Diagnosing Autism Spectrum Disorders in Deaf Children Using Two Standardised Assessment Instruments: The ADIR-Deaf Adaptation and the ADOS-2 Deaf Adaptation

Abstract

The aim was to investigate the agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation overall diagnostic categorisation for autism (AUT) and a wider threshold to include autism spectrum (ASD) in a cohort of deaf children with and without ASD. We compared results of the instruments used on their own and when combined and propose standard criteria for the combined use of the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for use with deaf children. In total, 116 deaf children had a Gold standard NICE guideline assessment; 58 diagnosed with ASD and 58 without ASD, and for both groups a blinded informant based ADI-R Deaf adaptation and direct assessment using the ADOS-2 Deaf adaptation were separately completed. There was moderate agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for the wider threshold of ASD (Kappa, 0.433). To achieve the lowest number of false negatives, the most successful assessment tool approach is using the wider threshold of ASD with either ADI-R Deaf adaptation or ADOS-2-Deaf adaptation (95% sensitivity). This compares with 88% for the ADI-R Deaf adaptation alone and 74% for the ADOS-2-Deaf adaptation alone (wider threshold of ASD). To achieve a low number of false positives, the most successful assessment tool approach is a combination of ADI-R Deaf adaptation and ADOS-2- Deaf adaptation (using the narrow threshold of autism for both) (95% specificity). This compares with 83% for the ADI-R Deaf adaptation alone and 81% for the ADOS-2-Deaf adaptation (narrow threshold) alone. This combination is therefore recommended in specialist clinics for diagnostic assessment in deaf children.

Integrating psychology into pediatric audiology/otolaryngology clinics: Gaps and a model of care.

“…Innovative examples include standardized ASL administration for the Differential Ability Scales-II (Hardy-Braz et al, 2007) and Wechsler Intelligence Scale for Children, fifth edition technical reports for use with DHH children who use ASL, spoken English, or Total Communication (Costa et al, 2016; Day et al, 2015). Also, DHH adaptations now exist for Autism Diagnostic Observation Schedule, second edition (Phillips et al, 2022) and Autism Diagnostic Interview-Revised (Allgar et al, 2021). Youth Quality of Life Instrument-Deaf and Hard of Hearing module (YQOL-DHH; Patrick et al, 2011) and Hearing Environments and Reflection on Quality of Life (HEAR-QL; Umansky et al, 2011) are available.…”

Assessing Autism in Deaf/Hard-of-Hearing Youths: Interdisciplinary Teams, COVID Considerations, and Future Directions

“…Despite widespread use around the world, the ADOS-2 specifically states that it was not intended for use with children with sensory differences, as is the case for D/HH children (Lord et al, 2012) because it relies on verbal speech to assess differences in social affect and communication and many D/HH children use a different communication modality (Mood & Shield, 2014). Even with these considerations in mind, several studies have characterized the use of the ADOS-2 to assess autism in D/HH children (Allgar et al, 2021; Holzinger et al, 2022; Mood & Shield, 2014). Groups who have administered the ADOS-2 in D/HH groups have transparently described the approaches they used during data collection in the absence of evidence-based modifications, which included task modifications (e.g., response to name) and scoring modifications (e.g., overall language level; Mood & Shield, 2014).…”

“…Finally, Wright and colleagues (2022) adapted the ADI-R for D/HH children suspected of autism with excellent sensitivity and specificity (89% and 81%, respectively). When used together, the Deaf-adapted ADOS-2 and ADI-R show excellent diagnostic specificity (e.g., reducing false positives) when relying on the autism cutoff values for both instruments (Allgar et al, 2021), thus underscoring the importance of capturing current behaviors in addition to a thorough developmental history. In summary, these studies demonstrate emergent validity to support Deaf-adapted measures of the ADOS-2 (Phillips et al, 2022) and ADI-R (Wright et al, 2022), both of which required the removal and addition of items, task modifications, and scoring modifications; these changes still require validation as a novel measure in groups with complicated medical and genetic co-occurrence.…”

Special Issue “Early Intervention for Hearing Loss in Children: Drafting from Theory to Clinical Practice”

“…Information from audiological assessments needs to be complemented by systematic observations on functional listening in everyday settings to inform parent behaviors and/or clinical decisions. Another study [ 8 ] investigates the validity of two well-established diagnostic instruments for autism spectrum disorders adapted for the use with deaf signing children. As a result, the combination of the adapted autism diagnostic interview (ADI-R) and direct assessment (autism diagnostic observation schedule version 2; ADOS-2) are recommended for clinical practice.…”