Journal of the American Academy of Child and Adolescent Psychiatry · 2026
Diagnostic Accuracy of the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule, Second Edition, in a Naturalistic High-Risk Autism Spectrum Disorder Sample Aged 6-25 Years.
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Cartigny Ariane, Gosling Corentin J, Chatzis Georges, Godin Ophélia, Frajerman Ariel, Humeau Elise, Atzori Paola, Pereira Sara Ramos, Ellul Pierre, Antoun Stephanie, Derbel Chema Sahnoun, Zante Elodie, Pottelette Julien, Robert Natalia, Pomies Virginie, Chesnoy Gabrielle, Weill Delphine, Coutelle Romain, Speranza Mario, Amestoy Anouck, FACE-ASD (FondaMental Advanced Centers of Expertise for Autism Spectrum Disorder) Groups, Moutier Sylvain, Leboyer Marion, Cortese Samuele, Delorme Richard
Аннотация
OBJECTIVE: The Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) are widely regarded as gold-standard instruments for the diagnosis of autism spectrum disorder (ASD). However, evidence for their diagnostic accuracy in naturalistic clinical settings remains limited among children and adolescents. We assessed their accuracy, individually and in combination, within a real-world clinical sample aged 6-25 years without intellectual disability (ID).
METHOD: This retrospective study analyzed 798 participants referred for ASD assessment, reflecting high diagnostic prevalence typical of specialized settings: 336/415 children/early adolescents and 353/383 late adolescents received a final ASD diagnosis. Diagnostic accuracy of both instruments and their combination ('OR-rule' and 'AND-rule') was assessed against a multidisciplinary consensus clinical diagnosis.
RESULTS: The ADI-R showed fair specificity in children and adolescents (82.3% and 86.7%) but poor sensitivity (51.2% and 43.9%). Conversely, the ADOS-2 demonstrated fair sensitivity (89.6% and 80.5%) but poor specificity (50.6% and 66.7%). Allowing diagnosis by either ADOS-2 or ADI-R increased sensitivity at the cost of more false positives, while requiring criteria on both instruments increased specificity at the cost of more false negatives. Exploratory analyses indicated reduced diagnostic accuracy of the two instruments in adolescents and poorer ADI-R accuracy in children with higher IQs, and in female adolescents.
CONCLUSION: The ADI-R and ADOS-2, alone or combined, did not achieve clinically acceptable levels of both sensitivity and specificity. Their combination nonetheless supports context-dependent trade-offs between sensitivity and specificity, helping clinicians prioritize either case detection or avoidance of false positives. In conclusion, while the ADI-R and ADOS-2 are valuable assessment tools for individuals without ID, they cannot replace integrated expert clinical judgment.
METHOD: This retrospective study analyzed 798 participants referred for ASD assessment, reflecting high diagnostic prevalence typical of specialized settings: 336/415 children/early adolescents and 353/383 late adolescents received a final ASD diagnosis. Diagnostic accuracy of both instruments and their combination ('OR-rule' and 'AND-rule') was assessed against a multidisciplinary consensus clinical diagnosis.
RESULTS: The ADI-R showed fair specificity in children and adolescents (82.3% and 86.7%) but poor sensitivity (51.2% and 43.9%). Conversely, the ADOS-2 demonstrated fair sensitivity (89.6% and 80.5%) but poor specificity (50.6% and 66.7%). Allowing diagnosis by either ADOS-2 or ADI-R increased sensitivity at the cost of more false positives, while requiring criteria on both instruments increased specificity at the cost of more false negatives. Exploratory analyses indicated reduced diagnostic accuracy of the two instruments in adolescents and poorer ADI-R accuracy in children with higher IQs, and in female adolescents.
CONCLUSION: The ADI-R and ADOS-2, alone or combined, did not achieve clinically acceptable levels of both sensitivity and specificity. Their combination nonetheless supports context-dependent trade-offs between sensitivity and specificity, helping clinicians prioritize either case detection or avoidance of false positives. In conclusion, while the ADI-R and ADOS-2 are valuable assessment tools for individuals without ID, they cannot replace integrated expert clinical judgment.