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Ritvo Autism and Asperger Diagnostic Scale

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The Ritvo Autism & Asperger Diagnostic Scale (RAADS) is a psychological self-rating scale developed by 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]

Ritvo Autism and Asperger Diagnostic Scale
Purposediagnosis of autism spectrum disorder

Background

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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 now and when young, only true now, only when young, or never true.

Uses

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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

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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

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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

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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

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References

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  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. ^ a b Engelbrecht, Natalie (4 April 2020). "RAADS-R". embrace-autism.com. Retrieved 2023-03-28.
  9. ^ a b 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. ^ a b 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. ^ a b 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?". European Journal of Psychological Assessment. 37 (3). doi:10.1027/1015-5759/a000598. S2CID 235741023.
  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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