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      Screening von Kindern und Jugendlichen mit hochfunktionaler Autismus-Spektrum-Störung anhand ausgewählter Items des ADI-R

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          Abstract

          Fragestellung: Zum Screening von Autismus-Spektrum-Störungen (ASS) stehen verschiedene Fragebogenverfahren zur Verfügung. Leider zeigen neuere Studien, dass diese Verfahren zwar tatsächlich in der Lage sind, betroffene Personen mit ASS zu identifizieren, aber bezüglich der differentialdiagnostischen Abgrenzung zu anderen komplexen Störungsbildern (z. B. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung [ADHS], emotionale Störungen, Persönlichkeitsstörungen), insbesondere bei Personen ohne deutliche kognitive Beeinträchtigung, Probleme aufweisen (niedrige Spezifität). Methodik: In der vorliegenden Studie wurde an einer großen Inanspruchnahme-Stichprobe aus 309 Patienten (153 mit ASS, 156 mit sonstigen psychischen Störungen, IQ > 70) geprüft, inwiefern ausgewählte Items des ADI-R im Screening-Prozess von hochfunktionalen ASS eingesetzt werden können. Ergebnisse: Bei einem Cut-off von 5 zeigte sich eine hohe Sensitivität (0.93), bei einem Cut-off von 6 eine gute Spezifität (0.74). Dieses Ergebnis blieb für verschiedene Untergruppen (Einteilung nach Diagnose/Alter/IQ/Geschlecht) stabil. Schlussfolgerung: Insgesamt hat sich gezeigt, dass acht Interviewfragen des ADI-R dazu dienen können, Kinder und Jugendliche mit hochfunktionaler ASS von solchen mit anderen psychischen Störungen zu unterscheiden. Die Kombination aus früh beginnenden, ausgeprägten Auffälligkeiten im sozialen Kontakt mit stereotypen oder zwanghaft-ritualisierten Verhalten oder Interessen kann anhand weniger Fragen zu Screening-Zwecken ermittelt werden. Jedoch ist im weiteren Verlauf eine ausführliche und spezifische weitere kinder- und jugendpsychiatrische Diagnostik notwendig.

          Screening interview for early detection of high-functioning autism spectrum disorders

          Objective: Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities. Method: The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD. Results: The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74. Conclusion: The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.

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          Most cited references 45

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          Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample.

          Autism spectrum disorders are now recognized to occur in up to 1% of the population and to be a major public health concern because of their early onset, lifelong persistence, and high levels of associated impairment. Little is known about the associated psychiatric disorders that may contribute to impairment. We identify the rates and type of psychiatric comorbidity associated with ASDs and explore the associations with variables identified as risk factors for child psychiatric disorders. A subgroup of 112 ten- to 14-year old children from a population-derived cohort was assessed for other child psychiatric disorders (3 months' prevalence) through parent interview using the Child and Adolescent Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety disorders, depressive disorders, oppositional defiant and conduct disorders, attention-deficit/hyperactivity disorder, tic disorders, trichotillomania, enuresis, and encopresis were identified. Seventy percent of participants had at least one comorbid disorder and 41% had two or more. The most common diagnoses were social anxiety disorder (29.2%, 95% confidence interval [CI)] 13.2-45.1), attention-deficit/hyperactivity disorder (28.2%, 95% CI 13.3-43.0), and oppositional defiant disorder (28.1%, 95% CI 13.9-42.2). Of those with attention-deficit/hyperactivity disorder, 84% received a second comorbid diagnosis. There were few associations between putative risk factors and psychiatric disorder. Psychiatric disorders are common and frequently multiple in children with autism spectrum disorders. They may provide targets for intervention and should be routinely evaluated in the clinical assessment of this group.
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            Autism from 2 to 9 years of age.

            Autism represents an unusual pattern of development beginning in the infant and toddler years. To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis. Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview-Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses. Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics. At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age. Consensus best-estimate diagnoses at 9 years of age. Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted kappa of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years. Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.
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              Measuring autistic traits: heritability, reliability and validity of the Social and Communication Disorders Checklist.

              Autistic traits are widely distributed in the general population, but the boundaries of the autistic spectrum are unclear. Whole-population surveys of unselected samples of children are hampered by the lack of appropriate screening instruments. To assess whether the Social and Communication Disorders Checklist (SCDC) fulfils the need for a sensitive measure of autistic traits, which can be completed in a few minutes and which measures heritable characteristics in both males and females. A12-item scale, the SCDC, was completed by three independent samples drawn from a twin register, a group with Turner syndrome and children with a diagnosis of autistic-spectrum disorder attending clinics. The data were used to establish the heritability, reliability and validity of the checklist. Traits measured by the SCDC were highly heritable in both genders (0.74). Internal consistency was excellent (0.93) and test - retest reliability high (0.81). Discriminant validity between pervasive developmental disorder and other clinical groups was good, discrimination from non-clinical samples was better; sensitivity (0.90), specificity (0.69). The SCDC is a unique and efficient first-level screening questionnaire for autistic traits.
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                Author and article information

                Journal
                kij
                Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie
                Hogrefe AG, Bern
                1422-4917
                1664-2880
                Mai 2015
                : 43
                : 3
                : 207-219
                Affiliations
                [ 1 ] Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Phillips-Universität Marburg
                Author notes
                Prof. Dr. phil. Inge Kamp-Becker, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Phillips-Universität Marburg, Hans-Sachs-Str. 6, 35039 Marburg, Deutschland, mailto: kampbeck@ 123456med.uni-marburg.de
                Article
                kij_43_3_207
                10.1024/1422-4917/a000354
                Product
                Self URI (journal-page): https://econtent.hogrefe.com/loi/kij
                Categories
                Originalarbeiten/Original articles

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