SCDC was sent to parents of twins

agedSCDC was sent to parents of twins

aged 5–17 years from a register of births
B R I T I S H J O U R N A L O F P S Y C H I A T
R Y B R I T I S H J O U R N A L O F P S Y C H I A T R Y in5–17 years from a register of births in
( 2 0 0 5 ) , 1 8 7 , 5 6 8 ^ 5 7 2 ( 2 0 0 5 ) ,
1 8 7 , 5 6 8 ^ 5 7 2
south-east Wales (details available
insouth-east Wales (details available in
ScourfieldScourfield et alet al , 2004). Of
the 1109 families, 2004). Of the 1109
Me asurin g autistic traits : herit ability, families contacted, 670 replied, a
response rate ofcontacted, 670 replied, a
reliabilityMe asurin g autistic traits : herit response rate of 60%. The mean age of
the girl twins was60%. The mean age of
ability, reliability a n d v alidit y o f t h e S o the girl twins was 10.6 years (s.d.10.6
years (s.d.¼ 3.3) and that of the boys3.3)
cial a n d C ommunic a tiona n d v alidit y o f and that of the boys was 10.6 years
th e S o cial a n d Communic a tion Dis o r d e (s.d.was 10.6 years (s.d.¼ 3.2). There
were 2783.2). There were 278
DAV I D H . S KU S E , W IL L I A M P. L . M A NDY a n d J A NE S
r s Ch e c kli s tDis or d e r s C h e c kli s t
C O URF I E L DDAV I D H . S KU S E , W I L L I A M P. L . M A
monozygotic pairs (124 male pairs
andmonozygotic pairs (124 male pairs
NDY a n d J A NE S C O URF I E L D and 154 female pairs) and 378 dizygotic
pairs154 female pairs) and 378 dizygotic
pairs (198 opposite-gender pairs, 99 male
pairs(198 opposite-gender pairs, 99 male
B ackgroundB ackground Autistic tr Autism may not be an excessively pairs and 81 female pairs).and 81 female
aits are widelyAutistic tr aits are rareAutism may not be an excessively pairs). The test–retest reliability study
widely distribute d in the gener al p rare disorder (Volkmardisorder (Volkmar sampleThe test–retest reliability study
opulation, butdistribute d in the et alet al , 2004). Rather, it, 2004). sample was recruited from a database of
Rather, it could represent the extreme of femaleswas recruited from a database of
gener al p opulation, b ut the b
a quantita-could represent the extreme of females with Turner syndrome, based on a
oundaries of the autistic sp
Social and Communication Disorders Checklist Measuring
a quantita- tive distribution of autistic
ectrumthe b oundaries of the autistic traits that aretive distribution of autistic
nationalwith Turner syndrome, based on a
national case register. It comprised 254
sp ec trum are uncle ar.Whole - p
autistic traits: heritability, reliability and validity of the
opulationDavid sur veys H.ofa Skuse,
r e un cle William
a
traits that are present in the general
P. L. Mandy
population (e.g.present andinJane the general
individualscase register. It comprised 254
individuals (mean age 15.7 years, s.d.
r.Wh ole Scourfield
10.1192/bjp.187.6.568Access
- p o p ul atio n s ur v e y s o population the(e.g. most recentet alet al ,
SpikerSpiker (mean age 15.7 years, s.d.¼ 4.2,
fAimsAim
unselected s Tosa
versiona sse
mple ss
atswh of ether 2002; Constantino & Todd,, 2002;
the S o 187:568-572.BJP
children
DOI: 2005, range4.2, range 3.3–19.1). Verbal IQ data
cial a ndTo a sse ss wh
areun s ele c te d s a mple s o f c ether the S o Constantino & Todd, 2003). Surveys of were available3.3–19.1). Verbal IQ data
cial a nd
hildre n aCo remmunic
hamp ered atio byn Dis
theolack r large unselected samples2003). Surveys were available for 72 of these individuals,
rd e of
of large unselected samples are required scored on thefor 72 of these individuals,
s Ch
a e c klis tCommunic
ppropriateha mp eredation by the Disorder
lack of et to alet
test al
and , 2002),
refine this littlehypothe-are
evidence on scored on the Wechsler Intelligence Scale
s
a Che cklist Material
ppropriate (SCD
screC) fulf ils the ne ehttp://bjp.rcpsych.org/content/suppl/2005/12/01/187
ening d validity, 2002),
required to test little evidence
and refine thison validity
hypothe- for ChildrenWechsler Intelligence Scale for
for a sensitive(SCD
instruments.scre C) fulf
ening .6.568.DC1.html
ils the ne e d sis.
instruments. (Ehlers(Ehlers Supplementary
et alet alinstruments
, 1999; Scott, material can be found
Supplementary at: et
1999;
Currently
alet al
Scott
,
et
available
2003),
alet
applicability
al , 2002;
to a
Cohen,
de-sis. Children (Wechsler, 1992): the mean
limited
for a sensitive m e a s ur e o f a uti s ti age, Currently
2003), available
applicability instruments
to a limitedde- signed
age verbal IQ was(Wechsler, 1992): the mean
c t r a it s , w hicReferences
h c a n b eme a sure http://bjp.rcpsych.org/content/187/6/568#BIBL
2002;
o to Cohenautistic traits suffersigned to
measure verbal IQ was 96.9This
(s.d.96.9 (s.d.¼ 17.6,
article range of
cites children24 (Charmanrange
articles, 3of of which
f a utis tic tr ait s, whic h c a n b e measure autistic traits
children (Charman et alet al , 2001),suffer limitations rangeyou can
58–130).17.6, range 58–130).
access that for
renderfree them at:
unsuitable
to 20min)forlimitations Participants in the validity study com-
complete d in a few minutes and 2001) and time (up taken for
Me thodMe thoddAin12
whichcomplete
permissions
a few
- itemminutes
permissions@rcpsych.ac.ukwrite
sc ale,andth e that render them
comple-and time (up unsuitable
to 20min) for taken to To
large- for obtainin reprints
Participants or com-
the validity study
scale
permission surveys:
to poor sensitivity
reproduce material prisedthis
from patients from three
paper, separate
please
SCD C,A12-item
which me a sures Reprints/
scale,
heritathe bleSCDC,
charac comple- tion (Berumenttion (Berument et
wa s (Southlarge-scale surveys: poor sensitivity clinics:prised patients from three separate
completein
teristics dbby othme
threarticle
ea indep
sures endentwa
heritable alet al , 1999; Constantino, 1999;
to this at You scan respond
(South
Constantino & Todd, 2003). We predicted clinics: the social and communication
complete
charac teristics
d by threin b eoth indep
male s a nds a Informed
endent that& Todd,
consent
2003).
was
We
obtained
predicted the disordersthe social and communication
thatfrom
mple s dr
female http://bjp.rcpsych.org/letters/submit/bjprcpsych;187/6/568
s.male
awn s froam ndafet winmaler e s.gis te r, fromInformed consent was obtained
disorders clinic at Great Ormond Street
Social and Communication
all participants in accordance with guide- Disordersthe
as a mple s dr awn from fro m a t win r e Thegis Royal
Social College
and Communication of Disorders Hospital forclinic at Great Ormond Street
all participants in accordance with guide-
ter, a gr o u p wit h Tur n e r s y n dr PsychiatristsPublished
o Checklist (SCDC) (SkuseChecklistby on
(SCDC) Hospital for Children, London (Children,
lines from the appropriate hospital
m e a n d c hil d Downloaded
r e ngr o up wit h September
Tur n (Skuse 27,
et alet al , 1997) would,
ethicslines from the appropriate hospital 1997) London (nn¼ 230), a child and230), a
2014http://bjp.rcpsych.org/
would fulfil the needThree for a independent
brief, simple child and adolescent mental health
e r s yn dr o m e a n d c hil dr e n with ethics committees.
