Ritvo Autism and Asperger Diagnostic Scale

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Ritvo Autism and Asperger Diagnostic Scale
Purposediagnosis of autism spectrum disorder

The Ritvo Autism & Asperger Diagnostic Scale (RAADS) is a psychological self-rating scale developed by Dr. Riva Ariella Ritvo (NPI UCLA and CSC Yale). An abridged and translated 14 question version was then developed at the Department of Clinical Neuroscience at the Karolinska Institute, to aid in the identification of patients who may have undiagnosed ASD. [1]

Contents

Background

Autism is often difficult to diagnose in adults due to overlapping symptoms with various other disorders. This can lead to a misdiagnosis, or an entirely missed diagnosis of ASD. This poses a challenge to psychiatrists in identifying undiagnosed adults who may have autism. [2] Adults are being referred or self referred for diagnosis with increasing frequency, making this a useful clinical tool. [3] A score of 64 or more has been shown to be consistent and support a clinical diagnosis, but in the case the clinical diagnosis differs from the test score, the clinical diagnosis should take precedence. [4] Many studies suggest that adults can remain undiagnosed due to the difficulty of gaining an accurate history of the adult's development through childhood, milder presenting or less common traits, and lack of accurate knowledge from medical professionals. [5] [6]

The test itself has been revised and has multiple iterations: RAADS, RAADS-R, and RAADS-14. The RAADS-14 differs most dramatically, consisting of 14 questions organised into three domains: mentalizing deficits, sensory reactivity, and social anxiety. The RAADS-R, revised in 2011 after the original in 2008, [7] has 80 questions organised into four domains: social relatedness, circumscribed interests, language, and sensory-motor symptoms. The test itself is formatted with an answering mechanism akin to a likert scale, with participants providing a response to statements with answers of varying severity, such as whether a behaviour was experienced only when young, now and when young, only true now, or never true.

Uses

The test itself is free to access, and is often used as a means of self-assessment, taking approximately 10–30 minutes to complete. [8] Ritvo, the creator of the assessment, states that the test as a whole is best utilised as a clinical tool completed with a clinician present. This also allows for direct communication between patient and clinician, which Ritvo states is a valuable addition for diagnostic purposes.

The RAADS-R test is available online in English and Swedish and has been translated into various languages for the purpose of assessing its accuracy in identifying ASD, [8] in addition to its performance in comparison to other popular diagnostic tools. [9] When translated for participants in the Netherlands, the RAADS-R correctly identified ASD in 80% of cases, with high sensitivity as opposed to another popular measure, the AQ. The French version of the RAADS-R [10] demonstrates a high standard of validity and reliability in identifying adults who have ASD.

Diagnostic accuracy

One advantage that the RAADS-R has in comparison to other commonly used autism screening tests is that it has specific questions that target hyposensitivity and hypersensitivity, [9] which correlates with diagnostic criteria in the DSM-5. The RAADS-R is also recommended by the National Institute for Health and Care Excellence, or NICE, [11] which operates within the UK in order to provide nationwide healthcare guidelines. Research conducted in English countries looked at the effectiveness of the RAADS-R test, [12] and found that it was an effective tool in order to expedite a diagnosis with adult mental health services, but should not be used in isolation. Further research published in Autism in the United States found that the test is generally accurate. The participants' age, gender, autism diagnosis, or self diagnosis did not impact how they answered the questions presented. [13]

Comorbidities

Further uses of the RAADS-R test can be seen with its application to identifying comorbidities, or the existence of multiple disorders with overlapping symptoms that can be identified as symptoms of ASD. The RAADS-R test has been used to assess symptoms of autism present in those with eating disorders, as some studies [14] suggest a possible correlation between eating disorders and ASD. This is due to the overlap and similarities between the two providing common struggles, such as those pertaining to social skills and communication. An Italian version of the test was created to assess a possible correlation and comorbidity between eating disorders and ASD, and found that 33% of patients with eating disorders presented with high ASD traits, with the RAADS-R showing high agreement.

