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Anorexia nervosa, autism, and the ADOS: how appropriate is the new algorithm in identifying cases?

Research output: Contribution to journalArticle

Original languageEnglish
Article number507
Number of pages7
JournalFrontiers in Psychiatry
Volume10
Early online date18 Jul 2019
DOIs
DateAccepted/In press - 27 Jun 2019
DateE-pub ahead of print (current) - 18 Jul 2019

Abstract

Thirty years of scholarship has suggested that anorexia nervosa (AN) may be a ‘female presentation’ of autism, supported by work which has found elevated rates of autism traits and diagnoses among women with clinical levels of AN. These traits are often assessed using the Autism Diagnostic Observation Schedule – 2nd Edition (ADOS-2), considered the ‘gold-standard’ tool. Recently, the authors of the ADOS-2 revised the diagnostic algorithm for the adult version of the assessment – the one most often used with AN patients. We therefore examined differences in the scores, rates of diagnosis, and correlations with other mental health issues between the two diagnostic algorithms among women with and without AN. 175 women with current AN, who had recovered from AN, and with no history of AN, between the ages of 12 and 53, took part in an ADOS-2 assessment. Their scores were then calculated according to both the original and the new algorithms. The new ADOS-2 algorithm identifies more women as potentially being on the autism spectrum than the old algorithm, Under both algorithms, more currently ill AN patients were identified as potentially being autistic than those with no history of AN. Recovered individuals represented a mid-point between the scores of those with and without AN on both algorithms. There were no correlations with mental health scores in any group, meaning that the new ADOS-2 algorithm is not falsely identifying anxious behaviours or depressive presentations as signs of autism in this group. Overall, we found that more AN patients and recovered individuals scored above cut-off on the new ADOS-2 algorithm, suggesting that women who experience AN may have more autistic traits which in part persist following weight restoration and recovery. However, the ADOS-2 should not be used alone but in combination with broader clinical assessments to determine whether an autism diagnosis is appropriate for these women.

    Research areas

  • clinical interview, women, comorbidity, autism, anorexia nervosa

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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Frontiers at https://doi.org/10.3389/fpsyt.2019.00507 . Please refer to any applicable terms of use of the publisher.

    Final published version, 958 KB, PDF document

    Licence: CC BY

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