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Diagnosing autism spectrum disorder in community settings using the Development and Well‐Being Assessment: validation in a UK population‐based twin sample
Author(s) -
McEwen Fiona S.,
Stewart Catherine S.,
Colvert Emma,
Woodhouse Emma,
Curran Sarah,
Gillan Nicola,
Hallett Victoria,
Lietz Stephanie,
Garnett Tracy,
Ronald Angelica,
Murphy Declan,
Happé Francesca,
Bolton Patrick
Publication year - 2016
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/jcpp.12447
Subject(s) - autism spectrum disorder , autism diagnostic observation schedule , telephone interview , population , autism , nice , psychology , positive predicative value , pervasive developmental disorder , clinical psychology , psychiatry , pediatrics , medicine , predictive value , social science , environmental health , sociology , computer science , programming language
Background Increasing numbers of people are being referred for the assessment of autism spectrum disorder ( ASD ). The NICE ( UK ) and the American Academy of Pediatrics recommend gathering a developmental history using a tool that operationalises ICD / DSM criteria. However, the best‐established diagnostic interview instruments are time consuming, costly and rarely used outside national specialist centres. What is needed is a brief, cost‐effective measure validated in community settings. We tested the Development and Well‐Being Assessment ( DAWBA ) for diagnosing ASD in a sample of children/adolescents representative of those presenting in community mental health settings. Methods A general population sample of twins ( TEDS ) was screened and 276 adolescents were selected as at low ( CAST score < 12; n = 164) or high risk for ASD ( CAST score ≥ 15 and/or parent reported that ASD suspected/previously diagnosed; n = 112). Parents completed the ASD module of the DAWBA interview by telephone or online. Families were visited at home: the ADI ‐R and autism diagnostic observation schedule ( ADOS ) were completed to allow a best‐estimate research diagnosis of ASD to be made. Results Development and Well‐Being Assessment ASD symptom scores correlated highly with ADI ‐R algorithm scores (ρ = .82, p < .001). Good sensitivity (0.88) and specificity (0.85) were achieved using DAWBA computerised algorithms. Clinician review of responses to DAWBA questions minimally changed sensitivity (0.86) and specificity (0.87). Positive (0.82–0.95) and negative (0.90) predictive values were high. Eighty‐six per cent of children were correctly classified. Performance was improved by using it in conjunction with the ADOS . Conclusions The DAWBA is a brief structured interview that showed good sensitivity and specificity in this general population sample. It requires little training, is easy to administer (online or by interview) and diagnosis is aided by an algorithm. It holds promise as a tool for assisting with assessment in community settings and may help services implement the recommendations made by NICE and the American Academy of Pediatrics regarding diagnosis of young people on the autism spectrum.