ASD has also been shown to play a role in those with diagnosed bipolar disorder among multiple other comorbidities. [15] This case study revealed another use for the RAADS-R in identifying possible comorbidities, and the repeated likelihood of missed diagnosis in adulthood that can be unearthed using the test, despite frequent symptom overlap.

The RAADS-14, the 14 question version of the test, has been applied to use in New Zealand. Generally it has been proven to be a valid measure, correlating strongly with the Autism Spectrum Quotient, or AQ-10. However, when applied to a New Zealand population, [16] the test has high sensitivity, but not specificity, resulting in a higher number of false positives when solely relying upon test scores. The authors of the above research state a possible improvement to the RAADS-14 through modification of its psychometric properties to suit a particular cultural group.

Limitations

There are a few limitations to the RAADS test that make it important to use alongside professional clinical diagnostic processes. [17] Some limitations may include questions being misinterpreted or misunderstood, unawareness or over-reporting of symptoms, and the same symptoms being rated different levels of "obtrusiveness" in daily functioning. [18]

The RAADS test has only shown moderate accuracy in clinical settings. [19] It has also been shown to require further academic study due to its likelihood of returning a false positive. [10] In an evaluation of the screening effectiveness of the RAADS-R among 50 participants, there was no association between RAADS-R scores and a future clinical diagnosis of autism. [11]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Neurodevelopmental diagnosis now categorized under Autism Spectrum Disorder

Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD by relatively unimpaired spoken language and intelligence.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

<span class="mw-page-title-main">Controversies in autism</span> Controversies about both the cause of autism and the nature of the diagnoses themselves

Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own.

<span class="mw-page-title-main">Conditions comorbid to autism spectrum disorders</span> Medical conditions more common in autistic people

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.

The Autism Diagnostic Observation Schedule (ADOS) is a standardized diagnostic test for assessing autism spectrum disorder. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and the person under assessment. The examiner observes and identifies aspects of the subject's behavior, assigns these to predetermined categories, and combines these categorized observations to produce quantitative scores for analysis. Research-determined cut-offs identify the potential diagnosis of autism spectrum disorder, allowing a standardized assessment of autistic symptoms.

<span class="mw-page-title-main">Autism therapies</span> Therapy aimed at autistic people

Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

The autism-spectrum quotient (AQ) is a questionnaire published in 2001 by Simon Baron-Cohen and his colleagues at the Autism Research Centre in Cambridge, UK. Consisting of fifty questions, it aims to investigate whether adults of average intelligence have symptoms of autism spectrum conditions. More recently, versions of the AQ for children and adolescents have also been published.

Asperger syndrome (AS) was formerly a separate diagnosis under autism spectrum disorder. Under the DSM-5 and ICD-11, patients formerly diagnosable with Asperger syndrome are diagnosable with Autism Spectrum Disorder. The term is considered offensive by some autistic individuals. It was named after Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. Problems in diagnosis include disagreement among diagnostic criteria, the controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis for non-technical reasons. As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Diagnosis, treatment, and experiences of autism varies globally. Although the diagnosis of autism is rising in post-industrial nations, diagnosis rates are much lower in developing nations.

The history of autism spans over a century; autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.

The Modified Checklist for Autism in Toddlers (M-CHAT) is a psychological questionnaire that evaluates risk for autism spectrum disorder in children ages 16–30 months. The 20-question test is filled out by the parent, and a follow-up portion is available for children who are classified as medium- to high-risk for autism spectrum disorder. Children who score in the medium to high-risk zone may not necessarily meet criteria for a diagnosis. The checklist is designed so that primary care physicians can interpret it immediately and easily. The M-CHAT has shown fairly good reliability and validity in assessing child autism symptoms in recent studies.

Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.

