Rapid Assessment of Autistic Social Impairment in a Taiwanese Population

Background: Autism spectrum disorders (ASDs) and other developmental disorders such as ADHD and specific development delay all present with some impairments in social interaction that can be confused with ASDs.  Recognizing the spectrum of autistic traits in affected children is important both for differential diagnosis of these conditions and for appropriate assessment and treatment in individual cases.  The Social Responsiveness Scale (SRS) is an assessment tool that provides a quantitative rather than categorical measure of social impairment.  Previous research has established the discriminant and concurrent validity of this scale in US populations; however no data are yet available from Chinese Mandarin-speaking populations.

Objectives: (1) To characterize the spectrum of autistic traits among children at an early-intervention clinic and among typical controls in Taipei.  (2) To examine the cross-cultural validity of the SRS in a Chinese Mandarin-speaking population.

Methods: Participants are the primary caretakers of children referred for developmental evaluation at Taipei Veterans General Hospital and GuanDu Hospital in Taipei from July 2009- April 2010.  Four study groups are included: (1) ASD (n=18): including autism syndrome, Asperger syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS), (2) ADHD+DD (n=11): including comorbid ADHD and DD as described in 3 and 4,  (3) ADHD (n=19): including inattentive, hyperactive-impulsive, and combined type, (4) Developmental Delay (DD, n=28): including speech/language, learning, motor development, and other specific and nonspecific DDs. Diagnoses are made based on DSM-IV and ICD-10 criteria, with a team of experienced clinicians coming to a consensus based on all available information obtained from assessments and clinical evaluations.  Controls are parents of children attending local kindergartens.  SRS total and five subscale scores (i.e. social awareness, social cognition, social communication, social motivation, autistic mannerisms) are compared between the ASD group and the other three groups.

Results: Preliminary results indicate that children with clinically-diagnosed ASDs have significantly higher SRS total and all five subscale scores than children with either ADHD or DD.  However, children with ASDs are only statistically different from children with ADHD+DD in social communication, social motivation, and the SRS total scores (all p<.05).  Results from unaffected controls are pending at this time.

Conclusions: Findings from these preliminary data support the cross-cultural validity of the SRS as a tool for distinguishing ASD from other developmental conditions (e.g. ADHD, DD), and as a tool for characterizing autistic traits in these non-ASD disorders.  This finding is important for future research that may use the scale for differential diagnosis of autism from other neuropsychiatric conditions, as well as for large-scale epidemiologic studies of ASD.  In addition, the SRS may be useful for identifying autistic traits in children who do not meet criteria for full-scale ASD diagnoses, yet may nevertheless benefit from special interventions to address their social impairment.

This study remains in progress.  Additional data from unaffected controls and a larger sample size will be included for the meeting.  Findings from the study will further clarify the spectrum of autistic traits in the Taiwanese population, and more fully examine the validity of the SRS as a cross-cultural diagnostic tool.