Is the ADOS a Useful Instrument to Help in the Diagnosis of ASD Women?

Background:

In the last recent years there is a growing amount of scientific literature that shows the different clinical manifestation of ASD symptoms in women compared to men. It is well known that female-specific manifestation of autistic features fits imperfectly with current, male-based conceptualizations of ASD (Hiller et al. 2014;Lai et al. 2015).

Compared to males, females with ASD are: 1) less likely to have externalizing behaviours, and are more vulnerable to internalizing problems, such as anxiety, depression and eating disorders (Mandy, 2012; Huke, 2013); 2) have a greater social motivation (Sedgewick et al. 2015) 3) better non-verbal communication (Rynkiewicz et al. 2016) and 4) score lower on measures of repetitive and stereotyped behaviour (Van Wjingaarden-Cremers et al. 2014).

For these reasons, females are at substantially elevated risk of going undiagnosed: frequently mislabelled or missed entirely (Lai and Baron-Cohen 2015). Thus, many females who, if skillfully assessed, would meet full diagnostic criteria for ASD, never receive a ASD diagnosis.

Objectives:

1) To compare scores in selected ADOS items between men and women (based on previous literature): gestures, eye-contact, facial expression, prosody, stereotyped language, imagination, stereotypes and mannerisms, sensory abnormalities, restrictive interest, hyperactivity and anxiety. This analysis will be performed in a sample of 100 women and 100 men in whom ADOS has been administered in the last 8 years.

2) To study the agreement between ADOS cut-off label and the final clinical judgement.

Methods:

200 participants (100 girls and 100 boys matched by chronological age and secondary, when possible, by mental age) evaluated, from April 2009 to September 2017, in a Child and Adolescent Psychiatry Department of a General University Hospital in the context of one of the following: 1) diagnostic evaluation 2) to treat comorbidity or 3) participating in different research projects.

Procedure:

The ADOS was administered individually by a clinician with the appropriate reliability for the administration of the instrument. The evaluation was video-recorded. All the ADOS were immediately scored at the end of the evaluation. Final diagnosis was determined by clinical psychologists and psychiatrists with extensive experience in ASD based on all available information, including (always) full psychiatric and developmental interviews with parents or guardians (ADI-R when necessary), unstructured observation of the child, review of previous medical and educational records and ADOS scores. The diagnosis was therefore established following standard recommendations (Volkmar et al 2014) based on DSM-IV-TR ASD criteria (before 2013) criteria and/or DSM 5 criteria (after 2013).

Results: At the present moment all the evaluations have already been conducted and data are being incorporated in a database. We will conduct the statistic analyses during the next month.

Conclusions:

ASD girls are at risk of receiving non-spectrum classification in ADOS or ADOS-2 while their developmental history and clinical manifestations confirm ASD.

It could be the case that future editions of evaluating tools as ADOS need to contemplate differed cut-off scores for girls and boys. We intend to provide data to help with the discrimination of symptoms or behaviors that are differentially expressed by girls and boys.