Der Diagnostische Beobachtungsbogen für Autismus Spektrumstörungen (DiBAS)

Zusammenfassung

Anliegen: Evaluation des Diagnostischen Beobachtungsbogens für Autismus Spektrumstörungen (DiBAS).

Methoden: Der DiBAS wurde bei insgesamt 91 Patienten mit Intelligenzminderung und Autismusverdacht angewandt (8/2009 – 12/2011) und eine Item-, Praktikabilitäts- und diagnostische Validitätsanalyse durchgeführt.

Ergebnisse: Der DiBAS zeigte eine hohe Praktikabilität (100 %) und eine gute diagnostische Validität für Autismus (ROC-Analyse; AUC = 0,808, Sensitivität 83 %, Spezifität 64 %, Übereinstimmung mit Fallkonferenzwert 74 %, Cohen’s Kappa 0,469, 12 valide Items).

Schlussfolgerung: Der DiBAS ist ein praktikables und valides Screeninginstrument.

Abstract

Background: One in four individuals with intellectual disability (ID) are additionally diagnosed with autism spectrum disorders (ASD) that may not be recognized und thus remain untreated until adulthood. Diagnosing ASD in adults with ID is challenging and there is a lack of specific diagnostic measures.

Methods: The Diagnostic Behavioral Assessment for ASD (DiBAS) is a DSM-5/ICD-10 based caregiver-report screener consisting of 20 Likert-scaled items. This study evaluates the item validities and -difficulties, and the scale’s feasibility and validity in a clinical, adult ID sample (N = 91) from 8/2009 to 12/2011.

Results: The DiBAS was applicable in all individuals (100 %) and yielded an adequate diagnostic validity reflected by ROC analysis and an AUC of 0.808. Using a cut-point of 30, the sensitivity and specificity values were 83 % and 64 %, the agreement with the final diagnostic classification was 74 %, and Cohen’s kappa was 0.469. Single item analysis revealed 12 valid DiBAS variables that predominantly could be assigned to the social interaction and non-verbal communication domains; item difficulties varied from 0.21 to 0.84. The scale’s internal consistency was appropriate (Cronbach’s alpha 0.749).

Conclusions: The DiBAS is a promising psychometrical sound scale of high feasibility to screen for ASD in adults with ID, which could be further specified by single item analysis.

Schlüsselwörter

Intelligenzminderung - Autismus - Diagnostik - Itemanalyse - Validität

Keywords

intellectual developmental disability - autism - diagnostics - item analysis - validity

