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Assessing Differences in Lifetime Item Scores of the Spanish ADI-R in Latino Children with ASD and Children with DD
There is a growing body of research that has identified significant disparities in ASD diagnoses among racial/ethnic minority children (e.g., Daniels & Mandell, 2014). Thus, it is critical that research addresses possible issues in the diagnostic tools used with diverse populations. The Autism Diagnostic Interview-Revised (ADI-R; Lord et al. 1994) is a ‘gold-standard’ parent interview that provides a composite of past and current behaviors as it pertains to ASD. Select items from the extensive interview are then used to determine whether the individual demonstrates sufficient symptoms that would merit an ASD diagnosis. However, little is known whether the selected algorithm items from the ADI-R are adequate in identifying children with ASD in a Latino population.
Objectives:
The objective of this paper is to evaluate the utility of all lifetime items from the Spanish ADI-R in distinguishing between children with ASD and children with DD in a U.S. based Latino population.
Methods:
The current study included 50 Spanish-speaking Latino parents of children and adolescents who were between 4 and 16 years of age and received a clinical diagnosis of ASD (n = 29) or a Developmental Delay (DD; n= 21). Clinical diagnoses were confirmed by review of the medical records. The official Spanish version of the ADI-R was administered by trained interviewers. All lifetime item scores were converted based on the recommended guidelines (e.g., Rutter et al. 2003).
Results:
Analyses were first conducted on the lifetime algorithm items to determine which items distinguished children with ASD from children with DD. In the social reciprocity domain, the following items were significantly different between children with ASD and children with DD: social smiling, range of facial expressions, showing/directing attention, seeking to share enjoyment, use of other’s body, offering comfort, and quality of social overtures. All restricted and repetitive behavior items, with the exception of unusual preoccupations and verbal rituals, distinguished the ASD and DD groups. The communication domain had the fewest items that were significantly different between children with ASD and children with DD. Additional analyses were then run on additional lifetime non-algorithm items. These analyses showed that children with ASD had higher levels of impairment on comprehension of simple language, social disinhibition, difficulties with changes to routines/environment, and self-injury (all p’s < .05). These additional non-algorithm items demonstrated the largest differences observed between children with ASD and children with DD.
Conclusions:
The results of this study demonstrate that the communication domain had the lowest proportion of items that distinguished between ASD and DD, whereas the restricted and repetitive behavior items had the highest proportion of items. The results also find that additional items not included in the diagnostic algorithms of the ADI-R may enhance the validity of the parent interview among Latino families. This can be attributed distinct ways that ASD manifests or is perceived by Latino parents. With the publication of the DSM-5 and its updated diagnostic criteria for ASD, it is important to evaluate how existing diagnostic tools can be used to inform new diagnoses. 