The Study Of The Application Of The Assessment Scale Of The Core Symptoms Of Autism Spectrum Disorder

Part 1 Evaluation on the Reliability and Validity of Chinese Version Autism Diagnostic Observation Schedule Module-1 and Clinical ApplicationObjective:To evaluate the reliability and validity of Chinese version Autism Diagnostic Observation Schedule (ADOS), and to discuss the clinical value and applicability of ADOS in China.Methods:After developing appropriate inclusion and exclusion criteria, we selected 60 children as our subjects who were clinically diagnosed with autism (AD,24), pervasive developmental disorder-not otherwise specified (PDD-NOS,22), other developmental disorders (Non-ASD,10) and typical developmental children (TD,4), and administered ADOS-Module 1 in them. We used Cronbach’s a coefficient to measure the internal consistency, Spearman rank correlation coefficient to evaluate test-retest reliability, and Kruskal-Wallis and Bonferroni correction test to examine empirical validity of the Chinese version ADOS-Module 1. In addition, We compared the agreement between clinical diagnosis and ADOS classification respectively according to DSM-IV-TR and DSM-V.Results:The Chinese version ADOS-Module 1 is composed of 4 domains-A. Communication; B. reciprocal social interaction; C. play and D. repetitive behaviors and restricted interests. The results are as follows: ①internal consistency:The Cronbach’s a coefficient of the whole schedule was 0.93, A domain was 0.79. B domain was 0.89, A+B domain was 0.93.②test-retest reliability:test-retest reliability coefficients were:A domain 0.84, B domain 0.92. A+B domain 0.89. C domain 0.91, and D domain 0.88 (All P<0.01).③empirical validity:All of the differences between autism group and 3 other groups in scores of A domain-B domain and the sum of A and B domains had statistically significance(All P<0.001). The scores between PDD-NOS group and 3 other groups also had statistically significance(All P<0.01). The scores between non-ASD group and typical group were of no statistically significant difference(P=0.350, P=0.102, P=0.163). ④the consistency of the clinical diagnoses and ADOS classifications:According to the DSM-IV-TR criteria, the consistency rate of the clinical diagnoses and ADOS classifications was 71.4%. According to the DSM-V criteria, the rate was 91.1%, the sensitivity of ADOS-Module 1 was 96.5%, and the specificity was 61.5%.Conclusion:The reliability and empirical validity of Chinese version ADOS-Module 1 is so good that it can provide assistance in early diagnosis of children with suspected autism spectrum disorders, with high clinical value in China.Part 2 Evaluation on the Reliability and Validity of Chinese Version Short Sensory ProfileObjective:To test the sensory processing function of children with autism spectrum disorder, developmental delay/mental retardation and typically developing children, and to evaluate reliability and validity of the Chinese version Short Sensory Profile (SSP). Methods:According to specific inclusion and exclusion criteria,220 children, including the children diagnosed with autism spectrum disorder (ASD group) or developmental delay/mental retardation (DD/MR group) and typically-developing children (TD group), were recruited, and all the diagnoses were based on the DSM-V criteria. Parents/caregivers of 181 children (81 ASD children,52 DD/MR children,48 typically-developing children) completed the questionaires. Internal reliability (internal consistency) was evaluated with Cronbach’s a coefficient using the data of all the 181 children. Test-retest reliability was examined using the data of 50 children (23 ASD children,14 DD/MR children,13 TD children) in a 2-week interval. Content validity was assessed with the Spearman rank correlation coefficients. Construct validity was measured by confirmatory factor analysis to investigate if the 7-factor model of the original SSP was applicable to Chinese data. Discriminate validity was examined by comparing the Chinese version SSP scores between the ASD group and the TD group matched for chronological age.Results:1. Reliability analysis:The Cronbach’s a coefficient of the whole scale was 0.902, and those of each subscales were from 0.653 to 0.895. The test-retest reliability coefficient of the whole scale was 0.907, and those of each subscales were from 0.7-0.9, and all those of each items were above 0.6.2. Validity analysis:Content validity:the Spearman rank correlation coefficients between each item and the whole scale ranged from 0.303 to 0.558. Except items 2(0.453) and 5(0.470), the Spearman rank correlation coefficient between items and corresponding subscales and between each section and the whole questionnaire were above 0.5. The correlation coefficients between each subscale and the whole scale ranged from 0.501 to 0.799 (All P<0.01).10 common factors were extracted in the factor analysis, explaining 65.054% of the variance, which supported the 7-factor model of the original SSP. The differences of the prevalence and severity of sensory processing dysfunction between ASD group and the other two groups were statistically significant.Conclusion:The Chinese version Short Sensory Profile is a reliable and valid instrument for evaluating children’s sensory processing function in China, and it can be used for the screening of sensory processing disorder in typically developing children and children with developmental disorders.Part 3 Study of Subtypes of Sensory Processing Disorder in Chinese Children with Autism Spectrum DisorderObjective:To explore the prevalence, severity and subtypes of sensory processing disorder in children with autism spectrum disorder (ASD) by further analyzing their data of Chinese version Short Sensory Profile (SSP) in Part 2.Methods:The data of Chinese version SSP of children with ASD were further analyzed using SPSS statistical software V19.0. We got the subtypes of sensory processing dysfunction in children with ASD by the Ward’s minimum variance hierarchical cluster analysis approach. Then, one-way ANOVA analysis, Kruskal-Wallis test and Post-hoc Tukey test were used to compare the age and sensory processing function of each sensory modal of each subtypes, and the features of each subtypes were summarized.Results:The majority (86.42%) of participants exhibited sensory processing dysfunction overall when compared with normative data provided with the SSP. The outcome of the cluster analysis demonstrated that the participants can be categorized into 4 subtypes according to their features of sensory processing dysfunction.Subtype 1 (n=19) 23.5%):this subtype is characterized by definite sensory processing dysfunctions across all domains measured by SSP, especially the movement sensitivity and Low Energy/Weak domains.Subtype 2 (n=9,11.1%):this subtype is characterized by severe difficulties in the Taste/Smell domain, but typical performance or only mild difficulties in Movement Sensitivity and Low Energy/Weak domains. The performances in other domains are mildly to moderately atypical.Subtype 3 (n=30,37.0%) and 4 (n=23,28.4%):both are characterized by mostly typical sensory processing function, except in the domains of Underresponsive/Seeks Sensation and Auditory Filtering. The difference between the two subtypes is that subtype 3 is more likely to seek sensation than subtype 2.Conclusion:This study demonstrated that the prevalence of sensory processing disorder in children with ASD in China is relatively high, and children with ASD can be categorized into several subtypes according to different functional states of each sensory modal. The results of the study will allow us to estimate the potential of individual sensory-based therapies in autism in the remediation of core autism deficits.