Introduction
Methods
Participants
Clinical classification | 12-20/NV21-47 | SW21-47 | PH21-47 | ||||||
---|---|---|---|---|---|---|---|---|---|
N | Mean | SD | N | Mean | SD | N | Mean | SD | |
ASD
| |||||||||
Age (months) | 263 | 32.2a,b
| 7.4 | 192 | 36.1a,c
| 6.5 | 164 | 40.2c
| 4.8 |
NVIQ | 230 | 57.7d,e
| 19.0 | 164 | 69.4d,e
| 19.0 | 136 | 81.9d,e
| 19.0 |
ADI SA/SC | 263 | 11.6c,f
| 3.9 | 192 | 9.8c,f
| 4.2 | 164 | 8.6c,f
| 4.6 |
ADI RRB | 263 | 3.3f
| 2.5 | 192 | 3.5c,f
| 3.0 | 164 | 2.9c,f
| 2.5 |
ADI IGP/RPI | 263 | 10.4c,f
| 2.3 | 192 | 6.7c,f
| 2.5 | 164 | 2.8c,f
| 1.6 |
ADI tot2dom | 263 | 14.9 | 5.5 | 192 | 13.3 | 6.2 | 164 | 11.5 | 6.0 |
ADI tot3dom | 263 | 25.2 | 7.1 | 192 | 20.0 | 8.0 | 164 | 14.3 | 7.1 |
ADOS T NW SA | – | – | – | ||||||
ADOS T NW RRB | – | – | – | ||||||
ADOS T SW SA | 1 | 22.0 | 1 | 6.0 | – | ||||
ADOS T SW RRB | 1 | 5.0 | 1 | 14.0 | – | ||||
ADOS 1 NW SA | 135 | 14.8f
| 3.3 | 62 | 12.5 | 3.1 | 13 | 11.2a
| 3.1 |
ADOS 1 NW RRB | 135 | 3.4f
| 1.9 | 62 | 2.4 | 1.8 | 13 | 1.8c,f
| 1.6 |
ADOS 1 SW SA | 60 | 16.4 | 3.1 | 98 | 12.6c,f
| 4.5 | 75 | 10.4c,f
| 5.0 |
ADOS 1 SW RRB | 60 | 3.8 | 1.6 | 98 | 2.4f
| 1.7 | 75 | 2.5c,f
| 1.8 |
ADOS 2 SA | – | 3 | 14.7 | 4.2 | 59 | 10.5c,f
| 4.5 | ||
ADOS 2 RRB | – | 3 | 4.7 | 1.5 | 59 | 2.7c,f
| 2.3 | ||
Non-spectrum disorders
| |||||||||
Age (months) | 60 | 25.6a
| 9.3 | 90 | 33.4a,g
| 7.7 | 120 | 38.1h
| 6.0 |
NVIQ | 44 | 74.0d,i
| 25.1 | 81 | 82.6d,j
| 18.8 | 116 | 93.1d,j
| 16.7 |
ADI SA/SC | 60 | 3.6f
| 3.1 | 90 | 4.8f,g
| 3.6 | 120 | 4.2f,g
| 3.8 |
ADI RRB | 60 | .9f
| 1.5 | 90 | 1.3f
| 1.9 | 120 | 1.4f,h
| 1.9 |
ADI IGP/RPI | 60 | 4.5f
| 3.6 | 90 | 3.7f,g
| 2.5 | 120 | 2.1f,g
| 1.6 |
ADI tot2dom | 60 | 4.5 | 4.0 | 90 | 6.1 | 4.4 | 120 | 5.6 | 4.9 |
ADI tot3dom | 60 | 8.9 | 6.9 | 90 | 9.8 | 6.1 | 120 | 7.7 | 5.9 |
ADOS T NW SA | – | 4 | 7.3 | 6.9 | – | ||||
ADOS T NW RRB | – | 4 | 2.3 | 1.3 | – | ||||
ADOS T SW SA | 2 | 5.0 | 7.1 | 2 | 4.0 | 1.4 | 3 | 5.0 | 6.2 |
ADOS T SW RRB | 2 | .5 | .7 | 2 | .5 | .7 | 3 | 2.7 | .6 |
ADOS 1 NW SA | 34 | 5.1f
| 5.0 | 18 | 7.4 | 4.9 | 2 | 4.5a
| .7 |
ADOS 1 NW RRB | 34 | 1.0f
| 1.4 | 18 | 1.2 | 1.4 | 2 | 1.0f,h
| 1.4 |
ADOS 1 SW SA | 8 | 2.9 | 1.7 | 41 | 4.5f
| 3.8 | 62 | 3.8f
| 3.0 |
ADOS 1 SW RRB | 8 | .6 | .7 | 41 | 1.0f
| 1.2 | 62 | .6f
| .8 |
ADOS 2 SA | 6 | 2.7 | 4.6 | 39 | 5.4f,g
| 3.2 | |||
ADOS 2 RRB | 6 | .7 | .8 | 39 | 1.2f,h
| 1.4 | |||
Typical development
| |||||||||
Age (months) | 7 | 22.3b
| 7.3 | 42 | 26.4c,g
| 5.3 | 166 | 35.1d,h
| 8.5 |
NVIQ | 7 | 97.7e,i
| 20.4 | 41 | 101.4e,j
| 12.3 | 164 | 109.3e,j
| 13.2 |
ADI SA/SC | 7 | 4.1c
