Update in Diagnosis of Autism พญ. จ ฑามาส (ว โรจน อน นต ) วรโชต ก าจร ภาคว ชาก มารเวชศาสตร ม.สงขลานคร นทร 21 กรกฎาคม 2554
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1 Update in Diagnosis of Autism พญ. จ ฑามาส (ว โรจน อน นต ) วรโชต ก าจร ภาคว ชาก มารเวชศาสตร ม.สงขลานคร นทร 21 กรกฎาคม
2 Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) 2
3 ADOS Since 1989 By Catherine Lord, Ph.D. Michael Rutter, M.D., FRS Pamela C. DiLavore, Ph.D. Susan Risi, Ph.D. 3
4 Semi-structure tasks minutes 4 modules ADOS 4
5 ADOS ADOS Expressive language level Module Minimum Maximum Module 1 no speech Simple phrases Module 2 Flexible three-word phrases Verbally fluent Module 3 Verbally fluent - (child/younger adolescent) Module 4 Verbally fluent - (adolescent/adult) 5
6 ADOS activities 1. Communication 2. Reciprocal Social interaction 3. Imagination/Creativity 4. Stereotyped Behavior and Restricted Interests 6
7 ADOS Module 1 1. Free play 2. Response to name 3. Response to joint attention 4. Bubble play 5. Anticipation of a routine with objects 6. Response to social smile 7. Anticipation of a social routine 8. Functional and symbolic imitation 9. Birthday party 10. Snack 7
8 ADOS Code Score 0 No evidence of abnormality 0 1 Mildly abnormal 1 2 Definite abnormal 2 3 Markedly abnormal 2 7 Abnormal behavior that is not 0 encompassed by the other rating 8 Inapplicable 0 8
9 ADOS Scoring Communication + Reciprocal Social Interaction Classification Autism Autism spectrum disorder Non-autism spectrum disorder 9
10 ADOS Reliability Interrater.92 Test Retest.82 Validity Module 1 Module 2 Module 3 Module 4 Sensitivity Specificity
11 ADOS Limitation Not applicable for individual with severe sensory and motor impairment Developmental level at least 18 months Nonverbal adult Require training Cost 11
12 ADI-R Since 1989 By Michael Rutter, M.D., F.R.S. Ann LeCouteur, M.B.B.S. Catherine Lord, Ph.D. 12
13 ADI-R Structured interview Developmental age > 2 years old 1.5 to 2.5 hours 93 items 8 sections 13
14 ADI-R Sections 1. Background questions 2. Introductory questions 3. Early development 4. Age at which key language skill were acquired or loss 5. Language and communication functioning 6. Social development and play 7. Interests and behaviors 8. General behavior problem such aggression, self-injury 14
15 ADI-R Code Score 0 Behavior is/was not present 0 1 Behavior is/was present but not severe 1 2 Definite abnormal 2 3 Definite abnormal more severe than Abnormal behavior but not type specified 0 8 Not applicable 0 9 Not Known or not asked 0 15
16 ADI-R Scoring A: Qualitative abnormalities in reciprocal social interaction B: Qualitative abnormalities in communication C: Restricted, repetitive, and stereotyped pattern of behavior D: Abnormality of development evident at or before 36 months 16
17 ADI-R Reliability Validity Interrater Test Retest Sensitivity 1 Specificity
18 ADI-R Limitation Interview Take time Mental age at least 2 years Require training Cost 18
19 โครงการว จ ย การพ ฒนาแบบทดสอบ Autism Diagnostic Observation Schedule (ADOS) Autism Diagnostic Interview-Revised (ADI-R) และ Vineland-II Adaptive Behavior Scales (VABS-II) ฉบ บภาษาไทย 19
20 คณะผ ว จ ย ห วหน าโครงการว จ ย พญ. จ ฑามาส วรโชต ก าจร ภาคว ชาก มารเวชศาสตร ห วหน าโครงการว จ ยร วม ดร.นพ.วรส ทธ ศรศร ว ช ย หน วยระบาดว ทยา ผ ว จ ยร วมโครงการ รศ.ดร.นพ.พรพรต ล มประเสร ฐ ภาคว ชาพยาธ ว ทยา พญ.ศศ วรา เร องพ ระก ล ภาคว ชาก มารเวชศาสตร พญ.อ ไรวรรณ ศร เทพ ภาคว ชาก มารเวชศาสตร พญ.กมรพรรณ จ ระกะน ตย ภาคว ชาก มารเวชศาสตร พญ.ณ ฐกา ร จ รไพบ ลย ภาคว ชาก มารเวชศาสตร ค ณ ขน ษฐา หะย มะแซ ภาคว ชาก มารเวชศาสตร ค ณ ท พว ลย ด วงช ภาคว ชาก มารเวชศาสตร ค ณ ช ชชญา ส วรรณมาลา ภาคว ชาก มารเวชศาสตร ค ณ ดาฮ ยา หล เบ ญหมาน ภาคว ชาก มารเวชศาสตร 20
21 ข นตอนการเก บข อม ลในการศ กษา Hospital-based data collection Sample size = 207 AS 79, PDD 39, DL 43, TD 46 Single words or Expressive language level < 30 mo PDDSQ, VABS, ADI, and experts evaluation Phrase speech or Expressive language level > 30 mo ADOS module 1 ADOS module 2 Result positive for ASD Intervention and genetic testing Family support group 21
22 Preliminary data Age 3.6 years (+ 1.4) Male 159 (69.1%) Diagnosis (N = 207) Autism 79 PDD-NOS 39 Delayed language 43 Typical development 46 22
23 Preliminary data ADOS ADI-R (N = 206) (N = 182) Sensitivity Specificity Positive predictive value Negative predictive value
24 Preliminary data Agreement between ADOS and ADI-R Observation agreement 81.1% Expected agreement 53.4% Kappa
25 25
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