L'écart des informateurs définit des sous-groupes séparés et cliniquement utiles dans le trouble du spectre de l'autisme

Aperçu: G.M.

La divergence entre les informateurs (parents et enseignants) dans les notes de sévérité des symptômes essentiels se manifeste généralement lors de l'évaluation du trouble du spectre de l'autisme.

Le but de l'étude était d'examiner si le degré de divergence entre les cotes de symptômes de du trouble du point de vue du parent et de l'enseignant définit des sous-groupes distincts et cliniquement significatifs des jeunes avec un diagnostic de TSA.

Le degré de divergence entre les parents et les enseignants à propos de la gravité des symptômes de TSA semble fournir plus d'informations utiles sur le plan clinique que la dépendance à l'égard d'un domaine ou qu'un trouble spécifique des symptômes et offre ainsi une approche novatrice et rentable pour évaluer l'altération fonctionnelle.  

Cette conclusion contraste avec les approches de clustering de symptômes existantes dans TSA , qui traitent les profils internes de la sévérité des symptômes comme étant généralisables dans tous les paramètres. La variabilité intra-enfant dans l'expression des symptômes à travers les paramètres peut fournir des informations utiles pour caractériser le phénotype TSA.

J Child Psychol Psychiatry. 2017 Apr 27. doi: 10.1111/jcpp.12730.

Informant discrepancy defines discrete, clinically useful autism spectrum disorder subgroups

Lerner MD¹, De Los Reyes A², Drabick DAG³, Gerber AH¹, Gadow KD⁴.

Author information

1

Department of Psychology, Stony Brook University, Stony Brook, NY, USA.

2

Department of Psychology, University of Maryland, College Park, MD, USA.

3

Department of Psychology, Temple University, Philadelphia, PA, USA.

4

Department of Psychiatry, Stony Brook Medicine, Stony Brook, NY, USA.

Abstract

BACKGROUND:

Discrepancy between informants (parents and teachers) in severity ratings of core symptoms commonly arise when assessing autism spectrum disorder (ASD). Whether such discrepancy yields unique information about the ASD phenotype and its clinical correlates has not been examined. We examined whether degree of discrepancy between parent and teacher ASD symptom ratings defines discrete, clinically meaningful subgroups of youth with ASD using an efficient, cost-effective procedure.

METHODS:

Children with ASD (N = 283; 82% boys; M_age  = 10.5 years) were drawn from a specialty ASD clinic. Parents and teachers provided ratings of the three core DSM-IV-TR domains of ASD symptoms (communication, social, and perseverative behavior) with the Child and Adolescent Symptom Inventory-4R (CASI-4R). External validators included child psychotropic medication status, frequency of ASD-relevant school-based services, and the Autism Diagnostic Observation Schedule (ADOS-2).

RESULTS:

Four distinct subgroups emerged that ranged from large between-informant discrepancy (informant-specific) to relative lack of discrepancy (i.e. informant agreement; cross-situational): Moderate Parent/Low Teacher or Low Parent/Moderate Teacher Severity (Discrepancy), and Moderate or High Symptom Severity (Agreement). Subgroups were highly distinct (mean probability of group assignment = 94%). Relative to Discrepancy subgroups, Agreement subgroups were more likely to receive psychotropic medication, school-based special education services, and an ADOS-2 diagnosis. These differential associations would not have been identified based solely on CASI-4R scores from one informant.

CONCLUSIONS:

The degree of parent-teacher discrepancy about ASD symptom severity appears to provide more clinically useful information than reliance on a specific symptom domain or informant, and thus yields an innovative, cost-effective approach to assessing functional impairment. This conclusion stands in contrast to existing symptom clustering approaches in ASD, which treat within-informant patterns of symptom severity as generalizable across settings. Within-child variability in symptom expression across settings may yield uniquely useful information for characterizing the ASD phenotype.

© 2017 Association for Child and Adolescent Mental Health.

PMID: 28449247

DOI: 10.1111/jcpp.12730