| 5.3 | 42 | 1.8c,g
| 3.0 | 166 | 1.0c,g
| 1.8 |
ADI RRB | 7 | 1.6 | 2.1 | 42 | 1.0c
| 1.8 | 166 | .7c,h
| 1.2 |
ADI IGP/RPI | 7 | 4.4c
| 4.5 | 42 | 1.6c,g
| 1.8 | 166 | .6c,g
| .9 |
ADI tot2dom | 7 | 5.7 | 7.4 | 42 | 2.8 | 4.3 | 166 | 1.7 | 2.5 |
ADI tot3dom | 7 | 10.1 | 11.8 | 42 | 4.5 | 5.6 | 166 | 2.3 | 3.0 |
ADOS T NW SA | 2 | 1.5 | 2.1 | 15 | 2.5 | 3.0 | 24 | 1.5 | 1.8 |
ADOS T NW RRB | 2 | .5 | .7 | 15 | .9 | 1.2 | 24 | .5 | .7 |
ADOS T SW SA | 2 | 1.5 | 2.1 | 18 | 1.4 | 1.3 | 36 | 1.4 | 1.7 |
ADOS T SW RRB | 2 | 0 | 0 | 18 | .8 | 1.4 | 36 | .5 | .8 |
ADOS 1 NW SA | 2 | 10.0 | 7.1 | – | 2 | 12.0c,h
| 0 | ||
ADOS 1 NW RRB | 2 | 4.5 | 3.5 | – | 2 | 2.0 | 2.8 | ||
ADOS 1 SW SA | 1 | 1.0 | 7 | 5.3c
| 5.2 | 33 | 1.7c
| 2.0 | |
ADOS 1 SW RRB | 1 | 0 | 7 | 1.3 | 2.1 | 33 | .6c
| .9 | |
ADOS 2 SA | – | – | 66 | 1.3c,g
| 1.5 | ||||
ADOS 2 RRB | – | – | 66 | .4c,h
| .7 |
Sweden | NL Nijmegen | Israel | UK | Spain | NL Utrecht | Iceland | Macedonia | France | Finland | |
---|---|---|---|---|---|---|---|---|---|---|
N | 234 | 230 | 206 | 188 | 115 | 42 | 39 | 20 | 17 | 13 |
Sex
| ||||||||||
Male % | 73.9 | 81.3 | 51.9 | 86.7 | 80.0 | 69.0 | 76.9 | 85.0 | 76.5 | 46.2 |
Age in months
| ||||||||||
Mean (SD) | 36.9 (6.9) | 32.9 (5.6) | 32.6 (8.8) | 35.7 (9.5) | 32.6 (6.4) | 39.6 (7.2) | 39.0 (6.1) | 41.5 (5.2) | 34.8 (6.5) | 14.85 (1.2) |
IQ
| ||||||||||
NVIQ mean (SD) | 81.1 (18.1) | 77.2 (24.0) | 106.5 (14.9) | 69.8 (20.7) | 60.5 (21.2) | 113.0 (16.6) | 91.7 (12.6) | 40.4 (10.6) | 90.0 (23.9) | |
Developmental cell
| ||||||||||
12-20/NV21-47 % | 29.5 | 24.8 | 2.4 | 49.5 | 53.9 | 21.4 | 15.4 | 75.0 | 5.9 | 100.0 |
SW21-47 % | 35.0 | 33.0 | 20.4 | 28.2 | 26.1 | 26.2 | 48.7 | 25.0 | 35.3 | 0 |
PH21-47 % | 35.5 | 42.2 | 77.2 | 22.3 | 20.0 | 52.4 | 35.9 | 0 | 58.8 | 0 |
BE Clinical Diagnosis
| ||||||||||
ASD % | 62.4 | 67.0 | 3.4 | 78.2 | 61.7 | 76.2 | 82.1 | 100.0 | 58.8 | 0 |
NS % | 32.1 | 32.6 | 8.3 | 16.0 | 35.7 | 19.0 | 17.9 | 0 | 23.5 | 100.0 |
TD % | 5.6 | .4 | 88.3 | 5.9 | 2.6 | 4.8 | 0 | 0 | 17.6 | 0 |
ADI-R scores
| ||||||||||
Above clin cutoff % | 46.6 | 46.5 | 2.9 | 75.5 | 53.9 | 69.0 | 64.1 | 100.0 | 70.6 | 0 |
Above res cutoff % | 29.9 | 25.7 | 1.5 | 68.6 | 43.5 | 54.8 | 33.3 | 100.0 | 58.8 | 0 |
12-20/NV21-47
| ||||||||||
ASD
| ||||||||||
SA mean (SD*) | 9.2 (3.7) | 10.2 (3.7) | 10 | 13.1 (2.9) | 12.0 (3.7) | 12.6 (5.1) | 13.0 (3.5) | 16.1 (2.2) | 17 | |
RRB mean (SD*) | 3.2 (2.2) | 1.7 (2.4) | 2 | 4.7 (2.4) | 2.3 (1.9) | 3.6 (1.4) | 3.6 (1.1) | 4.9 (2.3) | 3 | |
IGP mean (SD*) | 8.8 (2.8) | 9.7 (2.5) | 11 | 11.4 (.9) | 10.8 (2.0) | 10.0 (2.2) | 11.8 (.4) | 11.1 (1.3) | 12 | |
