Trastorno del espectro autista: diagnóstico clínico y test ADOS / Autism spectrum disorder: clinical diagnosis and ADOS Test

INTRODUCCIÓN: El trastorno del espectro autista (TEA) es un desorden neurobiológico altamente prevalente, cuyo diagnóstico clínico es un desafío constante. OBJETIVOS: Describir el perfil clínico, en una cohorte de niños con TEA desde su derivación al especialista hasta la realización de un test diagnóstico. PACIENTES Y MÉTODO: Estudio descriptivo desde los primeros síntomas pesquisados por la madre, hasta la certificación diagnóstica de una serie de 50 niños, diagnosticados clínicamente con TEA entre 2012-2016. Se incluyeron niños de 3 a 10 años al momento del Test ADOS-G, con lenguaje de al menos una palabra. Los niños fueron evaluados neuropsicológicamente (funcionali dad, intelectualidad y test ADOS). Comparamos las medianas de edad al diagnóstico neurológico, según carga de sintomatología autista y nivel cognitivo. RESULTADOS: El test ADOS corroboró un TEA en 44 niños (88%), 93,1% eran varones. La edad promedio al diagnóstico clínico y test ADOS fue 48,2 ± 18,3 y 62,6 ± 23,3 meses. La consulta neurológica en el 72% de los casos fue motivación parental/educador por síntomas como trastorno interacción social y retraso de lenguaje. El 34,1; 47,7 y 18,2% tenían sintomatología autista leve, moderada y severa respectivamente. En 5 de 27 ni ños en los que se realizó la evaluación neuropsicológica se detectó déficit cognitivo. La mediana de edad al diagnóstico fue significativamente menor en niños con sintomatología autista grave vs leve- moderada (p 0,024). CONCLUSIÓN: La sintomatología autista determina la precocidad de consulta, por lo que es necesario orientar a la población general, educadores y personal de salud, respecto a estos síntomas.

INTRODUCTION: Autism Spectrum Disorder (ASD) is a neurobiological disorder of high prevalence, whose clinical diagnosis is a constant challenge. OBJECTIVES: To describe the clinical profile in a co hort of children with ASD from referral to the specialist to a diagnostic test. PATIENTS AND METHOD: Descriptive study from the first symptoms perceived by the mother to the diagnostic confirmation of a series of 50 consecutive cases, which were clinically diagnosed with ASD between 2012 and 2016. Children aged between 3 to 10 years at the time of the ADOS-G test and language of at least one word were included. The children were evaluated neuropsychologically (functionality, intellectuality and ADOS test). We compared the median age to the neurological diagnosis, according to the autistic symptomatology and cognitive level. RESULTS: The ADOS test corroborated an ASD in 44 children (88%), 93.1% were males. The average age at clinical diagnosis and ADOS test was 48.2 ± 19.3 and 62.6 ± 23.3 months. The neurological consultation in 72% of cases was parental/educator initiative due to symptoms such as social interaction disorder and language delay. The autistic symptomato logy was mild, moderate and severe in 34.1, 47.7 and 18.2% respectively. In five of 27 children who were neuropsychologically evaluated cognitive deficits were detected. The median age at diagnosis was significantly lower in children with severe autism symptoms vs the ones with mild-moderate symptoms (p-value 0.024). CONCLUSION: Autistic symptoms determine the early consultation; the refore, it is necessary to guide the general and educational population as well as health professionals regarding these symptoms.

Confiabilidad intercalificadores y validez de constructo del Test Gestáltico de Bender (segunda versión) / Inter-scorer reliability and construct validity in the Bender Gestalt Test (second version)

