ADOS testing not required for ASD diagnosis by developmental-behavioral pediatricians

Trained developmental-behavioral pediatricians can generally diagnose autism spectrum disorder (ASD) in young children without the need for additional Autism Diagnostic Observation Schedule (ADOS) testing, finds a prospective multicenter study. The study, conducted through the Developmental Behavioral Pediatrics Research Network (DBPNet) and led by Boston Children’s Hospital, was published October 17 in the journal JAMA Pediatrics.

The ADOS was originally developed as a research tool. Through semi-structured observations, specially trained evaluators assess children’s communication skills, social interaction, and imaginative use of materials.

The ADOS was never designed to be used in the clinic. But currently, ADOS testing is often required for young children to receive an ASD diagnosis that is accepted by early intervention agencies, schools, and insurers. This study shows that in the majority of cases, young children may be able to have a diagnostic evaluation for ASD by a developmental-behavioral pediatrician without using the ADOS.”

William Barbaresi, MD, Study’s Principal Investigator and Chief of the Division of Developmental Medicine at Boston Children’s

ADOS administration is time consuming, adds additional cost to the diagnostic process, and there are not enough people trained to administer it. “The requirement for ADOS testing has become a barrier to timely diagnosis and initiation of treatment,” Barbaresi says. “Young children can wait months or even years for an assessment, making it difficult for them to access intensive early intervention services when they are most effective -; ideally starting at around 24 months of age.”

The study involved 349 children aged 18 months to 5 years who were evaluated at nine academic pediatric centers. Developmental-behavioral pediatricians (DBPs) first made a diagnosis based on their clinical assessment. A specially trained clinician then administered the ADOS, the results of which were shared with the DBP, who then could revise their diagnosis.

In 90 percent of cases, the diagnosis including the ADOS was consistent with the original clinical diagnoses. Consistency was most likely when the clinician felt highly certain of their original diagnosis.

“Overall, this study is good news,” says Barbaresi. “We believe it has the potential to change current practice by reducing wait times for diagnostic evaluations so that children can receive early, intensive treatment for ASD.” The other participating centers were the Children’s Hospital of Philadelphia, Children’s Hospital Colorado, University of Arkansas for Medical Sciences, University of California-Davis, Children’s Hospital Los Angeles, Hospital of St. John of God (Linz, Austria), Rainbow Babies and Children’s Hospital (Cleveland, Ohio); and the Children’s Hospital at Montefiore (Bronx, NY).

The study was funded by the Maternal Child Health Bureau, Health Resources and Services Administration of the U.S Department of Health and Human Services (UA3MC20218). The authors report no conflicts of interest.

Journal reference:

Barbaresi, W., et al. (2022) Clinician Diagnostic Certainty and the Role of the Autism Diagnostic Observation Schedule in Autism Spectrum Disorder Diagnosis in Young Children. JAMA Pediatrics.