NS
| ||||||||||
SA mean (SD*) | 4.3 (3.1) | 4.4 (3.0) | 0 | 4.4 (3.0) | 3.9 (2.7) | 4 | 12 | .9 (1.5) | ||
RRB mean (SD*) | 1.7 (1.7) | .6 (.9) | 0 | 1.2 (1.9) | .6 (1.1) | 5 | 1 | .1 (.3) | ||
IGP mean (SD*) | 3.8 (3.2) | 7.4 (3.7) | 0 | 5.3 (3.8) | 4.6 (3.2) | 12 | 9 | 2.2 (2.0) | ||
TD
| ||||||||||
SA mean (SD*) | 8.5 (.7) | 0 (0) | 12 | 0 | ||||||
RRB mean (SD*) | 3.0 (1.4) | 0 (0) | 5 | 0 | ||||||
IGP mean (SD*) | 8.0 (.0) | .3 (.6) | 11 | 3 | ||||||
SW21-47
| ||||||||||
SA mean (SD*) | 8.2 (3.5) | 8.8 (4.2) | 8 | 11.7 (3.7) | 11.5 (4.1) | 10.9 (4.8) | 9.2 (3.9) | 17.4 (1.7) | 11.0 (1.0) | |
RRB mean (SD*) | 2.9 (2.4) | 1.5 (2.4) | 3 | 6.0 (2.7) | 3.1 (2.7) | 4.7 (2.6) | 2.5 (2.0) | 8.2 (3.3) | 6.0 (1.0) | |
IGP mean (SD*) | 5.2 (2.6) | 6.8 (2.6) | 7 | 7.7 (2.1) | 8.6 (1.5) | 6.7 (2.2) | 6.5 (2.0) | 9.6 (.9) | 6.3 (.6) | |
NS
| ||||||||||
SA mean (SD*) | 5.6 (3.5) | 5.0 (3.6) | 2.0 (2.3) | 4.3 (2.3) | 3.7 (3.0) | 12.5 (4.9) | 4.7 (4.5) | .5 (.7) | ||
RRB mean (SD*) | 1.7 (1.5) | .4 (.8) | .3 (.5) | 2.0 (3.2) | .9 (1.8) | 4.0 (2.8) | 1.8 (2.3) | 3.5 (4.9) | ||
IGP mean (SD*) | 3.4 (2.4) | 4.5 (2.3) | 1.3 (1.5) | 5.0 (3.3) | 2.9 (1.9) | 8.5 (2.1) | 3.3 (2.3) | 5.0 (.0) | ||
TD
| ||||||||||
SA mean (SD*) | 9 | 2 | 1.0 (1.4) | 8.0 (7.0) | 6 | 0 | ||||
RRB mean (SD*) | 0 | 0 | .8 (1.1) | 5.0 (4.4) | 0 | 0 | ||||
IGP mean (SD*) | 5 | 0 | 1.3 (1.5) | 4.0 (1.0) | 6 | 1 | ||||
PH21-47
| ||||||||||
SC mean (SD*) | 7.5 (4.8) | 7.9 (3.9) | 9.2 (5.0) | 9.5 (5.5) | 12.1 (5.0) | 9.2 (4.8) | 7.4 (2.6) | 12.5 (3.9) | ||
RRB mean (SD*) | 3.0 (2.6) | 1.7 (1.8) | 3.0 (3.2) | 4.6 (3.2) | 2.5 (1.6) | 3.3 (1.7) | 2.6 (1.4) | 4.3 (2.1) | ||
RPI mean (SD*) | 3.1 (1.1) | 2.6 (1.8) | 3.2 (1.6) | 2.8 (2.0) | 3.5 (1.8) | 2.1 (1.6) | 1.9 (.9) | 3.5 (1.0) | ||
NS
| ||||||||||
SC mean (SD*) | 4.2 (3.3) | 4.9 (4.0) | .7 (1.1) | 4.4 (5.5) | 2.5 (1.8) | 6.2 (3.1) | 9.5 (10.6) | |||
RRB mean (SD*) | 1.7 (2.0) | .9 (1.2) | 1.0 (1.5) | 2.0 (2.8) | 1.1 (1.4) | 4.6 (3.4) | 3.0 (2.8) | |||
RPI mean (SD*) | 2.5 (1.2) | 2.2 (1.7) | .9 (1.1) | 1.1 (1.9) | 1.4 (1.6) | 2.4 (2.1) | 2.5 (.7) | |||
TD
| ||||||||||
SC mean (SD*) | 4.2 (3.2) | .6 (1.1) | 3.6 (2.5) | 0 | 5.0 (.0) | .5 (.7) | ||||
RRB mean (SD*) | 1.8 (1.5) | .6 (1.0) | 1.7 (2.9) | 0 | 1.5 (.7) | .0 (.0) | ||||
RPI mean (SD*) | 1.9 (1.6) | .5 (.8) | 1.0 (1.0) | 0 | 1.5 (2.1) | .0 (.0) |
Measures and Procedures
Enrollment and Site Differences
Sweden | NL Nijmegen | Israel | UK | Spain | NL Utrecht | Iceland | Macedonia | France | Finland | |
---|---|---|---|---|---|---|---|---|---|---|
Total n | 234 | 230 | 206 | 188 | 115 | 42 | 39 | 20 | 17 | 13 |
