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Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the Autism Diagnostic Observation Schedule: A systematic review and meta-analysis

机译：追踪自闭症谱系诊断的时间稳定性和自闭症诊断观察时间表测量的严重程度：系统评价和荟萃分析

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BACKGROUND: Exploring ways to improve the trajectory and symptoms of autism spectrum disorder is prevalent in research, but less is known about the natural prognosis of autism spectrum disorder and course of symptoms. The objective of this study was to examine the temporal stability of autism spectrum disorder and autism diagnosis, and the longitudinal trajectories of autism core symptom severity. We furthermore sought to identify possible predictors for change. METHODS: We searched PubMed, PsycInfo, EMBASE, Web of Science, Cochrane Library up to October 2015 for prospective cohort studies addressing the autism spectrum disorder/autism diagnostic stability, and prospective studies of intervention effects. We included people of all ages with autism spectrum disorder/autism or at risk of having autism spectrum disorder, who were diagnosed and followed up for at least 12 months using the Autism Diagnostic Observation Schedule (ADOS). Both continuous ADOS scores and dichotomous diagnostic categories were pooled in random-effects meta-analysis and meta-regression. RESULTS: Of 1443 abstracts screened, 44 were eligible of which 40 studies contained appropriate data for meta-analysis. A total of 5771 participants from 7 months of age to 16.5 years were included. Our analyses showed no change in ADOS scores across time as measured by Calibrated Severity Scores (mean difference [MD] = 0.05, 95% CI -0.26 to 0.36). We observed a minor but statistically significant change in ADOS total raw scores (MD = -1.51, 95% CI -2.70 to -0.32). There was no improvement in restricted and repetitive behaviours (standardised MD [SMD] = -0.04, 95% CI -0.19 to 0.11), but a minor improvement in social affect over time (SMD = -0.31, 95% CI -0.50 to -0.12). No changes were observed for meeting the autism spectrum disorder criteria over time (risk difference [RD] = -0.01, 95% CI -0.03 to 0.01), but a significant change for meeting autism criteria over time (RD = -0.18, 95% CI -0.29 to -0.07). On average, there was a high heterogeneity between studies (I2 range: 65.3% to 93.1%). DISCUSSION: While 18% of participants shifted from autism to autism spectrum disorder diagnosis, the overall autism spectrum disorder prevalence was unchanged. Overall autism core symptoms were remarkably stable over time across childhood indicating that intervention studies should focus on other areas, such as quality of life and adaptive functioning. However, due to high heterogeneity between studies and a number of limitations in the studies, the results need to be interpreted with caution.
机译：背景：自闭症谱系障碍的运动轨迹和症状改善方法在研究中很普遍，但是自闭症谱系障碍的自然预后和症状过程知之甚少。这项研究的目的是检查自闭症谱系障碍的时间稳定性和自闭症的诊断，以及自闭症核心症状严重程度的纵向轨迹。我们还试图确定可能的变化预测因素。方法：我们搜索了截至2015年10月的PubMed，PsycInfo，EMBASE，Web of Science，Cochrane图书馆，以探讨针对自闭症谱系障碍/自闭症诊断稳定性的前瞻性队列研究，以及干预效果的前瞻性研究。我们纳入了患有自闭症谱系障碍/自闭症或有自闭症谱系障碍风险的所有年龄段的人，这些人使用自闭症诊断观察时间表（ADOS）进行了诊断和随访至少12个月。连续的ADOS评分和二分类诊断类别均汇总在随机效应荟萃分析和荟萃回归中。结果：筛选的1443篇摘要中，有44篇符合条件，其中40篇研究包含适合荟萃分析的数据。从7个月大到16.5岁，共计5771名参与者被纳入研究。我们的分析显示，通过校正的严重度评分（平均差异[MD] = 0.05，95％CI -0.26至0.36）衡量，ADOS评分在整个时间中没有变化。我们观察到ADOS总原始分数有轻微但统计学上的显着变化（MD = -1.51，95％CI -2.70至-0.32）。限制和重复行为没有改善（标准MD [SMD] = -0.04，95％CI -0.19至0.11），但随着时间的推移，社会影响略有改善（SMD = -0.31，95％CI -0.50至- 0.12）。随着时间的推移，未观察到满足自闭症谱系障碍标准的变化（风险差异[RD] = -0.01，95％CI -0.03至0.01），但随着时间的推移，满足自闭症标准的显着变化（RD = -0.18，95％ CI -0.29至-0.07）。平均而言，研究之间存在较高的异质性（I2范围：65.3％至93.1％）。讨论：尽管有18％的参与者从自闭症转向自闭症谱系障碍诊断，但总体自闭症谱系障碍患病率没有变化。整个自闭症核心症状在整个儿童时期都非常稳定，表明干预研究应侧重于其他领域，例如生活质量和适应性功能。但是，由于研究之间的高度异质性以及研究中的许多限制，因此需要谨慎解释结果。

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