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Saturday, May 9, 2009
Northwest Hall (Chicago Hilton)
12:00 PM
Background: Autism Spectrum Disorders (ASDs) are more commonly diagnosed today than they were in the past. Practice parameters recommend the use of standardized tools when considering an ASD diagnosis, although little research has been done to characterize the use of these tools in large populations.
Objectives: To characterize changes in the use of ASD diagnostic tools.
Methods: The Autism and Developmental Disabilities Monitoring (ADDM) Network has been formed to track prevalence and describe the population characteristics of children with ASDs in multiple areas of theUnited States . Use of ASD diagnostic tests were analyzed from the ADDM Network sites in four US populations (areas of AZ, GA, MD, and SC) over three time periods (2000, 2002, and 2004 surveillance years).
Results: A total of 1,985 eight-year-old children met DSM-IV-TR criteria for an ASD through systematic review of evaluation records from multiple sources. Of these children, 64.7% were evaluated by a professional using an ASD test. There was a steady increase in the proportion of children evaluated using an ASD test: 56.4% in 2000, 64.7% in 2002, and 71.3% in 2004 (χ2=32.3, p<.001). ASD test use increased significantly for both boys (p<.001) and girls (p<.001). Test use increased more sharply for girls, so while boys were more likely than girls to have had an ASD test in 2000 (p<.001), but by 2004 the proportions were similar (p=.299). There was a significant increase in the use of ASD tests for both White (p=.001) and Black children (p<.001), but not for Hispanic children (p=.112). ASD tests were used at similar proportions for White and Black children in the 2000 cohort (p=.978), but test use rose more sharply for Black children (from 58.3% to 73.3% to 79.9%) than for White children (from 58.5% to 60.3% to 70.4%). Consequently, Black children were more likely to be evaluated using an ASD test in both 2002 (p=.002) and 2004 (p=.011). Of the ASD tests given, the Childhood Autism Rating Scale was by far the most commonly used (62.5%), followed by the Gilliam Autism Rating Scale (GARS; 14.9%), Autism behavior Checklist (5.5%), Autism Diagnostic Observation Schedule (ADOS; 5.0%), Gilliam Asperger’s Disorder Scale (3.4%), Autism Diagnostic Interview (ADI; 2.7%), and another ASD test (6.0%). Increased use of the ADOS, ADI-R, and GARS relative to other tests was evident. ASD tests were more often administered in school settings (64.6%) than health settings (33.6%), and were utilized most commonly by Ed.S. psychologists (30.9%) followed by Ph.D. psychologists (19.8%), developmental pediatricians (8.0%), Masters-level psychologists (8.0%), and Ed.D. psychologists (6.1%). Neurologists and psychiatrists (both 0.4%) rarely reported the use of an ASD test. The mean age of first ASD test reported was 64 months overall, with no significant change over time (p=.483).
Conclusions: Given that ASDs are behaviorally-defined disorders, the use of standardized tools is recommended for the diagnosis of these conditions. Although improvements were made over a four year period in the use of standardized tools, the use of “gold-standard” tools (the ADOS and ADI) remained low in these community settings.
Objectives: To characterize changes in the use of ASD diagnostic tools.
Methods: The Autism and Developmental Disabilities Monitoring (ADDM) Network has been formed to track prevalence and describe the population characteristics of children with ASDs in multiple areas of the
Results: A total of 1,985 eight-year-old children met DSM-IV-TR criteria for an ASD through systematic review of evaluation records from multiple sources. Of these children, 64.7% were evaluated by a professional using an ASD test. There was a steady increase in the proportion of children evaluated using an ASD test: 56.4% in 2000, 64.7% in 2002, and 71.3% in 2004 (χ2=32.3, p<.001). ASD test use increased significantly for both boys (p<.001) and girls (p<.001). Test use increased more sharply for girls, so while boys were more likely than girls to have had an ASD test in 2000 (p<.001), but by 2004 the proportions were similar (p=.299). There was a significant increase in the use of ASD tests for both White (p=.001) and Black children (p<.001), but not for Hispanic children (p=.112). ASD tests were used at similar proportions for White and Black children in the 2000 cohort (p=.978), but test use rose more sharply for Black children (from 58.3% to 73.3% to 79.9%) than for White children (from 58.5% to 60.3% to 70.4%). Consequently, Black children were more likely to be evaluated using an ASD test in both 2002 (p=.002) and 2004 (p=.011). Of the ASD tests given, the Childhood Autism Rating Scale was by far the most commonly used (62.5%), followed by the Gilliam Autism Rating Scale (GARS; 14.9%), Autism behavior Checklist (5.5%), Autism Diagnostic Observation Schedule (ADOS; 5.0%), Gilliam Asperger’s Disorder Scale (3.4%), Autism Diagnostic Interview (ADI; 2.7%), and another ASD test (6.0%). Increased use of the ADOS, ADI-R, and GARS relative to other tests was evident. ASD tests were more often administered in school settings (64.6%) than health settings (33.6%), and were utilized most commonly by Ed.S. psychologists (30.9%) followed by Ph.D. psychologists (19.8%), developmental pediatricians (8.0%), Masters-level psychologists (8.0%), and Ed.D. psychologists (6.1%). Neurologists and psychiatrists (both 0.4%) rarely reported the use of an ASD test. The mean age of first ASD test reported was 64 months overall, with no significant change over time (p=.483).
Conclusions: Given that ASDs are behaviorally-defined disorders, the use of standardized tools is recommended for the diagnosis of these conditions. Although improvements were made over a four year period in the use of standardized tools, the use of “gold-standard” tools (the ADOS and ADI) remained low in these community settings.