Recruitment
| ||||||||||
Clinical referral (reason) | 234 (dev pr) | 42 (ASD/dev pr) | 39 (ASD) | 20 (dev pr) | 17 (ASD) | |||||
Screening (population) | 230 (HR)1
| 96 (GP) | 115 (HR) | 13 (GP) | ||||||
General population | 206 | |||||||||
Research referral | 92 | |||||||||
Diagnostic team
| ||||||||||
Pediatrician | X | – | – | X | X | – | X | X | – | – |
(Child) psychiatrist | X | X | – | X | X | X | – | X | X | – |
(Child) psychologist | X | X | X | – | X | X | X | X | X | X |
Social worker | X | – | – | – | X | X | – | – | – | – |
Speech therapist | – | – | – | X | – | – | X | X | – | X |
Special educator | – | – | – | – | – | – | X | X | – | X |
Specialized nurse | – | – | – | – | – | X | – | – | – | X |
Other: | neurologist | – | – | – | – | – | – | – | – | MD; OT |
Diagnostic elements for BCE diagnosis
| ||||||||||
ADI-R | X | X | X | 188 | X | – | X | – | X | |
ADOS | X | X | X | 135 | X | X | X | – | X | |
Developmental history | X | X | – | – | – | X | – | X2
| – | |
Cognitive functioning | X | X | X | 135 | X | X | X | – | X | |
Language | – | X | – | 43 | – | X | X | X | – | |
Adaptive functioning | Vineland-II | – | Vineland | Vineland–II; N = 43 | Vineland | Vineland | Vineland | Vineland–II | – | |
Observation | Preschool | Preschool; P–C ia | – | Child; N = 53 | – | Preschool; Home; P–C ia | Preschool | Child | PC–ERA | |
Psychiatric assessment | – | X | – | – | X | – | – | – | – | |
Questionnaires | SCQ, CBCL | CBCL, TRF | – | – | – | – | CBCL; TRF; ADHD RS | – | – | |
Other
| Physical and neurological examination | Physical and neurological examination | Psychomotor development | ITSEA; neurological examination |
Best Clinical Estimate Diagnosis (BCE)
Autism Diagnostic Interview-Revised (ADI-R)
Non-verbal Level of Functioning
Design and Analyses
Results
Confirmatory Factor Analyses
12-20/NV21-47 | Factor loadings | SW21-47 | Factor loadings | PH21-47 | Factor loadings |
---|---|---|---|---|---|
Social affect
|
Social affect
|
Social affect
| |||
C. Attention to voice | .82 | C. Attention to voice | .70 | C. Attention to voice | .69 |
C. Direct Gaze | .80 | C. Direct Gaze | .79 | C. Direct Gaze | .80 |
C. Social Smiling | .77 | C. Social Smiling | .75 | C. Nodding to mean yes | .69 |
C. Seeking to share enjoyment | .68 | C. Seeking to share enjoyment | .65 | C. Seeking to share enjoyment | .78 |
C. Range of facial expression | .80 | C. Range of facial expression | .79 | C. Range of facial expression | .78 |
C. Inappropriate facial expression | .56 | C. Inappropriate facial expression | .63 | C. Offers comfort | .72 |
