Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research

Karoline Alexandra Havdahl, Vanessa Hus Bal, Marisela Huerta, Andrew Pickles, Anne Siri Øyen, Camilla Stoltenberg, Catherine Lord, Somer L. Bishop

Research output: Contribution to journalArticlepeer-review

98 Scopus citations


Objective Growing awareness that symptoms of autism spectrum disorder (ASD) transcend multiple diagnostic categories, and major advances in the identification of genetic syndromes associated with ASD, have led to widespread use of ASD symptom measures in etiologic studies of neurodevelopmental disorders. Insufficient consideration of potentially confounding factors such as cognitive ability or behavior problems can have important negative consequences in interpretation of findings, including erroneous estimation of associations between ASD and etiologic factors. Method Participants were 388 children 2 to 13 years old with diagnoses of ASD or another neurodevelopmental disorder without ASD. Receiver operating characteristics methods were used to assess the influence of IQ and emotional and behavioral problems on the discriminative ability of 3 widely used ASD symptom measures: the Social Responsiveness Scale (SRS), the Autism Diagnostic Interview–Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS). Results IQ influenced the discriminative thresholds of the SRS and ADI-R, and emotional and behavioral problems affected the discriminative thresholds of the SRS, ADI-R, and ADOS. This resulted in low specificity of ASD cutoffs on the SRS and ADI-R for children with intellectual disability without ASD (27–42%) and low specificity across all 3 instruments for children without ASD with increased emotional and behavioral problems (36–59%). Adjustment for these characteristics resulted in improved discriminative ability for all of the ASD measures. Conclusion The findings indicate that scores on ASD symptom measures reflect far more than ASD symptoms. Valid interpretation of scores on these measures requires steps to account for the influences of IQ and emotional and behavioral problems.

Original languageEnglish (US)
Pages (from-to)1054-1063.e3
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number12
StatePublished - Dec 1 2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


  • Autism Diagnostic Interview–Revised
  • Autism Diagnostic Observation Schedule
  • Social Responsiveness Scale
  • discriminative ability
  • measurement


Dive into the research topics of 'Multidimensional Influences on Autism Symptom Measures: Implications for Use in Etiological Research'. Together they form a unique fingerprint.

Cite this