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Autism Diagnostic Interview – Revised (ADI-R)

The Autism Diagnostic Interview™ – Revised (ADI™-R; Rutter, LeCouteur, & Lord, 2003) is the 2003 revision of the ADI™.

Overview

The interview is conducted with parents or caretakers who have knowledge about the individual’s current behavior and developmental history. The questions address the triad of symptoms related to autism spectrum disorders: Language/Communication; Reciprocal Social Interactions; and Restricted, Repetitive, and Stereotyped Behaviors and Interests. The measure consists of 93 yes/no questions followed by probe questions, which are scored on a scale of 0 to 2. Using a scoring template, the scores are converted into diagnostic criteria based on the International Classification of Diseases – 10th Revision (ICD-10; World Health Organization, 1993).

Summary

Author (yr) Age Range (yrs) Method of Administration/Format Approx. Time to Administer Subscales
Autism Diagnostic Interview – Revised (ADI-R)** Lord, Rutter, & LeCouteur (2003) ** *** Over 2

Structured interview; 93 items in three functional domains. Responses are coded in eight content areas. Yields algorithm cutoff scores.

1.5–2.5 hrs.

Screening/Diagnosis: D

**Instrument includes information related to developmental history. ***Instrument requires special training to administer.

Availability: Western Psychological Services, http://bit.ly/1qYt0bG

Research

Author (yr) Sample Size Topic(s) Addressed Outcome
Barton, Robins, Jashar, Brennan, Fein (2013) 422 - Age Range: 16.79 to 39.36 months Diagnostic sensitivity and specificity

Toddlers are vulnerable to stringent requirements for all three social-communication symptoms, and two restricted/repetitive symptoms. Receiver operating characteristic (ROC) curves mapped on cut-off sums for ADOS and ADI-R for participants. Optimal DSM-5 criteria (sensitivity= 0.93, specificity= 0.074) required meeting the ROC-determined cut-off criteria for 2/3 Domain A criteria, and 1 point for ¼ Domain B criteria. This modification will help ensure ASD is identified accurately in young children.

Author (yr) Sample Size Topic(s) Addressed Outcome
De Bildt, Oosterling, van Lang, Kuijper, Dekker, Sytema, . . . de Jonge, (2013) 1,204 Dutch children - Age Range: 3-18 Years Diagnostic sensitivity and specificity

ADI-R well-discriminated ASD from non-ASD with ID. All other criteria were sensitive at the cost of specificity, with the risk of over-inclusiveness. In group without ID, clinicians need to use best judgment, and choose best criteria.

Author (yr) Sample Size Topic(s) Addressed Outcome
Hus & Lord, (2013) 2,334 families, participants in the Simons Simplex Collection multi-site genetic study - Age Range: 4-18 years Implication for use of scores as a measure of ASD severity

When administering the ADI-R, how do ADI-R algorithm totals reflect past and current behaviors, which are influenced by child characteristics (demographics, behavior problems, and developmental language)? Outcome is to take language and age into account when measuring ASD severity.

Author (yr) Sample Size Topic(s) Addressed Outcome
Tsuchiya, Matsumoto, Yagi, Inada, Kuroda, Inokuchi, Koyama, . . . Takei, (2013) 51 & 317 (3 diagnostic groups) - Age Range: 3-19 years & 2-19 years Inter-rater reliability ADI-R, Japan version (ADI-R-JV)

Two independent raters. Inter-rater reliability, intra-class correlation coefficients of greater than 0.80, obtained for all three domains of ADI-R-JV. Discriminant validity, mean scores of the three domains were significantly higher in individuals with autistic disorder (AD) than other diagnostic groups. Regarding diagnostic validity, sensitivity and specificity for correctly diagnosing AD were 0.92 and 0.89, but sensitivity was 0.55 for individuals younger than 5 years. Specificity consistently high regardless of age and intelligence. ADI-R-JV shown to be a reliable tool with sufficient diagnostic validity for correctly diagnosing AD.