<span class="mw-page-title-main">Edward Ross Ritvo</span> American psychiatrist, autism researcher (1930–2020)

Edward Ross Ritvo was an American psychiatrist known for his research on genetic components of autism. He was a professor emeritus of UCLA's Neuropsychiatric Institute.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

References

  1. ↑ Eriksson, Jonna M; Andersen, Lisa MJ; Bejerot, Susanne (2013). "RAADS-14 Screen: validity of a screening tool for autism spectrum disorder in an adult psychiatric population". Molecular Autism. 4 (1): 49. doi: 10.1186/2040-2392-4-49 . PMC   3907126 . PMID   24321513.
  2. ↑ Eriksson, Jonna M.; Andersen, Lisa M. J.; Bejerot, Susanne (2013). "RAADS-14 Screen: validity of a screening tool for autism spectrum disorder in an adult psychiatric population". Molecular Autism. 4 (1): 49. doi: 10.1186/2040-2392-4-49 . PMC   3907126 . PMID   24321513.
  3. ↑ Ritvo, Riva Ariella; Ritvo, Edward R.; Guthrie, Donald; Ritvo, Max J.; Hufnagel, Demetra H.; McMahon, William; Tonge, Bruce; Mataix-Cols, David; Jassi, Amita; Attwood, Tony; Eloff, Johann (August 2011). "The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults: An International Validation Study". Journal of Autism and Developmental Disorders. 41 (8): 1076–1089. doi: 10.1007/s10803-010-1133-5 . PMC   3134766 . PMID   21086033.
  4. ↑ says, Maja (1 January 1970). "The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R)". Autism Spectrum News.
  5. ↑ Au-Yeung, Sheena K; Bradley, Louise; Robertson, Ashley E; Shaw, Rebecca; Baron-Cohen, Simon; Cassidy, Sarah (14 December 2019). "Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults" (PDF). Autism. 23 (6): 1508–1518. doi:10.1177/1362361318818167. ISSN   1362-3613. PMID   30547677. S2CID   56492460.
  6. ↑ Kondo, Tsuyoshi (November 2015). "How and Why is Autism Spectrum Disorder Misdiagnosed in Adult Patients? - From Diagnostic Problem to Management for Adjustment" (PDF). Mental Health in Family Medicine. 11 (2). doi:10.25149/1756-8358.1102011. hdl:20.500.12000/32905. S2CID   52228647 . Retrieved 2023-03-28.
  7. ↑ Ritvo, Riva Ariella; Ritvo, Edward R.; Guthrie, Donald; Ritvo, Max J.; Hufnagel, Demetra H.; McMahon, William; Tonge, Bruce; Mataix-Cols, David; Jassi, Amita; Attwood, Tony; Eloff, Johann (2011). "The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults: An International Validation Study". Journal of Autism and Developmental Disorders. 41 (8): 1076–1089. doi:10.1007/s10803-010-1133-5. ISSN   0162-3257. PMC   3134766 . PMID   21086033.
  8. 1 2 Engelbrecht, Natalie (4 April 2020). "RAADS-R". embrace-autism.com. Retrieved 2023-03-28.
  9. 1 2 Sizoo, Bram B.; Horwitz, E. H.; Teunisse, J. P.; Kan, C. C.; Vissers, Ctwm; Forceville, Ejm; Van Voorst, Ajp; Geurts, H. M. (October 2015). "Predictive validity of self-report questionnaires in the assessment of autism spectrum disorders in adults". Autism: The International Journal of Research and Practice. 19 (7): 842–849. doi:10.1177/1362361315589869. hdl: 2066/150216 . ISSN   1461-7005. PMID   26088060. S2CID   6573623.
  10. 1 2 Picot, Marie-Christine; Michelon, Cécile; Bertet, Héléna; Pernon, Eric; Fiard, Dominique; Coutelle, Romain; Abbar, Mocrane; Attal, Jérome; Amestoy, Anouck; Duverger, Philippe; Ritvo, Ariella Riva; Ritvo, Edward R.; Baghdadli, Amaria (2021-01-01). "The French Version of the Revised Ritvo Autism and Asperger Diagnostic Scale: A Psychometric Validation and Diagnostic Accuracy Study". Journal of Autism and Developmental Disorders. 51 (1): 30–44. doi:10.1007/s10803-020-04518-z. ISSN   1573-3432. PMID   32347469. S2CID   254571461.