instrumentfulfil the need for a brief, service (CAMHS)adolescent mental health
a diagnosis of autistic - sp ectrumwith ME THODME
samplescommittees. Three independent
simple instrument providing a reliable and service (CAMHS) clinic in Luton (clinic in
a dia gn o sis o f a uti s tic - s p e c tr THOD
samples participated in heritability,
valid dimensionalproviding
reliability andparticipated in reliable and Luton (nn ¼ 30) and another in30) and
aheritability,
um
Re sultdisorder
sRe sultattending
s Tr aitsclinic
me as.sured
The dat by valid dimensional measure of heritable another in Hartlepool (Hartlepool (nn ¼
reliability and validity studies. The
a
the weredisord
SCD CTr aits er attending
me a sured clinic s. The autistic traits inmeasure of heritable
by the 23). For the Great Ormond23). For the
heritability study wasvalidity studies. The
dat a were Great Ormond Street recruits, ICD–10
SCDC were usedhighly toherit
estaablish ble inthe herita heritability
b oth autistic traits in children
study with no learning
was conducted using the
psychiatric diag-Street recruits, ICD–10
bility, relia bilityused to establish
gender swere highly herit a ble in b oth the disability.children
Cardiff Study of with
Allconductedno learning
using the
heritability, relia bility a n d v alidit y o f disability. psychiatric diag- noses (World Health
gender s ( 0.74). Intern al consis tenc y Cardiff Study of All Wales and North of Organization, 1992)noses (World Health
twa he c h e c klis t .and validity
s excellent( 0.74) . Inter n al c o n of the England Twins, whichWales and North of
Organization, 1992) were established
checklist. England Twins, which is a population-
sis te n c y w a s e xcell e nt ( 0.9 3) using a novel compu-were established
based twin study of all twinis a
and test ^ rete st reliabilit y high( 0.9 using a novel compu- terised autism
population-based twin study of all twin
3) and test ^ rete st reliability high interview, the Develop-terised autism
births in Wales and Greater
interview, the Develop- mental,
( 0.81) . Dis c rimin a nt v alidit y b et Manchester.births in Wales and Greater
Dimensional and Diagnosticmental,
we e n( 0.81) . Dis c rimin a nt v alidit y Manchester. Data on the heritability of the Dimensional and Diagnostic Interview
b et we e n p er v a sive d evelo pment SCDC haveData on the heritability of the
(3di; SkuseInterview (3di; Skuse et alet al
al dis ord er a ndp er v a sive d evelo SCDC have been previously published
, 2004). In the, 2004). In the Great
pment al dis o rd er a nd other clinical (Scourfieldbeen previously published
Ormond Street clinic the majorityGreat
(Scourfield etet alal , 1999) but here are
Conclu
gro up ssion wa ssConclu
go o d,othersion sclinical
The SCD gro C re-analysed to, 1999) but here are re- Ormond Street clinic the majority of
is asunique
up wa s goandThe SCD C is a unique
o d, discrimination from analysed to examine gender differences
referrals concerned children with neuro-of
and -eclinical
non ff icient f ir s t- level s c ation
samplesdiscrimin re e referrals concerned children with neuro-
in more detail.examine gender differences
ningeno ff n
icient f irals st-alevel developmental or language problems.
from - clinic mplesscre w aening
sb in more detail. It is well established that
Thedevelopmental or language problems.
questionnaire
e for autistic
tte r ; s e n sitivit y ( 0 .9 tr 0 ) , s p e c i autism is a highlyIt is well established that The CAMHS recruits were categorised
De clar ation
aits.questionnaire o f int
for ere stDe
autistic tr aits. autism is a highly heritable disorder, so
f i c it yw a s b e tte r ; s e n sitivit y accord-CAMHS recruits were categorised
claration
( 0 .9 0 ) , of s pintere
e c i f st
i cNone.No ne any instrument pur-heritable disorder, so
it y (0.69). accord- ing to clinician diagnosis. None of
.(0.69). any instrument pur- porting to measure
go to: The British Journal of traits
autistic PsychiatryTo
shouldporting to measure
theing to clinician diagnosis. None of the
http://bjp.rcpsych.org/site/subscriptio
subscribe to autistic traits should itself show high
patients recruited into the survey had
parti-patients recruited into the survey
ns/ heritability (however,itself show high
had parti- cipated in previous research,
5 6 heritability (however, demonstrating high
and none hadcipated in previous
8 56 heritability does notdemonstrating high
research, and none had previously been
8 heritability does not prove the validity of
assessed with standardisedpreviously
the measure). Theprove the validity of the
been assessed with standardised
measure). The
 non-clinical (non-clinical (nn¼ 30)
populations (Skuse30) populations (Skuse
et a let al ,, 2004). Concurrent (2004).
S O C I A L A N D C O M M U N I C AT I O N D I S O R D E R S C H E C
K L I S T S O Concurrent
C I A L A N (nn¼D C O120),
M M U discriminant120),
N I C AT I O N D I S
O R D E R S discriminant
C H E C K L I ((nn¼
S T 120) and criterion (120)
and criterion (nn¼ 29) validity were29)
the Autism Diagnostic Interview –
validity were evaluated in autistic-
Revisedthe Autism Diagnostic Interview –
spectrum disorder andevaluated in autistic-
Revised (ADI–R; Lord(ADI–R; Lord et alet al
Ta b l e 1Ta b l e 1 Va lidi ty s a mple c h ar a c teri spectrum disorder and non-autistic patient
, 1994) and the 3di, 1994) and the 3di
s tic sVa lidi ty s ample c h ar a c teri s tic s groups. Test–retest andnon-autistic patient
(Skuse(Skuse et alet al , 2004), that most
groups. Test–retest and interrater
strongly, 2004), that most strongly
Autism and a Clinic control groupClinic c o n tr o l reliabilities were excellent (mostinterrater
discriminate autistic-spectrum
typicalAutism and gro up ((nn ¼ 76 )76 ) Normal reliabilities were excellent (most
disordersdiscriminate autistic-spectrum
a typical auti controlNormal control gr o u pgr o u p intraclasscorrelationcoefficientsweregreate
disorders from non-autistic conditions.
smauti sm ((nn ¼ ((nn ¼11 8 )11 8 ) rintraclasscorrelationcoefficientsweregreat
The domainsfrom non-autistic conditions.
20 8)20 8) er than 0.9). Concurrent validity of the
8282d8888
Gen er : m 4949 The domains of content
a l A g e , ye a r s : m e a n ( r an ge )Age, year s : mean (r ange) 8.9 ( 2 . 5
11 of the questions
3dithan 0.9). Concurrent validity of the 3di
^18.1)8.9
e , %Gen der ( 2.:5m^18.1) 10.8 (2.4 ^17.7 )1 0 . 8 ( (see 2.4^ Appendix)of
17. 7 ) 1 3 . 0content
( 7. 3 ^ of 17.the 4 )13questions
. 0 ( 7. (agreementwithindependentclinicianformu-
3^
al (see
e,1%7. 4 ) Ve r b a l22I Q : m e a n ( s . d . )Verbal IQ : mean ( s. d.) Appendix) comprise social reciprocity
(agreementwithindependentclinicianformu-
93.0 (20.6)93.0 (20.6 ) 102 .5 (13.8)102.5 (13.8 ) Non - verbal
(questions 1,compriseIQ : social reciprocity
lation) was very good (meanlation) was
mean
9 1. 9 (( 19. s. d.)No
0 )91.9n - (19.0)
verb33 a99.7
l IQ :(15.
m e5)99.7
a n ( s(15.
