Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research
Open accessAbstract
Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors.Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview-Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS).Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27-42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36-59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures.Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.
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Many current interventions build on Applied Behaviour Therapy and have shifted to more natural, child-initiated developmentally appropriate strategies instead of repeated discrete trials.
“Many current interventions build on the original ' Applied Behaviour Therapy ' 174 (ABA) and have shifted to more natural, child-initiated developmentally appropriate strategies and tasks instead of dependence on repeated ' discrete trials ' (known as discrete trial training, or DTT).”
From Autism spectrum disorder (2020) · cites this paper as [174]
The Introduction and Methods discuss autism symptom measures and diagnostic assessments, not the development of autism interventions. Searches for ABA, child-initiated strategies, and discrete trial training found no passage in our copy addressing the claimed shift. (LLM, conf=0.77)
Experimental — accuracy not yet measuredSex and gender and co-occurring ID and developmental, behavioral and medical conditions alter the presentation and measurement of core autism features.
“Furthermore, sex and gender7,8 and co-occurring ID and developmental, behavioral and medical conditions9,10 alter the presentation and measurement of core autism features.”
From Genetic correlates of phenotypic heterogeneity in autism (2022) · cites this paper as [10]
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Hidden Aspects of the Research ADOS Are Bound to Affect Autism Science
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Self-citationThe association of neurofibromatosis and autism symptomatology is confounded by behavioral problemsPreprint
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- Authors
- Havdahl, K. A., Hus Bal, V., Huerta, M., Pickles, A., Øyen, A.-S., Stoltenberg, C., Lord, C., & Bishop, S. L.
- Affiliations
- Weill Cornell Medicine (US)
- King's College London (GB)
- Norwegian Institute of Public Health (NO)
- University of California, San Francisco (US)
- Corresponding author
- Bishop, Somer L.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 55
- Issue
- 12
- Pages
- 1054-1063.e3
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC5131801
- OpenAlex
- W2524395647
- Cited by
- 139
- References
- 46
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 14 · 2023: 12 · 2022: 26 · 2021: 24 · 2020: 16 · 2019: 11 · 2018: 9 · 2017: 14
- FWCI
- 7.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, cc-by-nc-nd)
- Explore Bristol Research (submittedVersion, cc-by-nc-nd)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- King's College London
- Universitetet i Bergen
- National Institutes of Health (5rc1mh089721-02)
- Weill Cornell Medical College
- Helse Sør-Øst RHF (2012101)
- Norwegian Institute of Public Health
- National Institute of Mental Health (RC1 MH-089721, R01MH081873)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD065277, R01HD081199)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Keywords
- autism spectrum disorder, Social Responsiveness Scale, ADI-R, Autism Diagnostic Observation Schedule, emotional and behavioral problems, intellectual disability, diagnostic specificity, cut-off values, neurodevelopmental disorders, autism etiology
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Child, Child, Preschool, Female, Humans, Male, Psychiatric Status Rating Scales, Psychometrics
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