Hace algunos años, se ha publicado el nuevo Test Gestáltico de Bender, segunda versión (Bender-II). Esta nueva versión usa el Sistema de Calificación Global (SCG) para obtener los puntajes, que enfatiza la reproducción exacta de los diseños; junto con otros cambios estructurales, consiste en la mayor modificación realizada al Test de Bender para evaluar la habilidad visomotora en varias etapas del desarrollo humano. Pero aún hay pocas investigaciones que han estudiado su funcionamiento psicométrico en muestras hispanas y especialmente el error de medición en el procedimiento de la calificación. Se investigó el efecto de la variabilidad de la calificación del nuevo Bender-II sobre su validez de constructo con una medida de inteligencia. Se administraron el Bender-II y el Test Breve de Inteligencia de Kaufman (K-BIT) a 60 niños preescolares, y tres calificadores calificaron las figuras reproducidas mediante procedimientos estandarizados y el SCG. El análisis comparó las correlaciones obtenidas por cada calificador entre los puntajes del Bender-II y del K-BIT. Se halló que la variabilidad de los puntajes proveniente de la interpretación del SCG afectó moderadamente las correlaciones con el puntaje total y de las subescalas del K-BIT. Un calificador fue menos confiable y sus puntajes mostraron al menos 5% menos variancia compartida al compararlo con los otros calificadores. Se concluye que la interpretación de la validez se puede distorsionar aun cuando el error de medición es moderado pues interaccionan con otras fuentes de error. Esto sugiere que se debe garantizar un buen acuerdo en la calificación de pruebas que requieran juicio.

Although the impact of the measurement error in the accuracy of the classification of subjects and validity correlations is theoretically established, in a practical situation has not been explored the degree of impact on the new Bender-II (Brannigan & Decker, 2003). The practical situation of assessment is that which occurs in the professional context, in which one or more examiners of an assessment team assessing children in a particular institution. The new Bender-II has substantial modifications in its structure and functioning, making it different from the original instrument proposed by Bender (1938, 1946). Structural changes consisted in more of items (16 designs), complementary tests (fine motor and visual perception) and two major tests (Visual Constructive Memory and Visual Motor), the rating method Global Scoring System (GSS) and standardized record sheet for the child's behavior during the test administration. The GSS was created ad hoc for the Bender-II, and it is a method that emphasizes the exact reproduction of the designs; its origin is in the original gestalt approach of Bender. Main studies have been published in the manual (Brannigan & Decker, 2003), and subsequent studies have used the American standardization sample. However, in non-immigrant Hispanic population, to date there are some unpublished and published only one (Merino, 2012); therefore, it is not known how generalizable the findings and psychometric properties obtained in the American standardization sample are. The aim of the study was to examine the effect of the variability of the scoring of designs of the new Bender-II on construct validity with a measure of intelligence. The Bender-II and Kaufman Brief Intelligence Test (K-BIT - Kaufman, A. S. & Kaufman, A. L., 1994) was administered to 60 preschool children (between 4 and 5 years, 33 girls), and three scorers rated the designs reproduced, by standardized procedures and GSS. The analysis consisted of two steps: first, we estimated the consistency and inter-rater agreement using random two-way intraclass correlations (McGraw & Wong, 1996; Shrout & Fleiss, 1979). Second, for each scorer, correlations were calculated between scores on the Bender-II and K-BIT, and finally these correlations were compared with a test for dependent correlations with a common element (Steiger, 1980, Williams, 1959). The results indicate that there were slight differences between two scorers, but one of them had comparatively lower coefficients of consistency and agreement. In the all scorers, the magnitude of the consistency coefficients (> .85) and agreement (> .84) between the qualifiers indicate good levels of concordance with even moderate exercise time (two or three sessions). Correlations between scores on the Bender-II and K-BIT were around .43 and .61, and the lowest correlations occurred in the scorer that showed less consistency and agreement with other scorers, clearly indicating the impact of measurement error in the validity correlations. Compared with one of the rating, this difference was statistically significant, and the percentage reduction of covariance was at least 5%. Finally, the results indicate several points. First, we present other evidence for inter-rater reliability of the Bender-II, and that there were good levels of agreement and consistency. Second, there is potentially a reduction in the correlations of validity when a scorer has trouble for interpret consistently and correctly Global Scoring System. Correlations decreased, however, are not equal in all the scorers, and therefore must be verified the goodness of fit between scorer and the Bender it's qualification method approach. The results can be are idiosyncratic to the sample and study conditions, and the sample size constraints threaten the generalizability of the findings. However, the study conditions are close to professional practice and therefore can be generalized to some extent. In addition, can serve as a baseline to compare future studies of reliability in the Bender-II.