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The diagnosis of autism in adults can be challenging and requires comprehensive, multidisciplinary assessments. Research has identified with good evidence, both the reliability and validity of the Autism Diagnostic Interview-Revised (ADI-R) as a diagnostic tool for autism diagnosis (Lord et al., 1997; Sappok et al., 2013).
ADI-R is a structured interview, usually involving the parent of the subject, which provides information relevant to the diagnosis of autism. The interviewer scores the information provided and feeds these scores into an algorithm that is scored in three domains:
A – qualitative abnormalities in reciprocal social interaction (cut-off =10);
B – qualitative abnormalities in communication (cut-off =7/8, verbal and non-verbal); and
C – restricted, repetitive, stereotyped behaviours (cut-off =3).
Elevated scores indicate problematic behaviour in a particular area and when the scores meet or exceed the cut-offs in all of the three areas and if onset is before three years of age, a diagnosis of autism may be made (Le Couteur et al., 2003). Although the ADI-R is commonly used, autism is a clinical diagnosis and this should only be made in combination with a clinical assessment of the person (Risi et al., 2006).
In the last decade, the standardised instrument has been used all over the world and translated into other languages including Brazilian, Portuguese (Becker et al., 2012), Polish (Chojnicka and Płoski, 2012) and Japanese (Kenji et al., 2013) with good effect.
Much of the existing research seems to be based on studies in children and adolescents, particularly those with intellectual disability (ID) (Papanikalou et al., 2009; Bildt et al., 2004). Papanikolau et al. studied 77 Greek children with a range of intellectual abilities using the Autism Observation Schedule-Generic (ADOS-G) and ADI-R and both instruments had excellent sensitivity (0.88) and satisfactory specificity (0.69) for the diagnosis of autism. The combination of ADI-R and Autism Diagnostic Observation Schedule (ADOS) was also reported as clinically relevant by Bildt et al. (2004) in the diagnosis of children and adolescents with ID with a reported percentage agreement of 63.6 per cent. Meilleur and Fombonne (2009) suggested that a more severe autistic symptom profile was indicated by ADI-R in children who regressed compared with those who did not.
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