Author (yr) Sample Size Topic(s) Addressed Outcome
Lecavalier, Aman, Scahill, McDougle, McCracken, et al. (2006) 226 - Age Range: 5-17 years Validity

Internal consistency (coefficient alpha) of domain scores = 0.54–0.84 Convergent validity (Spearman-ranked correlation coefficients) – Social and total ADI-R had highest correlations to other instruments, range = -0.29 to 0.35, depending on scale and domain

Author (yr) Sample Size Topic(s) Addressed Outcome
Risi, Lord, Gotham, Corsello, Chrysler, et al. (2006) 1,297 - Age Range: 1.5-14 years Diagnostic sensitivity and specificity

Strict autism criteria used in combination with ADOS – 80% or higher for U.S. sample, 75% or higher for Canadian sample; lower for single use and use for other PDDs

Author (yr) Sample Size Topic(s) Addressed Outcome
Saemundsen, Magnússon, Smári, & Sigurdardóttir (2003) 54 - Age Range: 2–9.5 years Concurrent validity

ADI-R definition for autism used – 66.7% with CARS

Author (yr) Sample Size Topic(s) Addressed Outcome
Wiggins & Robins (2008) 142 - Age Range: 1.5-3 years Concurrent validity

Agreement improved with removal of Behavioral Domain of ADI-R (percent agreement with other measures): ADOS: AU class = 0.790, non-AU class = 0.701 CARS: AU class = 0.708 , non-AU class +0.753

Author (yr) Sample Size Topic(s) Addressed Outcome
LeCouter, Haden, Hammal, & McConachie (2008) 101 - Age Range: 2-4 years Concurrent validity

Agreement with ADOS: AU Social Interaction = 78%; AU Communication = 74%; Above/below AU cutoff = 81%, Above/below spectrum cutoff = 78%

Author (yr) Sample Size Topic(s) Addressed Outcome
Ventola, Kleinman, Pandey, Barton, Allen, Green, Robins, & Fein (2006 45 - Age Range: 1.5-2.5 years Concurrent validity

Cohen’s kappa:

ADOS and clinical judgment = 0.593

ADOS and CARS = 0.619

CARS and clinical judgment = 0.691

ADI-R and ADOS = 0.066

ADI-R and CARS = 0.095

ADI-R and clinical judgment = 0.153

Author (yr) Sample Size Topic(s) Addressed Outcome
Constantino, Davis, Todd, Schindler, Gross, et al. (2003) 61 - Age Range: AU Group: mean age = 8.0 Asperger PDD-NOS: mean age = 11.4 Non-PDD– mean age =1 3.2 Concurrent validity

Pearson’s coefficient correlation: SRS and ADI-R or DSM criteria = 0.7

Author (yr) Sample Size Topic(s) Addressed Outcome
Mazefsky & Oswald (2006) 78 - Age Range: 1.75–8 years Discriminative validity

73% agreement with team diagnoses; improved to 77% with team diagnoses when PDD-NOS and ASP removed

Author (yr) Sample Size Topic(s) Addressed Outcome
Mildenberger, Sitter, Noterdaeme, & Amorosa (2001) Group 1 – 16 Children Group 2 – 11 Children - Age Range: Mean age of 9 Discriminative validity

2 of 27 subjects were misclassified: one subject with infantile autism did not meet cutoff scores on all three dimensions; one subject with severe receptive language disorder was classified as autistic on all three dimensions.

Author (yr) Sample Size Topic(s) Addressed Outcome
Gray, Tonge, & Sweeney (2008) 209 - Age range: 1.5-4.5 years Discriminative validity

ADI-R and AU = 0.46 ADOS and AU = 0.73 ADSO and AU = 0.62

ADI-R and ADOS = 0.35 (Cohen’s kappa)

Author (yr) Sample Size Topic(s) Addressed Outcome
Frazier, Youngstrom, Kubu, Sinclair, & Rezai (2008) N/A Factor analysis

Mixed; subscales need revision

Author (yr) Sample Size Topic(s) Addressed Outcome
Moss, Magiati, Charman, & Howlin (2008 35 - Age Range: Time 1: 2.3–4.5 years Time 2: 9.1–12.1 years Test-retest reliability

80% for all three domains; Pearson correlation = 0.59

Author (yr) Sample Size Topic(s) Addressed Outcome
Cicchetti, Lord, Koenig, Klin, & Volkmar (2008) 1 - Age Range: 3.5 years Interrater reliability

94-96% with weighted kappas between 0.80 and 0.88

Author (yr) Sample Size Topic(s) Addressed Outcome
de Bildt, Sytema, Ketelaars, Kraijer, Mulder, et al. (2004) 184 - Age Range: 5-20 years Criterion validity and reliability

Sensitivity:

PDD: ADOS-G = .874

PDD: ADI-R = .716

AD: ADOS-G = .917

AD: ADI-R = .771

Specificity:

PDD: ADOS-G = .472

PDD: ADI-R = .787

AD: ADOS-G = .647

AD: ADI-R = .632

Agreement (percentage):

Age 5-8 = 83.4 for AD, 81.0 for PDD

Age 8+ = 57.8 for AD, 58.5 for PDD Total = 63.6 for AD, 63.6 for PDD

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