ADI-R

※上記の広告は60日以上更新のないWIKIに表示されています。更新することで広告が下部へ移動します。

原版のADI-Rは、2003年にアメリカのWPS社で発売されました。1989年にLe CouteurらによりADIとして発表されて以来、15年以上の研究・開発の成果を踏まえた検査です。すでにスペイン、ドイツ、イギリス、オーストラリア、韓国など、世界各国で使用されています。原版のADI-Rは、2003年にアメリカのWPS社で発売されました。1989年にLe CouteurらによりADIとして発表されて以来、15年以上の研究・開発の成果を踏まえた検査です。すでにスペイン、ドイツ、イギリス、オーストラリア、韓国など、世界各国で使用されています。

  • 自閉症診断ツールのスタンダードとして、世界的に高く評価されているADI-Rの日本語版です。
  • 精神年齢が2歳0カ月以上であれば、幼児から成人まで、幅広い対象者に利用できます。
  • 幼児から成人まで、幅広い年齢層に適用できるよう、項目ごとに評価の対象となる年齢期が設定されています。主な時期として、「現在」(過去3カ月間)、「今まで」(生まれてから現在までのいずれかの時点)、「4歳0カ月~5歳0カ月の間で最も異常な場合」の3つがあります。
  • DSM-IVおよびICD-10において診断的意義があるとされる機能領域(「相互的対人関係の質的異常」「意思伝達の質的異常」「限定的・反復的・常同的行動様式」)に焦点を当てて構成されています。対象者の行動の系統的、かつ詳細な特徴を得ることができます。
  • 治療の進展や発達成熟度の上昇、生活状況の変化などを反映した症状の経過を把握することができるため、フォローアップ調査にも有用です。
  • 「面接プロトコル」は、対象者の背景情報、行動の全体像を捉える導入質問、初期発達・発達指標に関する情報、言語やその他のスキルの獲得時期と喪失の有無、ASDに関連する機能領域、およびその他の臨床的意義のある行動全般についての、全93項目から構成されています。
  • 「包括的アルゴリズム用紙」は、2通りの用途(「診断アルゴリズム」および「現在症アルゴリズム」)を備えた、包括的なスコアリングシートです。「診断アルゴリズム」では、対象者の発達歴全体に注目しながら、カットオフ値をもとに診断評価を行います。「現在症アルゴリズム」では、対象者の過去3カ月の行動を評価し、症状の経時的変化の把握や治療計画に役立てることができます。

 

日本国内のADI-Rを受けられる医療機関

1.東大病院精神科こころの発達診療部

2.九州べテルクリニック福岡発達障害専門外来

 

Autism Diagnostic Interview-Revised (ADI-R)

Anne Le Couteur, Catherine Lord, Michael Rutter, Western Psychological Services, 2003

GOALS

The Autism Diagnostic Interview-Revised (ADI-R) is a clinical diagnostic instrument for assessing autism in children and adults. The ADI-R provides a diagnostic algorithm for autism as described in both the ICD-10 and DSM-IV. The instrument focuses on behavior in three main areas: qualities of reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults with mental ages from about 18 months and above.

DESCRIPTION

The ADI-R is a standardized, semi-structured clinical review for caregivers of children and adults. The interview contains 93 items and focuses on behaviors in three content areas or domains: quality of social interaction (e.g., emotional sharing, offering and seeking comfort, social smiling and responding to other children); communication and language (e.g., stereotyped utterances, pronoun reversal, social usage of language); and repetitive, restricted and stereotyped interests and behavior (e.g., unusual preoccupations, hand and finger mannerisms, unusual sensory interests). The measure also includes other items relevant for treatment planning, such as self-injury and over-activity. Responses are scored by the clinician based on the caregiver's description of the child's behavior. Questions are organized around content area, and definitions of all behavioral items are provided. Within the area of Communication, for example, "Delay or total lack of language not compensated by gesture" is further broken down into specific behavioral items: pointing to express interest, conventional gestures, head nodding, and head shaking. Similarly, within the area of Reciprocal Social Interaction, lack of socio-emotional reciprocity and modulation to context include the following behaviors: use of other's body, offering comfort, inappropriate facial expressions, quality of social overtures, and appropriateness of social response.

All questions ask about current behavior, with the exception of a few behaviors that only occur during specific age periods. In these cases, specific age restrictions are given. For example, items inquiring about group play are coded only for behavior displayed between the ages of 4 and 10 years; questions about reciprocal friendships are scored only for children ages 5 and above; and questions about circumscribed interests are scored only for children ages 3 and above. In addition to asking about current behavior, each question focuses on the time period when the behaviors were likely to be most pronounced – generally, between the ages of 4 and 5 years.

 

SCORING

The ADI-R interview generates scores in each of the three content areas (i.e., communication and language, social interaction, and restricted, repetitive behaviors). Elevated scores indicate problematic behavior in a particular area. Scores are based on the clinician's judgment following the caregiver's report of the child's behavior and development. For each item, the clinician gives a score ranging from 0 to 3. A score of 0 is given when "behavior of the type specified in the coding is not present"; a score of 1 is given when “behavior of the type specified is present in an abnormal form, but not sufficiently severe or frequent to meet the criteria for a 2”; a score of 2 indicates "definite abnormal behavior” meeting the criteria specified; and a score of 3 is reserved for "extreme severity" of the specified behavior. (The authors of the measure recode 3 as a 2 in computing the algorithm.) There are also scores of 7 (“definite abnormality in the general area of the coding, but not of the type specified”), 8 (“not applicable”), and 9 (“not known or not asked”) given under certain circumstances, which all are converted to 0 in computing the algorithm.

A classification of autism is given when scores in all three content areas of communication, social interaction, and patterns of behavior meet or exceed the specified cutoffs, and onset of the disorder is evident by 36 months of age. The same algorithm is used for children from mental ages 18 months through adulthood, with three versions containing minor modifications: 1) a life-time version; 2) a version based on current behavior; and 3) a version for use with children under the age of 4 years. The algorithm specifies a minimum score in each area to yield a diagnosis of autism as described in ICD-10 and DSM-IV. The total cutoff score for the communication and language domain is 8 for verbal subjects and 7 for nonverbal subjects. For all subjects, the cutoff for the social interaction domain is 10, and the cutoff for restricted and repetitive behaviors is 3.