. d (questions
.)5) Pr op or 1, tion2, of3,verbal
6 and IQ 10),
s bnon-verbal
elow 8 very good (mean kk¼ 0.74).0.74). Criterion
skills
0, %Pr op or tion of verbal IQ s b elow 8 0, % 2424 55 SCDC score: mean (s.d.)SCDC(8)2, 3, 6 and 10), non-verbal skills
validity of the 3di, in a comparisonCriterion
(8) and pragmatic
score: mean (s.d.) 16.6 (5.7 )16 . 6 ( 5 . 7 ) 13 . 0 ( 6 .1)13.0 ( 6 .1) 2 .9 ( 4 .0 )2.9 language usage (7,
validity of the 3di, in a comparison with the
(4.0 ) 11and pragmatic language usage (7, 11
ADI–R (Lordwith the ADI–R (Lord et alet al ,
and 12). Three questions concern func-
SCDC, Social and Communic ation Disorders Checklis and t.SCDC, Social and questions
Communication Disorder s
1994),was, 1994), was excellent, and the
12). Three concern func-
Checklist. 1. There wa s no dif f erence between mea n SCD C score s o f males and females in either of instrument’s ability toexcellent, and the
tional impairment (3–5). There is, how-
th e clinic gro up s, although1. There wa s no dif ference between mean SCD(3–5). C scores o f males and instrument’s ability to discriminate
tional impairment There is, how-
females in either of the clinic group s, although su c h di f f erenc e s are f o und in th e n orm al c on tr ol between autistic-spectrumdiscriminate
ever, no explicit question concerningever,
s.such di f f erenc e s are fo und in th e n orm al c on trols. 2 . Verb al IQ w a s av a ila ble f or 14 4 in between autistic-spectrum vv .. non-
dividu a l s in th e au ti sm gr o up a nd 2 0 clinic c o nno trolexplicit
s ; th ere question
w a s a signi concerning
f ic a n t di f f erenc e2 . autistic individuals was almost perfectnon-
Verb al IQ wa s available for 14 4 individu al s in the aucircumscribed ti sm group a ndinterests2 0 clinic c or on trols ; there wa s a autistic individuals was almost perfect
signific a n t dif ference b e twe en the group s :b e tween stereotypedcircumscribed
the group s : UU ¼ 969.5,969.5, interests
PP 55 0.0 or 5. T
here w afrom
s n o July
c orrela tionto
b eDecember
twe en ver b al IQ a nd stereotyped
SCD C s c or e (0.0 5. T h ere
(sensitivity 1.0, specificity(sensitivity 1.0,
years, 1999 patterns of w a s n o c orrela tio n
motor
b e twe en ver b a l IQ a nd SCD C s c ore (rr ¼ 77 0.12 ,0.12 , PP 44 0.1) .0.1) . 3. No n - verb al IQ w a s specificity 44 0.97).0.97). Concurrent
2003.years, from July 1999 to December behaviour.patterns of motor behaviour.
av a ilable f or 10 5 in dividu a l s in th e a u ti sm gr o For up afurther
nd 13 clinic c o n trol
validity s ; s c ore
analysis, s did
the n o t di f f validity of the SCDC wasConcurrent validity
diag-For
2003.
er a c c The or-3. CAMHS
No n - verrecruits
b al IQ w were
a s av a ilable f or 10 5 individu al s in th e au ti sm gr o up a nd 13 c linic of the SCDC was assessed by a comparison
consecutive
c o n trol s ; s c re-The
ore s didCAMHS
n o t di f recruits were further validity analysis, the diag- nosis of
f er a c c or- di n g t o gr o u p (di n g to gr o up ( UU ¼ 505.0,505.0, PP of mean scoresassessed by a comparison
consecutive
44 0.1). T here re- wa sferrals duringbetween
no correlation January nonand anIQautistic-spectrum
-verbal and SCDC score (0.1). disorder
T here wawasnosis
s no of
of mean scores on this measure of children
February between
correlation 2004.ferrals during
n on -verbal IQ January
and SCDCand an autistic-spectrum
score (rr ¼ 77 0.07,0.07, PP 44 0. 4 ).0. 4 ) .disorder was defined
with clinicallyon this measure of children
February 2004. An additional sample of according to ICD–10 criteria, todefined
with clinically diagnosed autistic-spectrum
normal controlsAn additional sample of according to ICD–10 criteria, to include
disorderdiagnosed autistic-spectrum
normal controls ((nn¼ 118) was recruited autism, atypical autism and Asper-include
disorder ((nn¼ 208) and children with
to enable the assess-118) was recruited to autism, atypical autism and Asper- ger other clinical208) and children with other
enable the assess- ment of the SCDC’s syndrome. In the Great Ormond Streetger
clinical diagnoses (diagnoses (nn ¼ 76).
validity as a screeningment of the SCDC’s syndrome. In the Great Ormond Street
Non-autistic conditions76). Non-autistic
validity as a screening instrument for clinic sample this was established
conditions in the comparison samples
autistic traits in the generalinstrument for fromclinic sample this was established includedin the comparison samples
autistic traits in the general population from the 3di (see below) according to con-
included conduct disorders, attention-
(Table 1). All members of thepopulation the 3di (see below) according to con-
deficit hyper-conduct disorders, attention-
(Table 1). All members of the control group ventional criteria based on the ADI– deficit hyper- activity disorder (ADHD),
had intellectual abilities withincontrol Rventional criteria based on the ADI–R
pragmatic dis-activity disorder (ADHD),
group had intellectual abilities within the algorithm (Lordalgorithm (Lord et alet al ,
pragmatic dis- orders oforders of language,
normal range, were English-speakingthe 1994), combined, 1994), combined with
Tourette syndromelanguage, Tourette
normal range, were English-speaking and findings from the Autism Diagnosticwith
syndrome andand obsessive–compulsive
were in mainstream schooling.and were in findings from the Autism Diagnostic disorder, diag-obsessive–compulsive
mainstream schooling. The SCDC was sent Observation Scale – Generic disorder, diag- nosed by experienced
out for completionThe SCDC was sent out (LordObservation Scale – Generic (Lord et
clinicians accordingnosed by experienced
for completion by parents. For participants alet al ,, 2000). Individuals meeting only
clinicians according to ICD–10 criteria. We
attending theby parents. For participants ICD–102000). Individuals meeting only
expected the meanto ICD–10 criteria. We
attending the Great Ormond Street ICD–10 diagnostic criteria for pervasive
expected the mean SCDC scores of these
Hospital clinic, thisGreat Ormond Street develop-diagnostic criteria for pervasive
clinical groups to beSCDC scores of these
Hospital clinic, this questionnaire formed develop- mental disorder not otherwise
clinical groups to be higher than those of
part of the pre-questionnaire formed part specifiedmental disorder not otherwise
children in the generalhigher than those of
of the pre- appointment assessment, and specified were categorised as non-cases
children in the general population, because
if initiallyappointment assessment, and if for thewere categorised as non-cases for
Est a blishin g SCDCEst of their associationpopulation, because of
initially incomplete the omission was the purpose of this study. The 3di is a
their association with autistic features (e.g.
ablishin g SCDC
rectified priorincomplete the omission was parentalpurpose of this study. The 3di is a
Geurtswith autistic features (e.g. Geurts et
psychometric
Reliabilitprior to prop
rectified er
the clinical assessment. parental autism interview that can be
alet al ,, 2004; Gilmour2004; Gilmour et
tiespsychometric
Unlike prop er administeredautism interview that can be
yR
In e li previousto
order a tob iassess the clinical assessment.
internal reliability, theIn administered to unselected clinical and
alet al , 2004). Accordingly a, 2004).
