Fletcher-Watson, Susan

McConachie, Helen

O'Hare, Anne

Petrou, Alex

English

Outcome measures for intervention studies for children with autism spectrum conditions (ASC) are currently limited. The Autism Diagnostic Observation Schedule – Change (ADOS-C; Lord, Carr, Grzadzinski, Morton, &amp; Colombi, 2013) is a detailed observation of social behaviours coded from a videoed interaction between parent and child. We explore the ADOS-C as a possible candidate measure and how it relates to the ADOS and measures of general ability and language which have also been used as outcomes. Thirty-three children (age range=25-71 months) were administered the Mullen Scales of Early Learning, the MacArthur Communicative Development Inventory, the ADOS, and the ADOS-C. All met criteria for autism on the ADOS. We will report correlational analyses between the ADOS-C total and the following scores: ADOS calibrated severity algorithm totals for Social Affect and Restricted, Repetitive Behaviours, Mullen visual reception and fine motor raw scores, and MCDI words produced raw score. To determine whether ADOS-C scores are independent of IQ and language, the sample will be split into 2 groups: Nonverbal and verbal children with low and high Mullen scores, respectively. We will explore how ADOS-C scores relate to ADOS severity scores in each group. We will also include a more detailed exploration of how individual ADOS-C and ADOS items map onto each other. Initial analysis of a subsample (n=14) reveals a positive correlation between ADOS-C total and ADOS RRB total (rs=.55, p&lt;.05). The ADOS-C total also correlates negatively with MCDI words produced and Mullen visual reception (both rs=-.55, p&lt;.05). We will discuss the potential of the ADOS-C as a valid outcome measure for use in intervention research, in particular its independence from measures of general functioning. We will further consider pragmatic aspects such as ease of scoring and administration

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     Edinburgh Research Explorer                                      ADOS-C: A new outcome measure for autism interventionstudiesCitation for published version:Petrou, A, Fletcher-Watson, S, O'Hare, A & McConachie, H 2013, 'ADOS-C: A new outcome measure forautism intervention studies', British Psychological Society Cognitive and Developmental SectionConference, Reading, United Kingdom, 4/09/13 - 6/09/13.Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 23. Jul. 2021The ADOS-C: A new outcome measure for autism intervention studies?IntroductionObjective outcome measures for intervention studies for children with autism spectrum conditions are currently limited. The Autism Diagnostic Observation Schedule –Change (ADOS-C1) is a detailed observation of social behaviours coded from a videoed interaction between parent and child. While we do not explore the primary purpose of the ADOS-C in how it may be used to track change in a child’s skills over time, we explore the ADOS-C as a possible candidate outcome measure with respect to the following study objectives.Alexandra M. Petrou1, Sue Fletcher-Watson1, Anne O’Hare2, and Helen McConachie31University of Edinburgh; 2Centre for Clinical Brain Sciences; 3Newcastle University1 Lord, C., Carr, T., & Gradzinski, R. (2013). Measuring emerging changes in social communication. International Meeting for Autism Research, San Sebastian, Spain. 2 Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start denver model. Pediatrics, 125, e17-23. 3 McConachie, H.R.M., Randle, V., Hammal, D., & Le Couteur, A. (2005). A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Journal of Pediatrics, 147, 335-340.Fig. 6. Example of ADOS-C item from coding manualEase of administration Fig. 7. Example of ADOS-C coding sheetReliability Based on 20 video partsIntra-rater: Weighted Kappa range = .49 – 1.00 indicating moderate to perfect agreement.Inter-rater: Weighted Kappa range = .00 – .65 indicating slight to substantial agreement. Whole scale agreementEach item scored within one point as agreement: Intra-rater = 99%  Inter-rater = 89% Reliability Item 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Intra-rater .60 .81 .96 .65 .87 .73 .62 .94 .85 .87 .49 .67 .72 .70 1.00 Inter-rater .13 .34 .32 .40 .23 .20 .34 .38 .56 .65 .00 .27 .09 .12 .40 Numbers shown are Weighted KappasFocus on child only Fig. 8. Examples of various interactions between parent and childStudy objectives Is the ADOS-C reliable to code and straightforward to administer?  Is the ADOS-C clinically relevant as measured by correlation with ADOS severity scores?  Is the ADOS-C independent of non-verbal ability and language which have also been used as outcome measures? 2,3MethodsThirty-three children (mean age=51.4 months, SD=12.5, range=25–71 months; males=26, females=7) were given: ADOS: Module 1 (n=24); Module 2 (n=9). All met criteria for autism. Severity scores of Social Affect (SA) and Restricted, Repetitive Behaviours (RBB).Mullen Scales of Early Learning: Non-verbal ability – Subscales of Visual Reception and Fine Motor skills. Averaged age equivalent score.MacArthur Communicative Development Inventory (MCDI): Language ability – Words produced raw score.ADOS-C: The ADOS-C comprises 15 items that are coded twice in two 5 minute video parts. Coded parts were counterbalanced across participants. • The ADOS-C average score was calculated by summing scores for items 1 – 13 for each part and then averaged.• The ADOS-C social communication score was calculated by summing scores for items 1 – 8 for each part and then averaged.DiscussionReliability and ease of administration Whole scale percentage agreements across the ADOS-C were substantial.  Intra-rater agreement was good at individual ADOS-C item level.  Poor Kappa ratings for inter-rater agreement may reflect a need for more detailed guidance to raters or a consistent training package for using the measure. Lord and colleagues are developing item score decision trees to improve reliability. The ADOS-C is simple and quick to administer and code.Clinical relevance  The strong relationship between the ADOS-C to ADOS severity scores reflects its clinical relevance.Independence of non-verbal ability and language The ADOS-C is not independent of non-verbal ability and language. This may affect its usefulness as an outcome measure for autism intervention studies.Future research Explore the sensitivity of the ADOS-C to change with intervention and test-retest reliability. Explore how variable or constant children are at any one point in time within a play session with an adult. The ADOS-C does not capture parent behaviour – The ADOS-C should be used to capture change in the same parent-child dyads over time; not to compare (for example) two groups of children at a single time point and not to compare the same child with two different adults. The ADOS-C average score correlated positively with the ADOS SA severity score (rs=.37, p<.05; Fig. 1) and the ADOS RRB score (rs=.36, p<.05, Fig. 2) to a moderate extent. ADOS-C social communication score correlated positively with the ADOS SA severity score to a moderate extent (rs=.38, p<.05, Fig. 3).Clinical relevanceFig. 1 Fig. 2 Fig. 3The ADOS-C average score correlated negatively with both the Mullen average age equivalent score to a moderate extent (rs=-.56, p<.01; Fig. 4) and with the MCDI words produced raw score to a large extent (rs=-.64, p<.001; Fig. 5).Non-verbal ability and languageFig. 4 Fig. 5With thanks to all the children and parents who took part and to Professor Lord and colleagues for making the ADOS-C available for our use prior to publication of the measure.amp12@hw.ac.ukalexpetrou2005@yahoo.co.uk

ADOS-C: A new outcome measure for autism intervention studies

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ADOS-C: A new outcome measure for autism intervention studies

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