![]() ![]() The Review included 21 relevant sets of analyses conducted on a total of 2900 children. Six tests were reviewed: Four gathered information about children’s behaviours from interviews with parents or carers (Autism Diagnostic Interview‐Revised (ADI‐R), Gilliam Autism Rating Scale (GARS), Diagnostic Interview for Social and Communication Disorder (DISCO), and Developmental, Dimensional, and Diagnostic Interview (3di)) one required that a trained professional observe a child’s behaviour on specific tasks (Autism Diagnostic Observation Schedule (ADOS)) and one combined observation of the child with interview of parents or carers (Childhood Autism Rating Scale (CARS)). Cochrane researchers reviewed 13 published articles to answer this question. To find out which of the commonly used tools is most accurate for diagnosing ASD in preschool children. An incorrect diagnosis of ASD (false‐positive result) may cause family stress, lead to unnecessary investigations and treatments, and place greater strain on already limited service resources. Not diagnosing ASD in children when it is present (false‐negative result) means children with ASD may miss receiving early intervention and families may miss receiving timely support and education. ![]() How accurate are tools for diagnosing autism spectrum disorder (ASD) in preschool children? How accurate are diagnostic tools for autism spectrum disorder in preschool children? Performance for all tests was lower when we excluded studies at high risk of bias. In one study that explored individual and additive sensitivity and specificity of ADOS and ADI‐R, combining the two tests did not increase the sensitivity nor the specificity of ADOS used alone. In two studies that included analyses for ADI‐R, ADOS, and CARS, ADOS had the highest sensitivity and CARS the highest specificity. In two studies that included analyses for both ADI‐R and ADOS, tests scored similarly for sensitivity, but ADOS scored higher for specificity. Studies that compared tests were few and too small to allow clear conclusions. The summary sensitivity for the ADI‐R was 0.52 (95% CI 0.32 to 0.71), and the summary specificity was 0.84 (95% CI 0.61 to 0.95). Sensitivity for ADI‐R ranged from 0.19 to 0.75, and specificity ranged from 0.63 to 1.00. The summary sensitivity for CARS was 0.80 (95% CI 0.61 to 0.91), and the summary specificity was 0.88 (95% CI 0.64 to 0.96).įor ADI‐R, there were five analyses with 634 children. Sensitivity of CARS ranged from 0.66 to 0.89, and specificity ranged from 0.21 to 1.00. The summary sensitivity was 0.94 (95% confidence interval (CI) 0.89 to 0.97), and the summary specificity was 0.80 (95% CI 0.68 to 0.88).įor CARS, there were four analyses with 641 children. Sensitivity of ADOS ranged from 0.76 to 0.98, and specificity ranged from 0.20 to 1.00. ![]() Overall, the prevalence of ASD for children in the included analyses was 74%.įor versions and modules of ADOS, there were 12 analyses with 1625 children. In this Review, we included 21 sets of analyses reporting different tools or cohorts of children from 13 publications, many with high risk of bias or potential conflicts of interest or a combination of both. To determine whether any diagnostic test has greater diagnostic test accuracy for age‐specific subgroups within the preschool age range. Specificity is the most important factor for diagnosis however, both sensitivity and specificity are of interest in this Review because there is an inherent trade‐off between these two factors.ġ. fewer false‐positives and fewer false‐negatives) than either test alone?Īs only one interview tool was identified, we modified the first three aims to a single aim (Differences between protocol and review): This Review evaluated diagnostic tests in terms of sensitivity and specificity. If data are available, does the combination of an interview tool with a structured observation test have better diagnostic test accuracy (i.e. Is there any combination of tests that, if offered in sequence, would provide suitable diagnostic test accuracy and enhance test efficiency?ĭ. Is the diagnostic test accuracy of any one test sufficient for that test to be suitable as a sole assessment tool for preschool children?Ĭ. Which ASD diagnostic tool ‐ among ADOS, ADI‐R, CARS, DISCO, GARS, and 3di ‐ has the best diagnostic test accuracy?ī. To identify how the best of the interview tools compare with CARS, then how CARS compares with ADOS.Ī. To identify which diagnostic tools, including updated versions, most accurately diagnose ASD in preschool children when compared with multi‐disciplinary team clinical judgement.Ģ. ![]()
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