Unlike previous evaluations of the Social
ties Accordingly a second test of concurrent
li t y
order to assess internal reliability,
Responsivenessevaluations the
of the Social general populationto unselected clinical
validity was per-second test of concurrent
SCDC’s internal consistency
Responsiveness Scale (Constantino was calcu- & and general population samples; it
validity was per- formed, to compare SCDC
SCDC’s internal consistency
Todd, 2003) andScale (Constantino & Todd, was calcu- measures both symptom
scores of theformed, to compare SCDC
lated. External
2003) and the Autism reliability was evaluated
Screening intensitysamples; it measures both
scores of the clinically identified samples
inlated. External
Questionnaire reliability
(nowthe AutismwasScreening
evaluated symptom intensity and comorbidity across
with generalclinically identified samples
in terms of test–retest
Questionnaire (now known as the Social reliability; parents the full range of theand comorbidity
with general population controls
ofterms of test–retest
Communication Ques-knownreliability; parents
as the Social across the full range of the autistic (population controls (nn ¼ 118).118).
of 188 participants
Communication Ques- completed
tionnaire; the SCDC spectrum (Skuseautistic spectrum (Skuse
Criterion validity of the SCDC wasCriterion
for188 participants
Berumenttionnaire; completed the
Berument et alet al , SCDC et alet al , 2004). It is a, 2004). It is a
V al id i t validity of the SCDC was evaluated by
for a second
1999) in time,
clinical, at a mean
1999) in clinicalretest computerised procedure, for
yV a l i d i t determining correlationsevaluated by
We assessed
interval
populations, content
ofa second validity
time,
questionnaire at a primarily
mean retest administrationcomputerised procedure,
y determining correlations between the
byWe
interval assessed
of 2.7 content
years
completionpopulations, questionnaire validity
(s.d.2.7 yearsprimarily
(s.d.¼ for administration by trained interviewers,
questionnaire total score andbetween the
by comparing
0.5,
completion questions
range 1.51–5.39).0.5,
never followed in range
the SCDC
the 1.51– which generatesby trained interviewers,
questionnaire total score and the sub-scale
withcomparing
5.39).
standardised questions in the
interview.never SCDC the
followed with which generates symptom and diagnostic
scores of algorithms generatedthe sub-
items in standardised
standardised interview. interviews, such profiles for bothsymptom and diagnostic
scale scores of algorithms generated by
asitems in standardised interviews, such profiles for both autism and non-autistic
the 3di (Skuseby the 3di (Skuse et alet al ,
as conditions. The 3di’sautism and non-
2004), which are, 2004), which are
autistic conditions. The 3di’s test–retest
equivalent to the sub-scale scores of5 6 9 5
and interrater reliability weretest–retest 6 9
theequivalent to the sub-scale scores of
and interrater reliability were assessed in
the ADI–R algorithm (LordADI–R algorithm
unselected clinical (assessed in
(Lord et alet al , 1994)., 1994).
unselected clinical (nn¼ 50) and50) and
S K U S E E T
A L S K U S E E
T A L

Statistical analysis was conducted s.d.s.d.¼ 6.6) and the community diagnoses and 26 without a PDD
usingStatistical analysis was conducted control6.6) and the community control diagnosis.diagnoses and 26 without a PDD
using the Statistical Package for the group (mean score 2.9, s.d.group (mean diagnosis. These correlations were
¼ 258.72,258.72,(2,346) PP 55 0.001). How-
Socialthe Statistical Package for the Social score 2.9, s.d.¼ 4.0); one-way4.0); one- modest, which is un-These correlations
0.001). How- ever, it should be noted that
(2,346)
Sciences (SPSS version 11 for way ANOVA (ANOVA (FF were modest, which is un- surprising in
Levene’s testever, it should be noted that
Windows).Sciences (SPSS version 11 for view of the fact that the itemssurprising in
Levene’s test showed that the assumption
Windows). Test–retest reliability of the view of the fact that the items that make
of equality ofshowed that the assumption
SCDC wasTest–retest reliability of the up the SCDC were not derivedthat make
of equality of variances had been violated
SCDC was assessed using intraclass Discriminant validity was had thenbeen assessed up the SCDC were not derived from the
for this analysisvariances
correlation coeffi-assessed using byDiscriminant ADI–Rand are designed to measurefrom
violated for this validityanalysiswas then statistic
(Levene assessed
intraclass correlation coeffi- cients (ICCs). by determining the power the ADI–R and are designedtomeasure
19.6,(Levene statistic 19.6,ofPPthe 55SCDC
0.001). to
One-way ICCs were used,cients (ICCs). dis-determining the power of T2 thewas
SCDC to autistic traits rather than for diagnostic
Tamhane’s0.001). Tamhane’s
One-way ICCs were used, to allow for dis- tinguish participants pur-autistic traits rather than for
therefore used forT2 was with thereforeautistic-
used
inter-individual variability.to allow for spectrumtinguish participants with diagnostic pur- poses. Correlation with the
for p ost hocpos t hoc compari-compari-
inter-individual variability. Internal autistic-spectrum disorder from social interactionposes. Correlation with
sons between groups, as this testnon-
is
consistency was evaluated byInternal autistic participants,disorder from non- the social interaction sub-scale was 0.41
speciallysons between groups, as this test
consistency was evaluated by calculating autistic participants, using ROC analysis. (sub-scale was 0.41 (PP 550.001),
is specially designed for situations in
Cronbach’scalculating Cronbach’s aa This analysis was doneusing correlation0.001), correlation with the
which populationdesigned forROC analysis.
situations in
coefficient. Con-coefficient. Con- current This analysis was variances
done in two parts. First, language/communication sub-scalewith
which population differ, and is DIS CUS S IONDIS CUS
validity
R E SULTwasSR assessed
E SULT S using one- we found thatinvalidit
the SCDCin two differ, parts. and
First,is the language/communication sub-scale
Discriminant
conservative rela-variances S ION Population
waycurrent
He r i t a b ilivalidity
t y s t uwasd assessed using we found thatinthe SCDC was 0.30 (was 0.30 scre (PP 55 0.001) and
conservative
yDiscriminant rela- tion showed
to type 1 error. enin gPopulation
one-way analysis of variance (ANOVA),
yHe r i t a b ili t y s t u impressive
Thistionyto type
validit accuracy in discriminat-
1 error. This p ost hocpost
correlation
for a utistic tr ait sf scre
with0.001) and correlation with
with clinicalanalysis of variance (ANOVA), showed impressive accuracy enin
the g
repetitive and stereotyped
Earlier
d analyses of these data showed no
y clinical h oc analysisanalysis showed in that or a u t is t ic t r a it s
with group as the factor. discriminat- ing children with an autistic- ‘Is autism onerepetitive
behaviourthe end of the normal
and stereotyped
sig-Earlier analyses of these data showed significant differences in SCDCshowed that
Tamhane’s T2 (Tam-group as the factor. spectruming children with an autistic- spectrum‘Is
behaviour autism one
sub-scale wasend0.21of(sub-scale
the normal
no sig- nificant difference in the size of significant differences in SCDC scores exist
Tamhane’s T2 (Tam- hane, 1979) was spectrum disorder from (clinical plus non- spectrum
was 0.21 (PP of behaviour,
55 0.01). The or iscorrela-0.01).
it an
genetic influ-nificant difference in the size between all three clinical groups:scores
used as ahane, 1979) was used as a po st clinical)disorder abnormal
The correla- condi-of behaviour, or is it an
of genetic influ- ence in males and exist between allfrom three(clinical
clinicalplus non-for
groups:
hocpost h oc test totest to see which clinical) controls (AOCcontrols (AOC¼ abnormal condi- tion?’ (Medical Research
tionbetweentheSCDCtotalandthe3ditotaltio
females and no evidenceence in males each group comparison,for each group
diagnostic groups differed fromsee which 0.86,0.86, PPPP5555 0.001). Maximal0.001). Council, 2001).tion?’ (Medical Research
nbetweentheSCDCtotalandthe3ditotal
and females and no evidence of separate comparison, 0.001.0.001.
diagnostic groups differed from each Maximal discrimination between all Council,
score was2001). To date,
0.38 (score wasno0.38
whole (PP 55
non-additive genetic effects inof separate
other in terms of mean SCDC score.each pervasive devel-discrimination between population screen forTo date, no whole
0.001).0.001).
