John of God (Linz, Austria), Rainbow Babies and Children’s Hospital (Cleveland, Ohio), and the Children’s Hospital at Montefiore (Bronx, NY). The study’s other participating DBPNet 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. In the meantime, pediatric practices should feel comfortable relying on DBPs’ clinical judgment to refer young children for autism interventions unless the ADOS is required for insurance or other reasons, Barbaresi says. The investigators hope their findings will spur a national effort to persuade insurers and education agencies to change the requirements for ASD assessments. “We believe it has the potential to change practice by reducing wait times for diagnostic evaluations so children can receive early, intensive treatment for ASD.” Removing a barrier to early intervention “Overall, this study is good news,” says Barbaresi. Consistency was greatest when the clinician felt highly certain of their original diagnosis. In 90 percent of cases, the diagnosis, including the ADOS, was consistent with the original clinical diagnosis. If the ADOS is required for diagnosis, it becomes an additional barrier due to the time and training required. The ADOS was never designed to be used in the clinic. Results were shared with the DBP, who then could revise their diagnosis. A specially trained clinician then administered the ADOS. It involved 349 children 18 months to 5 years old seen at one of nine academic pediatric centers.ĭevelopmental-behavioral pediatricians (DBPs) first diagnosed the children based on their clinical assessment. The study, published last month in JAMA Pediatrics, was sponsored by DBPNet and funded by the U.S. Barbaresi, the study’s principal investigator, hopes it will convince intervention agencies, schools, and insurers to drop their requirement for the ADOS when a diagnosis is made by a trained expert. It finds that trained developmental-behavioral pediatricians can almost always diagnose ASD in young children without ADOS testing. Now, a multicenter study led by Boston Children’s through the national Developmental and Behavioral Pediatrics Research Network (DBPNet) is pushing back. If the ADOS is required for diagnosis, it becomes an additional barrier due to the time and training required.” ![]() That makes it difficult for them to access intensive early intervention services when they are most effective, ideally starting at around 24 months of age. “Young children can wait months or even years for an assessment to diagnose ASD. ![]() ![]() “The ADOS was never designed to be used in the clinic,” says William Barbaresi, MD, chief of the Division of Developmental Medicine at Boston Children’s Hospital. The time-consuming test adds cost to the diagnostic process, and there is a shortage of people trained to administer it. And that has unintentionally delayed care for many children. Through a series of semi-structured observations, trained evaluators assess children’s communication skills, social interaction, and imaginative use of materials.īut over time, the ADOS has come to be considered the gold standard for a clinical diagnosis of autism spectrum disorder (ASD). The Autism Diagnostic Observation Schedule, or ADOS testing, was developed in the 1980s as a tool for autism research. ![]() In a multi-site study, developmental-behavioral pediatricians were able to diagnose most autism cases in young children without ADOS testing (Image: AdobeStock).
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