• Literatur

• 1 Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res 2009; 65: 591-598
• 2 Kim SH, Lord C. Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. J Child Psychol Psychiatry 2012; 53: 143-151
• 3 Sappok T, Bergmann T, Kaiser H et al. Autismus bei erwachsenen Menschen mit geistiger Behinderung. Nervenarzt 2010; 81: 1333-1345
• 4 van Bourgondien ME, Reichle NC, Schopler E. Effects of a model treatment approach on adults with autism. J Autism Dev Disord 2003; 33: 131-140
• 5 Gühne U, Weinmann S, Arnold K et al. Das Training sozialer Fertigkeiten bei schweren psychischen Erkrankungen – ist es wirksam?. Psychiat Prax 2012; 39: 371-380
• 6 Engel C, Szrama E, Hässler F. Psychopharmakologische Therapie bei Geistiger Behinderung – Vergleich der Jahre 1991 und 2005. Psychiat Prax 2010; 37: 391-396
• 7 Bachmann CJ, Manthey T, Kamp-Becker I et al. Psychopharmacological treatment in children and adolescents with autism spectrum disorders in Germany. Res Dev Disabil 2013; 34: 2551-2563
• 8 Sappok T, Diefenbacher A, Bergmann T et al. Emotionale Entwicklungsstörungen bei Menschen mit Intelligenzminderung: Eine Fall-Kontroll-Studie. Psychiat Prax 2012; 39: 228-238
• 9 Sappok T, Schade C, Kaiser H et al. Die Bedeutung des emotionalen Ent- wicklungsniveaus bei der psychiatrischen Behandlung von Menschen mit geistiger Behinderung. Fortschr Neurol Psychiatr 2012; 80: 154-161
• 10 Reiss S, Szyszko J. Diagnostic overshadowing and professional experience with mentally retarded persons. Am J Ment Defic 1983; 87: 396-402
• 11 Matson JL, Shoemaker M. Intellectual disability and its relationship to autism spectrum disorders. Res Dev Disabil 2009; 30: 1107-1114
• 12 Kraijer D, Melchers P. Skala zur Erfassung von Autismusspektrumstörungen bei Minderbegabten (SEAS-M). Frankfurt: Swets; 2003
• 13 Bölte S, Holtmann M, Poustka F. The Social Communication Questionnaire (SCQ) as a screener for autism spectrum disorders: additional evidence and cross-cultural validity. J Am Acad Child Adolesc Psychiatry 2008; 47: 719-720
• 14 Rutter M, Bailey A, Berument SK et al. Social Communication Questionnaire (SCQ). Los Angeles: Western Psychological Services; 2001
• 15 Lord C, Rutter M, Le Couteur A. Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 1994; 24: 659-685
• 16 Lord C, Risi S, Lambrecht L et al. The Autism Diagnostic Observation Schedule-Generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord 2000; 30: 205-223
• 17 Sappok T, Diefenbacher A, Budczies J et al. Diagnosing autism in a clinical sample of adults with intellectual disabilities: how useful are the ADOS and the ADI-R?. Res Dev Disabil 2013; 34: 1642-1655
• 18 Knoedler DW. The Modified Overt Aggression Scale. Am J Psychiatry 1989; 146: 1081-1082
• 19 Yudofsky SC, Silver JM, Jackson W et al. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986; 143: 35-39
• 20 Miller JS, Bilder D, Farley M et al. Autism Spectrum Disorder Reclassified: A Second Look at the 1980s Utah/UCLA Autism Epidemiologic Study. J Aut Dev Disord 2013; 43: 200-210
• 21 Cicchetti DV, Volkmar F, Klin A et al. Diagnosing autism using ICD-10 criteria: a comparison of neural networks and standard multivariate procedures. Child Neuropsychol 1995; 1: 26-37
• 22 Sappok T, Heinrich M, Diefenbacher A. Psychometrische Eigenschaften der Autismus-Checkliste (ACL) für erwachsene Menschen mit Intelligenzminderung. Psychiat Prax DOI: DOI: 10.1055/s-0033-1343193.
• 23 Matson JL, Wilkins J, Boisjoli JA et al. The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA). Res Dev Disabil 2008; 29: 537-546
• 24 DeBildt A, Sytema S, Ketelaars C et al. Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnos- tic Interview-Revised (ADI-R), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Classification in Children and Adolescents with Mental Retardation. J Autism Dev Disord 2004; 34: 129-137
• 25 Berument SK, Starr E, Pickles A et al. Pre-Linguistic Autism Diagnostic Observation Schedule adapted for older individuals with severe to profound mental retardation: a pilot study. J Autism Dev Disord 2005; 35: 821-829
• 26 Bölte S, Westerwald E, Holtmann M et al. Autistic traits and autism spectrum disorders: the clinical validity of two measures presuming a continuum of social communication skills. J Autism Dev Disord 2011; 41: 66-72
• 27 Bastiaansen JA, Meffert H, Hein S et al. Diagnosing autism spectrum disorders in adults: the use of Autism Diagnostic Observation Schedule (ADOS) Module 4. J Autism Dev Disord 2011; 41: 1256-1266
• 28 Matson JL, Wilkins J, Ancona M. Autism in adults with severe intellectual disability: an empirical study of symptom presentation. J Intellect Dev Dis 2008; 33: 36-42
• 29 Shattuck PT, Seltzer MM, Greenberg JS et al. Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. J Autism Dev Disord 2007; 37: 1735-1747
• 30 Esbensen AJ, Seltzer MM, Lam KSL et al. Age-related differences in restricted repetitive behaviors in autism spectrum disorders. J Autism Dev Disord 2009; 39: 57-66
• 31 Bortz J, Döring N. Quantitative Methoden der Datenerhebung. In: Bortz J, Döring N, Hrsg. Forschungsmethoden und Evaluation. Berlin, Heidelberg: Springer; 2006: 137-293
• 32 Steffen P, Blum K. Menschen mit geistiger Behinderung: Defizite in der Versorgung. Dtsch Arztebl 2012; 109: A 860-862
• 33 Sappok T, Dern S. Menschen mit Autismus: Barrierefreier Zugang zur Versorgung. Dtsch Arztebl 2012; 11: 40-41