non-additive genetic effects in females
other in terms of mean SCDC score. all pervasive devel- opmental disorder population screen for autistic traits has
(Scourfieldfemales (Scourfield et alet al ,
(PDD) diagnoses andopmental disorder been published. Weautistic traits has been
1999). Here, addi-, 1999). Here, addi-
(PDD) diagnoses and non-PDD published. We simply do not know
tional analyses have further examined
diagnoses/normal comparisonsnon-PDD whether autisticsimply do not know
thetional analyses have further examined
diagnoses/normal comparisons was whether
Autism isautistic
a highlybehaviours are
heritable disorder, but
the question of gender differences and
obtained at a cut-off score of 9 pointswas continuous
ofAutism is with a highlya normalbehaviours
heritable disorder, arebut
have in-question of gender differences
obtained at a cut-off score of 9 points (a continuous
of the various screening instruments of
with a normal distribution
and have in- cluded the influence of a
score of 9 or above implied a case). Sen- severity,
availablethe as the workscreening
various ofdistribution of
scalar amplificationcluded the influence of
(a score of 9 or above implied a case). severity,
instruments as the work of
available SpikerSpiker
only the Social et
a scalar amplification or dampening of the
Sen- sitivity was 0.90 and specificity was alet al (2002) and
Responsiveness Constantino
Scale hasonly the &(2002)
Social
phenotype in either gen-or dampening of
0.69sitivity was 0.90 and specificity was and
Responsiveness Scale has been implies;
Constantino & Todd (2003) evaluated or
the phenotype in either gen- der.This
0.69 with this cut-off; the positive whether
in terms autism
of formal isTodd (2003) implies; or
heritabil-been
allows for comparison withanotherder.
predictivewith this cut-off; the positive whether
evaluated autism
in terms is distinct,
of formal either in terms
heritabil- ity
This allowsfor comparisonwith another
predictive validity was 0.75 and the He
of r i t a b
bimodality ili t y o f t h
ofdistinct,e S C D
either
by means of a twin study. Constantinoity in terms of
twin study of an autism trait measure
negative predic-validity was 0.75 and the bimodality
CHe r i t a bof
by means of
iliatquantitative
y o f tstudy.
twin heSC trait
D distribution
Constantino &
(Con-twin study of an autism trait
negative predic- tive validity was 0.86. Of or
C
Toddin qualita-quantitative
(2003) report a besttrait fittingdistribution
model&
measure (Con- stantino & Todd, 2003).
the 61 falsetive validity was 0.86. Of the or in qualita-
Todd (2003) report tive difference frommodel
a best fitting normal
These additionalstantino & Todd, 2003).
61 false positives obtained with this cut- development.tive
heritability estimate difference
of 0.48, from
with a normal
These additional analyses have shown no
off, 19positives obtained with this cut-off, development.
sampleheritability The estimate
SCDC may ofbe used
0.48, fora
with
evidence of separateanalyses have shown
19 (31%) were clinical control cases a first-stageThe
sample size of 788 SCDC twin may be The
pairs. usedbestfor a
no evidence of separate additive genetic
selected(31%) were clinical control cases first-stage
fittingsize of screen
788 twinof school-aged
pairs. The best
effects in males or femalesadditive
selected from children attending the populations
fitting modelinfor orderscreen
SCDC dataof school-aged
showed no
genetic
Int ern aleffects
a n dinemalesxt ernorafemales
l relia and no
Great Ormondfrom children attending the populations infor
signifi-model order
SCDC to data
provide an answer
showed no
evidence of scalar
bilit yIntern al and amplification
extern al orand no Great Ormond Street clinic. These were to thesecant
signifi- questions.to provide anand,
gender differences answer
using
evidence of scalar amplification or
reliabilit y of th e S CDCof
Cronbach’sCronbach’s
th e S for
aa coefficient cases of socialStreet clinic. These were to these questions.
similarcant gender differences and, using
dampening of the phenotypic trait in
CDC
the SCDC wascoefficient
eitherdampening for the SCDC
of the phenotypic was
trait in cases of social communication difficulty similar analyses, a substantially greater
0.93, showing
either gender. that the content
For both males and of the0.93,
females on referral thatcommunication difficulty heritabilityanalyses, a substantially
showing
thegender. thatForthebothcontent
malesofand thefemales on referral that had already been greater heritability of 0.76 with unique
instrument
the influence has of high internalenvironment
the shared assessed locally and werehad already environmental influ-of 0.76 with unique
consistency.instrument
wasinfluence of the shared has environment
high internal been assessed locally and were referred environmental influ- ences of 0.24. A
consistency. The ICCand
was non-significant for the
test–retest SCDC
best fitting to our national centre for a secondreferred heritability of 0.76 is closeences of 0.24. A
scores on aThe ICC forand
modelnon-significant test–retest
the best SCDC
fitting to our national centre for a second (or heritability of 0.76 is close to the
scores showed,
model on a clinical sample
for both of 188achildren
genders, even a third) opinion. Their presence is(or heritability estimates (about 0.9)to the
(Skuseclinical sample of
heritability ofshowed, for188
bothchildren
genders, a even a third) opinion. Their presence is heritability estimates (about 0.9) reported
(Skuse etetof alal , 1997) with a mean
Crit
likelye ri
toohave
n valiraised the false-positive in twin studies of clinical cases ofreported
heritability 0.74andnon-
Validit y of th e S
retest interval of, 1997) with a mean
sharedenvironmentalinfluence0.74andnon dit yCri t e to
rate;likely rio n raised the false-positive
have in twin studies of clinical cases of autism
Finally, criterion validity was assessed
CDCValidit
retest
C urr eynof
o n cinterval of th eyears
t 2.7
-sharedenvironmentalinfluence S (s.d.2.7 years
of 0.26 v a
rate;li d i t
amongy
byFinally, criterion validityfrom
comparisons the
was assessed (Baileyautism (Bailey et alet al , 1995). No
CDC
(s.d.¼
(summary
vali dit 0.5,
yCo range
ofncdata
urre1.51–5.39)
presented was0.5,
as a dataof general
by comparing popu-among
total scorescomparisons
on the SCDC from significant, 1995). No significant influence
The
range mean SCDC score
1.51–5.39) for the autistic-The the general popu- lation theon false-positive of the shared environmentinfluence of the
0.26 (summary
nt validit y score ofwas
data0.81 (95%
presented CIas0.76–
a withcomparing total scores the SCDC
mean SCDC for the autistic- rate
0.86).0.81
data (95% CI
supplement to0.76–0.86).
the online version of with was only 9%.lation
the ADI–R equivalent thealgorithm
false-positive shared environment emerged in our
spectrum group was 16.6 (s.d.spectrum rate was only 9%.equivalent
We repeated the ROC study, although the upperemerged in our
thissupplement to the online version of outputthe ADI–R algorithm
group was 16.6 (s.d.¼ 5.7), which5.7), analysisgenerated
excludingWe repeated
this paper).paper). output by the 3di, forthe theROCGreat study, although the upper 95% confidence
which was significantly higher than that analysis excluding data from
Ormondgenerated by the 3di,the for general
the limit of these estimates95% confidence
ofwas significantly higher than that of the population sample.data from (Street
the general limit of these estimates was 0.26 in
Great Ormond Street sample
clinical control group (mean score population sample. The sensitivity of the females and 0.45 in males;was 0.26 in
sample (nn¼ 230), comprising 73 chil-
11.6,the clinical control group (mean instrument (with theThe
230), comprising 73 chil-sensitivity
dren with of the females and 0.45 in males; therefore, it is
score 11.6, instrument
5705 autism, 131(with with theotheridentical
PDDdren cut-off)
with was possible that a larger sampletherefore, it
7 0 the same
autism, 131(0.9)withbutidentical
other PDD cut-off) was is possible that a larger sample size might
the same (0.9) but the specificity was have detected a more significantsize
reduced to 0.35.the specificity was might have detected a more significant
reduced to 0.35. effect.effect.
