostic Observation Schedule (ADOS) testing, according to a prospective multicenter study. The study, conducted by the Developmental Behavioral Pediatrics Research Network (DBPNet) and led by Boston Children's Hospital, was published Oct. 17 in the journal JAMA Pediatrics.

The ADOS was originally developed as a research tool. Through semi-structured observations, specially trained evaluators evaluate children's communication skills, social interaction, and imaginative use of materials.

The ADOS was never developed for clinical use. But currently, ADOS testing is often required for young children to receive an ASD diagnosis that is accepted by early intervention agencies, schools and insurers. This study shows that, in most cases, young children may be able to receive a diagnostic evaluation for ASD by a developmental behavior pediatrician without using the ADOS.”

William Barbaresi, MD, principal investigator and chief of developmental medicine at Boston Children’s

ADOS administration is time-consuming, adds additional costs to the diagnostic process, and there are not enough people trained to administer it. “The requirement for ADOS testing has become a barrier to timely diagnosis and initiation of treatment,” says Barbaresi. “Young children can wait months or even years for an assessment, making it difficult for them to access intensive early intervention services when they are most effective – ideally from around 24 months of age.”

The study involved 349 children aged 18 months to 5 years who were examined at nine academic pediatric centers. Developmental behavioral pediatricians (DBPs) initially made a diagnosis based on their clinical assessment. A specially trained clinician then administered the ADOS, the results of which were shared with the DBP, which could then revise its diagnosis.

In 90 percent of cases, the diagnosis, including ADOS, was consistent with the original clinical diagnoses. Consistency was most likely when the clinician was very confident of his or her original diagnosis.

“Overall, this study is good news,” says Barbaresi. “We believe it has the potential to change current practice by reducing wait times for diagnostic testing so children can receive early, intensive treatment for ASD.” The other participating centers were Children's Hospital of Philadelphia, Children's Hospital Colorado, University of Arkansas for Medical Sciences, University of California-Davis, Children's Hospital Los Angeles, Hospital of St. John of God (Linz, Austria), Rainbow Babies, and Children's Hospital (Cleveland, Ohio); and Children's Hospital at Montefiore (Bronx, NY).

The study was funded by the Maternal Child Health Bureau, Health Resources and Services Administration of the US Department of Health and Human Services (UA3MC20218). The authors report no conflicts of interest.

Source:

Boston Children's Hospital

Reference:

Barbaresi, W., et al. (2022) Clinician Diagnostic Determination and the Role of the Autism Diagnostic Observation Schedule in Autism Spectrum Disorder Diagnostics in Young Children. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2022.3605.

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