This study compared the Autism Diagnostic Observation Schedule (ADOS) algorithm scores of a sample of 26 children (ages 6–11) who were administered modules 1–3 of the ADOS with the clinical diagnoses for each of these children. The ADOS showed greater sensitivity in identifying ASD-related symptoms than physician diagnoses.
INTRODUCTION
The purpose of the sub-hypotheses in this study was to answer uncertainties regarding ethnicity and whether there are significant differences in the ways cultural groups respond to the ADOS score. Children with ASD and children without ASD were tested on the ADOS to determine the diagnostic accuracy of the ADOS.
LITERATURE REVIEW
Rationale of Research
This study explores the use of the ADOS as a diagnostic tool in the South African context. The primary purpose of this study was to explore the diagnostic ability of the ADOS.
Theoretical framework of Autistm Spectrum Disorders
- Historical perspectives of ASD
- ASD Defined
- Diagnosis and Classification of ASD
- Estimated prevalence and Trends
- Aetiological Issues
Assessment, differential diagnoses and comorbidities
- Assessment
- Diagnoses
- Comorbidities
Lord et al., (2011) state that the diagnosis of autism of any subtype can be made with sensitivity and specificity. However, an increasing number of children who have reached their normal language milestones are being diagnosed with ASD (Lord et al., 2011).
Gender, Culture and Socialisation
- Gender
- Culture
- Socialisation
Large ethnic differences in the diagnosis of ASDs have recently been identified (Matson et al., 2011; Chung et al., in Sipes, 2011). As already mentioned, eye contact between a child and an adult would be considered disrespectful in the Zulu culture (Grinker et al., 2011).
Autism Diagnostic Observation Schedule (ADOS)
- Standardisation
- Theoretical Considerations
- A Western tool within the South African Context
This study is part of the larger K-ASD study, which seeks to standardize and unlock the cultural relevance of the ADOS in South Africa. The reliability of the ADOS is beyond the scope of this study, but it is nevertheless taken into account to some extent. This aspect of the ADOS study is completed by the members of the K-ASD study.
The ADOS is a Western tool and this study aimed primarily to investigate its diagnostic ability in the South African context. Therefore, every effort has been made to standardize the ADOS for the South African context without changing the assessment process. In addition, the frog was also not used as a toy in the ADOS subtest, as many black children are afraid of frogs.
Dark-skinned dolls were added to modules 1, 2, and 3 of the ADOS for both task two and the birthday party.
METHODOLOGY
Research Design
Ho1: There is no significant difference between children of black, white, or Indian ethnicity with ASD and children with other special needs, based on the subgroup coding for communicative behavior on the ADOS. Ha1: There is a significant difference between children of black, white or Indian ethnicity with ASD and children with other special needs, based on the subgroup coding for communicative behavior on the ADOS. Ho2: There is no significant difference between children of black, white or Indian ethnicity with ASD and children with other special needs, based on the subgroup coding for reciprocal social interaction on the ADOS.
Ha2: There is a significant difference between children of Black, White, or Indian ethnic origin with ASD and those with other special needs based on the subgroup coding for Reciprocal Social Interaction on the ADOS. Ho3: There is no significant difference between children from Black, White, or Indian cultures with ASD and those with other special needs based on the subgroup coding for Imagination/Creativity on the ADOS. Ha3: There is a significant difference between children of Black, White, or Indian ethnic origin with ASD and those with other special needs based on the subgroup coding for Imagination/Creativity on the ADOS.
Ho4: There is no significant difference between the children of Black, White or Indian ethnic origin with ASD and those with other special needs based on the subgroup coding for Stereotyped Behavior and Restricted Interests on the ADOS.
Data Collection Procedure
- Sampling and Measures of recruitment
- Participants
- Inclusion and exclusion criteria
- The Assessment Process
- Forms of error in assessment
- Limitations in the Research Design
Those who spoke Zulu as their home language had an isiZulu interpreter present during the administration of the ADOS. This was consistent with the initial letter informing them of the study and requesting the child's participation. All three assessment measures are dependent on the researchers' accurate implementation of the assessment.
Notes were taken during the administration of the ADOS module by both researchers for each tested participant. This allows for a more precise exploratory test of the validity of the ADOS in this study. The use of the ADOS is highly dependent on the clinical experience of the researchers/examiners, how they subjectively score each participant and their experience with the instrument.
In this regard, the ADOS administrations have greatly contributed to the well-being of the children.