The instrument compares well with
existingThe instrument compares well
with existing autism screening tools in
S O C I A L A N D C O M M U N I C AT I O N D I S O R D E R S C H E C
terms of its psy-autism screening tools in K L I S T S O C I A L A N D C O M M U N I C AT I O N D I S
terms of its psy- chometric properties. O R D E R S C H E C K L I S T

Internal consistencychometric properties.

Internal consistency of the SCDC is very
high (0.93), indicatingof the SCDC is very
high
C om (0.93),
p a r indicating
a t i v e r ite has
l i aa simple individuals with the disorder and the Bailey, A. , L e Couteur, A. , Gottesman , I. ,Baile y, A. , L e
factorial structure, bothit has a simple Couteur,aA.
Autism s a, Gottesman , I.n, etic
s tro n gly ge et alet
di salo(1
rd9er9:5e)(1
vi d9e9n5ce
)
b ili t yComp arative gener-individuals with the disorder and
factorial f ro m aA u t i s m a s a s t r o n gl y g e n e t i c d i s o r d
reliabilit structure, bothyinofstudies
y and validit th of the gener- al population. The majority of e r : e vi d e n c e f r o m a Briti s h t win s tu dy.Britis h t
symptomatic cases and inin studies of people withal population. The majority of
e S CDCand validit y of th
symptomatic cases and in the general
e Berument
win s tu d y., P S s. yc
K. h , Rutter,
olo gicalM.M,eLdicin ord, eP C .s,Berument
yc h ol o gic,
S CDC people with autism probably have IQ S
Autis
al .MK.em ,dicin
Rutter,
s c ree ,,eM. nin, g
2525, Lq ord,
u eCs7.,
63^7 .tio
, 63^7
et
nnaletaire 7.al (1999)
: dia gn o s
population. The derivation ofthe general scores in theautism probably have IQ (1999)
tic
Britis v alidit y.Auti sm
h Journ al of s cPsychiatryBritis
re e nin g qu e s tiohnn aire :
population. The derivation of this 12-item scores in the normal range, although dia
Journ gn o alsof tic Psychiatry,,
v alidit y. 17 517 5 , 4
questionnaire from principalthis 12-item autistic behavioursnormal range, although Chakrabar
4 4^4 51., ti, 444^451.
S . & Fombonne , E . (2 0 01)Chakrabarti,
questionnaire from principal components S . & Fombonne , E . ( 2 0 01) Perva sivePerva sive
autistic behaviours may be developmental disorders in prescho ol
analysis of a longer 285285,
proportionately more commonmay be children.d
3093^3099., evelo pment al dis ord er s in pre s
instrumentcomponents analysis of a proportionately more common among ch
Charma o ol cn hildren.
, T. , Baron JA- MAJA
CohenMA,, , I. , Baird , G. ,Charma n ,
3093^3099.
longer instrument was described by those
(2002)? with learning
Contrary disabilitiesamong
evidence is provided T. , Baron - Cohen,
Commentary: the I. ,MoBairddif, ied G. , Checklist
et alet al (2for 0 01)(2 0
Skusewas described by Skuse et alet al 01)
those
by(2002)? with Contrary
learning disabilities
evidence is(Medical provided Autism inCommentary: the Mo dif ie d Che
(1997). Test–(1997). Test– retest reliability Research Council, 2001).
by SilvermanSilverman etIs(Medical
alet al (2002), cklist
3131,for Autism in To ddlers.To ddlers. Jo urnal
(established with anretest reliability of
145^14 A utis m 8.,and D evelopme ntal Disord ersJo
Research
who foundCouncil, that(2002), 2001). who Is autism
found that
(established with an interval of nearly 3 urnal
Cohen
145 ^14 ,of
I. LA , utis
. 8. m and
S c hmidt-L D evelo
ackner, pme ntal
S . , Romancz yk , RDisord
. ,Cohen ,
unidimensional,
social and language as claimed
deficitsby in Con-autism I. L . , S chmidt-L ackner, S . , Romanczyk , R . , etet alal (2 0 03)
ers,,
years) has not, to theinterval of nearly 3 unidimensional,
autisticsocial andaslanguage claimed by Con- in
deficits (2 0 03) T h e PDD B eh avior Inve ntor y : a r atin g s c
years) has not, to the best of our stantino
autistic disorders& Todd (2003) were not andclosely
Spikerstantino aleT h e P D D B e h a vi o r In v e nto r y : a r a t in g s
knowledge, been evaluated withbest of & Todd (2003)
correlated and Spikerwere
withdisorders et aletnotalclosely c a l e f o r a s s e s sin g r e s p o n s e t o inte r v e nti
our knowledge, been evaluated with correlated with stereotyped and repetitive o n in c hil d r e n wit hf o r a s s e s sin g r e s p o n s e
comparable instruments. The issue of t o intea rntin
Const v e o, ntiJ.oN.n & inTodd,
c hil dRr. eD.n(2 w 0it 0h 3)Const
p er v a asiv ed
ntino,
behaviours.stereotyped and repetitive evelo
valid-comparable instruments. The issue J. N. & pmentTodd, Ral. D. dis(2ord er.pAu
0 03) e r tiva s siv
ti cetdr eavitesAu l o ptims
behaviours. Screening questionnaires are e
ti nt c tarl di a it s os rind th e r.eJogen urnal erofalAputis m andJo urn
opulation: a t alwin of
of valid- ity was established in terms of generally notScreening questionnaires are A utis m an
s tudy.in the d Dgenere veloal pp mopulation
e ntal Di s ord : a terwin sD study.
content,ity was established in terms of generally not sensitive to the latter evelopmental t i nDiso , orders,, 3333,
a v i s 31^45., 31^ 45.
Archives
C o n s t a nofA rchives J . N .of, DGeneral , S.
content, concurrent validity, discriminant dimension of autisticsensitive to the latter A .0, 03)(2
To d d0 ,03)
PsychiatryGeneral
(2 R . Va
D . li, Cd oaPsychiatry,,
ntisot nao fnat b i n6060,
rioe, f Jq. 524
uNa.ntit , a3
^5
and criter-concurrent validity, discriminant dimension of autistic impairment, which
D
tiv a e vmi se a, sSu r. eAo fVa
0.,524^530. . , To d d , R . D . , e t
li d a ti o n o f a b ri e f q u a
alet al
and criter- ion validity. In common with has proved to beimpairment, which has ntit a tiv e m e a s u r e o f autistic tr aits: co mp
the Socialion validity. In common with the proved to be problematic, in terms of arison
Jo urnal of oftheAsocial
utis m respand onsivenessautistic
D evelopmentaltr aits:
Social Responsiveness Scale comp
Dis ordersJo arison ofurnal th e social
of A utis respmonsiven and D ess evelo sc ale
weak diagnosticproblematic, in terms of with t h e Disord
a utism ers,, dia gn o s tic inter vie w ^ re vis e
(ConstantinoResponsiveness Scale weak diagnostic differentiation, in studies
pmental 3333,,
d.sc
Ehlers ale , Swith
427^433.427^433. the autism
. , Gillb e rg , C diagno. & Wingstic , L inter
. (19 view ^
9 9 )Ehlers,
(Constantino et alet al ,, 2003), total of autistic
scores on the SCDC were2003), total Im p lic a t iindi-differentiation,
on in studies of S . , Gillb
revise d. er g , C . & Win g , L . (19 9 9 )
autistic indi- viduals with IQ scores in the AscreeningAscreening q u e s ti o n n air e f o r
scores on the SCDC were independent of sIm p l
Recent surveysi c a t i o n of thewith prevalence ofin the A s p e r g e r s y n dr o m e a n d ot h e r hig
normal rangeviduals IQ scores
IQ. The sensitivity andindependent of IQ. s
autismRecent surveys of the prevalence hquestionnaire for Asp erger syndro me an d
normal range (e.g. Berument(e.g. 2929,
The sensitivity and specificity values of autism in other high func tioning autism sp e c trum dis
Berument etthealetcommunity
al , 1999). indicateItems not 129^141.,
orderonne s in ,sc
obtained by Berumentspecificity values only anin the community indicateing not only Fomb E .ho(19ol91)Fombonne
agefunc tioning , E . (19 autism
91) The spuse
e
concern-, 1999). Items concern- such 12
ctrum 9^141. disorders ininscho ol age
obtained by Berument etet alal (1999) for an increase in the absent
numberfroming of casessuch of questionnaires childT h e u s e o f que s tio
traits are virtually children.children.
