The performance of children with mental health disorders on the ADOS-G: A question of diagnostic utility

Over the past few decades, the reported number of children identified as having one of the Autism Spectrum Disorders (ASD) has increased exponentially. One proposed reason for the dramatic increase in the prevalence of ASD is diagnostic substitution, whereby children with other disorders incorrectly receive a diagnosis of ASD. Little research has examined whether standardized diagnostic measures of ASD can appropriately distinguish high functioning children with ASD from children with mental health disorders. The present study evaluated the diagnostic utility of the Autism Diagnostic Observation Schedule, Generic (ADOS-G) Modules 3 and 4 in distinguishing ASD from mental health disorders in children and adolescents (aged 5–21 years) with at least average intellectual functioning. ADOS-G Modules 3 and 4 classifications were evaluated in 93 clinically referred children and adolescents with mental health disorders other than ASD. Fifteen percent of participants were misclassified as being in the Autism or Autism Spectrum category. This translates into a specificity score of 84.9%. Children and adolescents with a mood disorder had a higher likelihood of being misclassified than children and adolescents with other mental health disorders, while children and adolescents with a disruptive behavior disorder had a lower likelihood of being misclassified. Findings have implications for understanding the diagnostic usefulness of the ADOS-G and enhancing the diagnostic process for ASD.