ADI-R - Autism Diagnostic Interview

 The Autism Diagnostic Interview-Revised (ADI-R) is a semi-structured, and standardized interview designed for caregivers of autistics to gather information about the individual's behavior and development in key areas related to autism. The ADI-R is typically used for diagnostic purposes and for aiding in the assessment and treatment planning for autistics. [See posts on other Screening/Diagnostic Measures]

Limitations

• Limited applicability for nonspeaking individuals: The ADI-R is primarily designed for individuals with some level of spoken language skills.. Alternative assessment tools, may be necessary to complement the ADI-R in evaluating these individuals.
• The test is designed for a mental age of 18 months. [See post why Mental Age is problematic]
• Lack of emphasis on strengths and abilities: The ADI-R primarily focuses on identifying deficits and autism symptoms. A comprehensive assessment should also consider strengths and positive attributes that can contribute to a more holistic understanding of the individual.
• Does not factor in co-occuring condition and other complex health issues. 
• Limited assessment of current functioning: The ADI-R primarily focuses on gathering retrospective information about the individual's behavior and development. While it provides valuable insights into early childhood behaviors, it may not capture the individual's current functioning or changes in behavior over time. Assessing current symptoms and adaptive functioning requires additional measures or observations.
• Reliance on informant report: The accuracy and reliability of the information collected depend on the informant's memory, observations, and interpretation. There may be instances where informants may not have complete or accurate knowledge of the individual's behavior, especially in cases where the informant is not the primary caregiver or when there are multiple caregivers with different levels of involvement.
• Subjectivity and biases: The ADI-R is susceptible to subjective biases, both from the interviewer and the informant which can influence reliability of results.
• Language and cultural factors: The ADI-R was developed primarily in English-speaking populations and may not fully capture cultural and linguistic variations. Cultural and language factors can influence the interpretation and reporting of behaviors, potentially leading to variations in the assessment outcomes for individuals from different cultural backgrounds or those with limited language abilities.
  

ADI-R has 3 diagnostic classifications

1. Autism: meet the criteria for a diagnosis of ASD
2. Autism Spectrum: acknowledges the presence of autism-related symptoms while indicating that the individual's symptoms do not fully meet the diagnostic threshold for autism. They may exhibit mild-moderate symptoms
3. Non-spectrum: this classification suggests that the individual's symptoms or behaviors are better explained by other factors or conditions. They may still have some challenges or difficulties, but these are not consistent with the characteristics associated with autism.

ADI-R looks at 3 functional domains:

• Language/Communication: It covers areas such as gestures, non-verbal communication, spoken language, and the ability to initiate and sustain conversations.
• Reciprocal Social Interactions: Assesses the quality of social interactions, including emotional sharing, offering and seeking comfort, social smiling, eye contact, social responsiveness , sharing interests and enjoyments, friendships and responding to social cues.
• Restricted, Repetitive, and Stereotyped Behaviors and Interests (RRBI): Covers topics such as sensory interests and sensitivities, preoccupations, compulsions and rituals, adherence to routines, and repetitive motor behaviors and unusual sensory responses.

The interview also includes a section on Onset of Symptoms, which involves asking about when the parents first noticed concerns and when the symptoms first started.

Scoring and Interpretation:

Involves assigning numerical values to the responses provided by the informant. These values reflect the frequency and severity of particular behaviors associated with autism. The scores are then totaled and compared to specific cutoff scores or algorithms provided in the ADI-R manual. 

Interpretation of the scores involves comparing them to established diagnostic algorithms for children and adults. These algorithms consider the age and language level of the individual being assessed.

The ADI-R has specific cutoff scores that vary depending on the individual's age and language level. These cutoff scores (based on a typical population) are use to determine whether the individual's behavior falls within the range indicative of autism.  

History of the ADI-R:

The ADI-R was developed by Michael Rutter, Ann Le Couteur, and Catherine Lord. The first edition was in the late 1980s as the ADI. The revised version, the ADI-R, was introduced in the 2003. Different revisions and adaptations of the ADI-R have been developed for specific populations, such as toddlers (ADOS-Toddlers module) and individuals with limited language abilities (ADI-R Module 4).

Reference: Le Couteur, A., Lord, C., & Rutter, M. (2003). The Autism Diagnostic Interview-Revised (ADI-R). Los Angeles, CA: Western Psychological Services.