nn aire s in c hild psychiatry Jo urnal of re A utisse arch:m and mea D
the questionnaire now known(1999) for meetingincrease
traits are virtuallyinabsent the number of cases
from similar evelopmental Disformance
ordersJo andpsychiatry
urnal of A utis m and
the questionnaire now known as the suring their p er
meeting instruments (Constantinosimilar
screening D evelopme
research: mea ntal suringDisord th ers,,
eir p er formance and
Social Communication Question-as the conventionalcriteria,butadisproportionate
screening instruments (Constantino & choo sing
Geurts , H. M. an, optimal
Verte , S .cut- off.cho
, Oosterla an,oJ.sing
,Ge ur ants , H.
Social Communication Question- naire conventionalcriteria,butadisproportionate
Todd, 2003).& Todd, 2003). M.
optimal, Ver
Ca n the cut- t e , S
Children’s. , Oosterla
off. JoCommunicurnal of, J.Child
a n , et alet
ation al cklistC
(2 0 0 4a)(2
PsychologyJo
Che nt
(0.85 and 0.75 respectively) werenaire increase in the number of milder cases 0
urnal0 4 ) of Child Psychology an d Ps yc hia tr yan d
h e Childr e n’s Co mmu nic atio n C h e ckli s t dif f
(0.85 and 0.75 respectively) were closely thatincrease in the number of milder P
ere s ntiate
yc hiabtrety,, we 3232e n c, hil 67dr7^693.,677^693.
e n with a uti sm, c hil
similar to our own estimates ofclosely cases that fail to reach full ICD–10 or dre n withdi ff er enti ate b et we e n c hildre n with a
similar to our own estimates of 0.90 and DSM–IVfail to reach full ICD–10 or DSM–IV uti sm, c hildre n with ADHD, a n d n o rmal co
Gilmour,
ntrols ?ADHD, J . , Hill a ,B n .d, Pla
n ocrm e , alM.co ,Gilmour,
ntrols ?J. Jo , Hill,
urnal B. ,of
0.69 respectively, which were0.90 and (American Psychiatric Association, 1994) Place
Child ,PsychologyJo
M. , et alet al (2 0 0 4of)(2
urnal 004
Child ) SocialSocial
Psychology an d Ps
0.69 respectively, which were based on a (American Psychiatric Association, 1994) communic
yc hia tr yanation d P sdycefhia icittrsy,, in 4545,
conduc t dis
4 37^453., 4
ROC analysis of a sample thatbased on a criteria (Chakrabarti & Fombonne, order 53.
37^4 : a clinicalc o m m u ni c a ti o n d e f ic it
ROC analysis of a sample that contained a 2001;criteria (Chakrabarti & Fombonne, s in c o n du c t di s o rd e r : a clinic a l and
high proportion of childrencontained a 2001; Yeargin-AllsoppYeargin-Allsopp et community
Lord , C . , Rutter, survey.and
M. & Le Co community
uteur, A. (19 survey.
9 4 )Lord , C .
high proportion of children with no alet al , 2003). Subclinical, 2003). ,Journal
Rutt er,of M.Child
& Le Co Psychology
uteur, A . (19 an 9dJo 4 )urnal
Au ti of s mAuChildti
psychiatric diagnosis. Because thewith no Psychology
s m Diagnostic an dInterview
PsychiatryPsychiatry,,
^ Revise d: a4545, revised 9
Subclinical cases of autism may present
67
ver^sion 9 78., of aDi 9 67a ^ gn978.o s tic Inte r vie w ^ R e vi s
psychiatric diagnosis. Because the indirectly, forcases of autism may present e d : a r e vis e d v e r sio n o f a diagno stic
inclusion of the latter sample might indirectly, for example with conduct interview for caregivers of individu als
haveinclusion of the latter sample might problems at schoolexample with conduct withdiagno
Lord, C., Risi, sticS., inter
Lambrecht view for c are giver
, L.,Lord, s of S ., L
C ., Risi,
have led to inflated estimates of the problems at school (Gilmour(Gilmour et individuals
ambre cht , with L . , et possible
alet al pervasive
(2 0 0 0)(2 0 0 0) Th
SCDCled to inflated estimates of the SCDC alet al , 2004). The burgeoning, 2004). developmental
eThe Autism Diagno disorders.p stic o Ob s sible
servation p er v Sa siv
performance, we subsequently The burgeoning recognition of autistic e d evelo ^
chedule pmentGeneric: al disaAutismord er s. Diagno Jo urnal stic ofJo Ob
conductedperformance, we subsequently disorders is puttingrecognition of autistic urnal
ser vation of A utism S ch an eduled D evelo^ Generic pmental : a Disord
ersA u tism an d D evelopme
standardmeasure ntal Disord ers,,
ofsocialandcommunication
conducted a further ROC analysis in which disorders is putting a great strain on local 2424,659^685.,
deficitsstandard
Me dic al Re s e a rch 659^685.
mea sure
Council of social
(2 0 01)Me dic a and
l Re s e a rc
cases ofa further ROC analysis in which services. Rationala great strain on local communication defCicits a sso
h Coun cil ( 2 0 01) MR R e vie w o ciated
fMRC Rwith e vie w
cases of autistic-spectrum disorder were AC K NOW
services. LEDG
Rational E M E Nfor
planning T the likely the
o f A utism Rese arch: E pidemiolog y and d with
sp ectrum of autism.a s s o c iate
comparedautistic-spectrum disorder were number
SAC K NOW of as-yet-planning
L E D G E M Efor N the
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CausesA u tism Re se arch: E pidemiolog yaland
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cott s, p
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compared with other social We
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s t) : pDis r e ordli m ier s r,,y 3030, 2p 05^2 2 o3.,f a2UK s
communication and neurodevelopmental requires a better esti- mate than we na d e v elo m e nt
th e co n sul -gath ering of d at a for this study, a 05^2
c re e n2fo3.r m ain s tr e a m p rim a r y-d evelo
disorders. The highneurodevelopmental currently
nd to the consul have- of tantswhere
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disorders. The high sensitivity of the currently
collec tion of have
clinicof where
altant s who thea ssisted
boundaries
with the of cour
Au t i s m a was
s a dreplicatedsensitivity
i m e n s i o n a l d i sofo y-
Herits cf hield, olJ.,aMartin
a obilit ygoe fcshil ,o N., Lewis,
dcial
r e co G.,
n.school
gnitiv et alet
age al (1999)
children.
e skill s in c
instrument the autistic
collection spectrum
of clinical lie.boundaries
material, e sp ecially Drof the
Uttom (1999)
AutismAutism,,
hildre n a n dHerit 66 ,9^31.,9^31.
a bilit y o f s o cial co gnitiv
rthe
d einstrument
rAutism a swas a dime n sion (0.90),
al dis
Increasing evidencereplicated
supports the REF
Chowdhury
autistic E RENCE andm ateri
spectrum al,The
lie. e sp SCDC,
e c ia llyaDr U tto m
brief, e skills in c hildren a n d adolescent
order
which is appropriate for
hypothesisIncreasing a screening(0.90),
evidence supports
Ch
SREF owdhur
reliable E andRy a validThe
n d Dr M a SCDC,
ENC E uric e P a l abrief,
ce .Dr M a uri S c o u r f ie ld , s.