C. Appropriateness of social response | .81 | C. Appropriateness of social response | .73 | C. Pointing | .76 |
C. Interest in children | .85 | C. Interest in children | .71 | C. Directing attention | .80 |
C. Response to approaches of children | .81 | C. Response to approaches of children | .75 | C. Quality of social overtures | .82 |
C. Quality of social overtures | .77 | C. Social chat | .79 | ||
C. Use of other’s body | .54 | ||||
Repetitive and restricted behaviors
|
Repetitive and restricted behaviors
|
Repetitive and restricted behaviors
| |||
E. Repetitive use of objects | .81 | E. Repetitive use of objects | .89 | C. Stereotyped language | .87 |
E. Hand mannerisms | .65 | E. Hand mannerisms | .74 | E. Hand mannerisms | .74 |
E. Complex mannerisms | .79 | E. Complex mannerisms | .75 | E. Complex mannerisms | .68 |
E. Unusual sensory interests | .75 | E. Unusual sensory interests | .73 | E. Unusual sensory interests | .56 |
E. Unusual preoccupations | .55 | E. Unusual preoccupations | .31 | ||
E. Compulsions/rituals | .51 | E. Compulsions/rituals | .42 | ||
Imitation, gestures and play
|
Imitation, gestures and play
|
Reciprocal and peer interaction
| |||
C. Pointing | .81 | C. Pointing | .80 | C. Appropriateness of social response | .77 |
C. Gestures | .86 | C. Gestures | .80 | C. Interest in children | .83 |
C. Imitation of actions | .82 | C. Imitation of actions | .76 | C. Response to approaches of children | .92 |
C. Offering to share | .79 | C. Offering to share | .67 | ||
C. Imaginative play | .83 | C. Imaginative play | .79 | ||
C. Directing attention | .90 | ||||
CFI: .929 (.952a, .948b, .852c) |
CFI: .889 (.943a, .908b, .892c) |
CFI: .912 (.960a,.913b, .806c) | |||
RMSEA: .060 (.069a, .057b, .084c) |
RMSEA: .063 (.062a, .077b, .066c) |
RMSEA: .055 (.053a, .053b, .093c). |
Correlations with Participant Characteristics
Sensitivity and Specificity
Sensitivity non-US sample (95 % CI) | Sensitivity US samples | Specificity non-US sample (95 % CI) | Specificity US samples | |
---|---|---|---|---|
12-20/NV21-47
| ||||
Research cutoff = 13 | .66 (.60–.72) | .77a/.76b/.85c
| .95 (.86–.99) | .85a/.94b/.64c
|
Clinical cutoff = 11 | .78 (.72–.82) | .85a/.85b/.90c
| .93 (.84–.98) | .70a/.94b/.64c
|
SW21-47
| ||||
Research cutoff = 13 | .53 (.46–.60) | .71a/.72b/.89c
| .89 (.81–.95) | .90a/.92b/.89c
|
Clinical cutoff = 8 | .80 (.73–.85) | .94a/.96b/.97c
| .70 (.59–.79) | .81a/.83b/.58c
|
PH21-47
| ||||
Research cutoff = 16 | .45 (.37–.53) | .70a/.80b/.67c
| .93 (.86–.97) | .82a/.94b/.86c
|
Clinical cutoff = 13 | .56 (.48–.64) | .80a/.89b/.89c
| .81 (.73–.87) | .70a/.94b/.76c
|