Data Analysis
- Gender and ethnicity in the sample
- Concordant diagnoses
- Descriptive statistics
- Statistical analyses
- ADOS sub-category analyses
- Statistical analyses
- Analysis of personal files
- Descriptive statistics
The comparison of the concordant diagnostic power of the ADOS diagnoses per participant and that of the diagnoses of trained physicians was recorded as nominal, dichotomous data. The sample of n subjects was randomly selected from the group it represents (due to time constraints, children with or without ASD were selected from special education schools who were willing to participate in the study. They were blindly assigned to the researcher so that they never knew each participant's clinical diagnosis when the ADOS was administered to them). The ADOS subcategories of each group were also compared by ethnicity and the scores were entered as numerical values.
Thus, each ethnic group was compared with each algorithm to determine whether diagnosis on the ADOS varied along ethnic lines. In this regard, the specific question was: 'Did the variable ethnic groups in the sample respond differently to the subcategories of the ADOS in a statistically significant way. This meant that ethnic groups responded differently to the ADOS in a significant way, with subcategory scores differing greatly from one another.
After the ADOS was administered to the entire sample and scores were completed, the personal files of each study participant were analyzed by a trained clinician.
RESULTS
Introduction
- Gender and ethnicity in the sample
- Concordant diagnoses
- Descriptive statistics
- Statistical Analyses
- ADOS sub-category analyses
- Analysis of Personal files
Of the Indian participants in the sample, there was diagnostic agreement between the clinician and the ADOS for 5 of the 6 participants. Therefore, there had to be no more than 10% difference in outcome diagnoses between ADOS and clinicians. In this case, between ADOS diagnoses and clinician diagnoses (Lung, Gorko, Llewelyn & Wiggins, 2003).
Ho1: Based on subgroup coding for communicative behavior on the ADOS, there is no significant difference between white, black, or Indian children with ADHD and children with other disabilities. Ho2: There is no significant difference between white, black, or Indian children with ADHD and children with other disabilities based on subgroup coding for reciprocal social interaction behavior on the ADOS. Ho3: Based on subgroup coding for Imaginative/Creative Behavior on the ADOS, there is no significant difference between Black, White, or Indian children with ADHD and children with other disabilities.
Ha4: Based on subgroup coding for stereotyped behavior and restricted interests on the ADOS, there is a significant difference between Black, White, or Indian children with ADD and children with other special needs.
Discussion
Introduction
- Gender and ethnicity in the sample
- Concordant diagnoses
- Descriptive statistics
- Statistical analyses
- ADOS sub-category analysis
- Personal Files
Of the 26 study participants, there were 19 instances of diagnostic concordance between ADOS and clinicians. Ho1: There is no significant difference between children of black, white, or Indian cultures with ASD and those with other special needs based on subgroup coding for communicative behaviors on the ADOS. Ha1: There is a significant difference between children of Black, White, or Indian cultures with ASD and those with other special needs based on subgroup coding for communicative behaviors on the ADOS.
Ho2: There is no significant difference between Black, White, or Indian culture children with ASD and children with other special needs, based on the subgroup coding for reciprocal social interaction on the ADOS. Ha2: There is a significant difference between Black, White, or Indian culture children with ASD and children with other special needs, based on the subgroup coding for reciprocal social interaction on the ADOS. Ha3: There is a significant difference between Black, White or Indian children with ASD and children with other special needs, based on the subgroup coding for Imagination/Creativity on the ADOS.
Ho4: There is no significant difference between children of Black, White, or Indian cultures with ASD and those with other special needs based on subgroup coding for Stereotyped Behaviors and Restricted Interests on the ADOS.
Limitations and future research possibilities
However, these high percentages were not reflected in this study, the small sample size may have resulted in the results in this study not reflecting what has been found in other studies of a similar nature. This area of ASDs is such an under-researched field in South Africa, this study has highlighted many possible future studies that could build on from this one. This study used the child-centered approach to testing, and the researcher paid close attention to how the child responded to the ADOS tasks and the testing situation in general.
Some factors, such as maternal age at birth, were not addressed in this study, which would be good to include in future studies. Due to too many files with missing data, this study had to ignore the possible correlation shown. This study examined behavioral differences in ADOS subcategories between Black, White, and Indian cultures and noted significant differences in some subcategories.
It would be of future benefit to replicate this study at multiple locations in South Africa.
Conclusion
Prevalence of autism spectrum disorders in a population-based cohort of children in South Thames: Special needs and Autism Project (SNAP). Cross-cultural differences in challenging behavior in children with autism spectrum disorders: an international study between Israel, South Korea, Great Britain and the United States. Sorting out autism spectrum disorders: evidence-based medicine and the complexity of the clinical encounter.
Analysis of risk factors and early predictors of challenging behavior for children with autism spectrum disorder. Brief report: exploratory analysis of the ADOS-revised algorithm: specificity and predictive value with Hispanic children referred for autism spectrum disorders. A multinational study investigating the cross-cultural differences in social skills in children with autism spectrum disorders: a UK-US comparison.
Symptoms of depression and anxiety in children and adolescents with autism spectrum disorders without intellectual disabilities.
