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The influence of parental concern on the utility of autism diagnostic instruments

Research output: Contribution to journalArticle

  • Karoline Alexandra Havdahl
  • Somer L. Bishop
  • Pål Surén
  • Anne Siri Øyen
  • Catherine Lord
  • Andrew Pickles
  • Stephen von Tetzchner
  • Synnve Schjølberg
  • Nina Gunnes
  • Mady Hornig
  • W. Ian Lipkin
  • Ezra Susser
  • Michaeline Bresnahan
  • Per Magnus
  • Nina Stenberg
  • Ted Reichborn-Kjennerud
  • Camilla Stoltenberg
Original languageEnglish
Number of pages15
JournalAutism Research
Early online date22 Jun 2017
DateAccepted/In press - 4 May 2017
DateE-pub ahead of print (current) - 22 Jun 2017


The parental report-based Autism Diagnostic Interview-Revised (ADI-R) and the clinician observation-based Autism Diagnostic Observation Schedule (ADOS) have been validated primarily in U.S. clinics specialized in autism spectrum disorder (ASD), in which most children are referred by their parents because of ASD concern. This study assessed diagnostic agreement of the ADOS-2 and ADI-R toddler algorithms in a more broadly based sample of 679 toddlers (age 35-47 months) from the Norwegian Mother and Child Cohort. We also examined whether parental concern about ASD influenced instrument performance, comparing toddlers identified based on parental ASD concern (n=48) and parent-reported signs of developmental problems (screening) without a specific concern about ASD (n=400). The ADOS cutoffs showed consistently well-balanced sensitivity and specificity. The ADI-R cutoffs demonstrated good specificity, but reduced sensitivity, missing 43% of toddlers whose parents were not specifically concerned about ASD. The ADI-R and ADOS dimensional scores agreed well with clinical diagnoses (AUC≥0.85), contributing additively to their prediction. On the ADI-R, different cutoffs were needed according to presence or absence of parental ASD concern, in order to achieve comparable balance of sensitivity and specificity. These results highlight the importance of taking parental concern about ASD into account when interpreting scores from parental report-based instruments such as the ADI-R. While the ADOS cutoffs performed consistently well, the additive contributions of ADI-R and ADOS scores to the prediction of ASD diagnosis underscore the value of combining instruments based on parent accounts and clinician observation in evaluation of ASD.

    Research areas

  • ADI-R, ADOS, early diagnosis, screening

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 937 KB, PDF document


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