  11. 1 2 Jones, Sarah L; Johnson, Maria; Alty, Bronwen; Adamou, Marios (2021-09-11). "The Effectiveness of RAADS-R as a Screening Tool for Adult ASD Populations". Autism Research and Treatment. 2021: 9974791. doi: 10.1155/2021/9974791 . ISSN   2090-1925. PMC   8452438 . PMID   34552768.
  12. ↑ Brugha, Traolach; Tyrer, Freya; Leaver, Andrew; Lewis, Samantha; Seaton, Sarah; Morgan, Zoe; Tromans, Samuel; Rensburg, Kobus (March 2020). "Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population". International Journal of Methods in Psychiatric Research. 29 (1): e1814. doi:10.1002/mpr.1814. ISSN   1049-8931. PMC   7051834 . PMID   31899844.
  13. ↑ Sturm, Alexandra; Huang, Sijia; Bal, Vanessa; Schwartzman, Ben (2024-02-02). "Psychometric exploration of the RAADS-R with autistic adults: Implications for research and clinical practice". Autism. doi:10.1177/13623613241228329. ISSN   1362-3613. PMID   38305196. S2CID   267381710.
  14. ↑ Vagni, David; Moscone, Davide; Travaglione, Sara; Cotugno, Armando (1 December 2016). "Using the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) disentangle the heterogeneity of autistic traits in an Italian eating disorder population". Research in Autism Spectrum Disorders. 32: 143–155. doi:10.1016/J.RASD.2016.10.002. S2CID   151400476.
  15. ↑ Carmassi, Claudia; Bertelloni, Carlo Antonio; Salarpi, Gianluca; Diadema, Elisa; Avella, Maria Teresa; Dell'Oste, Valerio; Dell'Osso, Liliana (2019-05-26). "Is There a Major Role for Undetected Autism Spectrum Disorder with Childhood Trauma in a Patient with a Diagnosis of Bipolar Disorder, Self-Injuring, and Multiple Comorbidities?". Case Reports in Psychiatry. 2019: e4703795. doi: 10.1155/2019/4703795 . ISSN   2090-682X. PMC   6556326 . PMID   31249714.
  16. ↑ Kember, Sarah M.; Williams, Matt N. (2021). "Autism in Aotearoa: Is the RAADS-14 a valid tool for a New Zealand population?". S2CID   235741023.{{cite web}}: Missing or empty |url= (help)
  17. ↑ Brugha, Traolach; Tyrer, Freya; Leaver, Andrew; Lewis, Samantha; Seaton, Sarah; Morgan, Zoe; Tromans, Samuel; Rensburg, Kobus (March 2020). "Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population". International Journal of Methods in Psychiatric Research. 29 (1): e1814. doi: 10.1002/mpr.1814 . PMC   7051834 . PMID   31899844.
  18. ↑ Ritvo, Riva Ariella; Ritvo, Edward R.; Guthrie, Donald; Ritvo, Max J.; Hufnagel, Demetra H.; McMahon, William; Tonge, Bruce; Mataix-Cols, David; Jassi, Amita; Attwood, Tony; Eloff, Johann (August 2011). "The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults: An International Validation Study". Journal of Autism and Developmental Disorders. 41 (8): 1076–1089. doi: 10.1007/s10803-010-1133-5 . PMC   3134766 . PMID   21086033.
  19. ↑ Conner, Caitlin M.; Cramer, Ryan D.; McGonigle, John J. (2019). "Examining the Diagnostic Validity of Autism Measures Among Adults in an Outpatient Clinic Sample". Autism in Adulthood. 1 (1): 60–68. doi:10.1089/aut.2018.0023. ISSN   2573-9581. PMC   8992806 . PMID   36600688.
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