s.adolescent J . ,Britis
Ma r t h in Journ
, N. , Elal e y,
ofT. C . ,S cour f
which is appropriate for a screening c eP
reliable
A m l aa ncand
eric Pesyc
. hivalid
at ric Ascreening
s s o ci at ion (19questionnaire,
9 4 )Americ an ield,
The J., Martin ,relationship
genetic
PsychiatryBritis N., Eley, T. C.b, et
h Journ aletween ofalet al (2 0 0 4 )(2 0
social
Psychiatry,, 17
the hypothesis that autism is a S 04)
instrument, Psyc hiatric A ssociation (19 9 4 ) Diquestionnaire,
a g n o s t icDi a g n o
quantitative but specificity was autism is a
or dimension-that should finallyscreening
s t ic a n d S t a t i s t ic al M a n u al o f M e n t al Di s
cognitionT
517 h e ge n etic relatio n ship b et we
5 ,559^564.,559^564.
substantiallyinstrument, but e n s o cial co gnitio n and conduct
quantitative or dimension- alspecificity
spectrum, should finally allow this question to be
o rd e r sa n d St a t i s t ical M a n u al o f M e n t al D problems.a nd conduc t pro blem s. B
was
with substantially reduced.spectrum,
no clear qualitativeal This is no with answered
i s o rd e r s (4int h theallow
e d n)(4 t hthis e d n)question
( DSM ^ IV to).be
Wa ehavioral GeneticsB ehavioral Genetics,,
doubt
no clear because autisticreduced.
qualitative This is no
distinction between answered
shington, DC:in theDSM
APA.( context
^ IV ). ofWaashington,
whole-DC: 3434,, 37 7 ^383.37 7 ^ 3 8 3.
doubtfound
traits because autistic traits are
amongdistinction strongly
between population survey ofcontext of a whole-
APA.
correlated
traits foundwith commontraits are strongly
among population survey of school-age
correlated with common problems such as 5715
children.school-age children.
71
ADHD (Geurtsproblems such as ADHD
(Geurts et alet al ,, 2004) and conduct
disorder (Gilmour2004) and conduct
S K U S E E T
A L S K U S E E
T A L

Silv erma n , J. M. , S mith , C . J. , S c hmeidler, J.

,Silverma
(2 0 0 2)(2n0, 0J. 2)
M.Symptom
, S mith , Cdomains
. J. , S c hmeidler,
in autismJ. , aet
alet al
nd relate dSymptom domains in autism a nd CL INIC AL IMP L IC AT IONSC L
relate d co n ditions : evidence for f amilialit INIC A L IMP L IC AT IONS
y.conditions: evidence for familiality. American
S k u s e ,ofA
Journal D.H ., Jame
merican Jos urnal
, R . S of . , Me dical G The
&& Social a nd Communic ation Dis order s Checklis t ( SCDC )
B i s he onp ,ce D .dical
V. , m SGkTurn
uenetics,,
s e er’s, D s. 11 H . dro
, J ame
4m,eof6 s4^73.,
a ,n R .
Evid
eneticsMe fro
S . , B i s h o p , D . V. , e t a l e t a l ( 1 9 9 7 )
yn 411 is a brief a ndThe Social a nd Communic ation Dis order s
imp
6 4^ rinte
73.d X-Evid en ce fro m Turn er’s syn dro
(1 9 9 7 )
m e o f a n imp rinte d X- linked lo cus affecting
Checklis t ( SCDC ) is a brief a nd ef fec tive screening mea sure
cognitive func tion.linked lo cus affecting It will
for
&& be us
perva siveeful in s tudie s tha
developmental t aim tos.ef
disorder estimate
fe c tivethe b oundaries
screening
Skus
cognitivee , D. func, Warring tion.ton Na, tRureNa . , Bishop, tureD. ,, ,Skuse
387387,, , D. , of thesure
mea autis forticIt willsive
perva be us eful in s tudies
developmental tha t aim
disorder s. to es tima te
Warring ton , R . , Bishop
The d evelopment , D. , et alet al (2 0 0 4 )(2 0
705^70
04)
8.705 ^ 70al,8.dimension al a nd dia gno the b oundaries of the autis tic spec trum by mea suring autis tic
s ticT h e d evelo pment al, dim en sio n al a nd
dia gn o s tic inter vie w ( 3 di) : a n ov el co mp The SCD
trait
&& C c ancommunity
s in large be us ed tos fur ther our under
amples.spec trum sby tamea
nding o f the role
suring
uterize d a s s e s s me nt fo rinter view ( 3 di) : of subtic
autis - thresholdThe
trait s in largeSCD C c an besample
c ommunity us ed to s. fur ther our under s
a novel computerize d a sse s sment for a utism tanding of the role o f sub - threshold au tis tic tr aits in behavioural
sp e c tr um dis o rd er s.autism sp ectrum
disorders.
S o u t h , M .Journal, W illi a m ofsthe, B .A J . mericanJournal
, Mc M a h o n , W. M of. ,S
t dif ficulties a nd conditions such a s atten tion - deficitau tis tic tr aits
o
he
(2uth
0A0,merican
M.
2)(2 , Williams
0 0 2) , B. J. ,yMc
A Utilit
cademy o Mahon h e, W.
f t Child
of M.d
Gillia
an ,met
A alet
Autism
dole al in behavioural
LIMI TAT dif ficultie s a nd conditions such a s atten tion - deficit
R atinPsychia
scent g S c ale tr inUtilit
yA cademy y o f of t hChild
e Gillia
an d mAAutisdole hyperacTAT
IONSLIMI tivity a nd conduc t dis order s.hyperac tivity a nd conduc t
m R aPsychia
scent tin g S ctray,, le 4343,,
in research 548^558.54 and clinical8^558. p IONS
dis order s.
&& In terrater reliability data are
opulations.re se arch a nd clinical p opulation s.
Spiker,
Jo urnal D. of , Lotsp
A utis eich,mL andJourn
. J. , Dimic eli, alSof. ,SAputis
ike r,m D.an, L odt needed.In terr a ter reliabili ty da
s
Bpeh e i avior
c h , L .al J . phenot
, D imic eypic li , S .variation
, et alet al (2in 0autism
0 2)(2 0 0 2)
D evelopme ntal Disord ersD evelopmental Dis T ht e
&& aS areCDne Ce wdea sd.de sign e d f or la rge - s c a l e sur v ey s a nd i s n o
multiplexB
orders,, 3232 eh ,593^599.,
avior al phenot 593ypic ^59variation
9. in t s ui t a bl e f or pr ovidingT h e S CD C w a s de sign e d f o r l a rge - s
autism
A merican multiplex
Jo urnal families:
of M e dical evidence
GeneticsA form a e ric
continuo
a n J o ur nus al severity
o f M e dic graladient
Gene .families:
t ic s ,, 11 c a l e sur vey s a nd i s n o t sui t a bl e f or pr oviding clinic al
Ta mhane , A
evidence for. Ca.Ta mhane , A
continuo us. Cseverity
. (19 7 9 )(1gr 9 7 9 ) A.
adient diagnoses. It ha s excellent sensitivity, bu t low specificity with regard
411 4 , 129 ^136., 129^136.
co mp a ris o n o f p ro ce dure sA c o mp a ri s o
n o f p ro ce d ure s for multiple comp arisons of to
The
&& theclinic
SCDC isaladiagnoses.
parent-rep Itorha s excellent
t mea sure. A sensitivity,
self-rated verbusion
t lowfor
specificity
adults ha
me
7 47a4ns, with une qualfor multiple comp ariso ns
with
s no tregard
beenThe to the
SCD diagno
C is a sis o f autism
parent-rep or itself.diagno
t mea sure. Asis o f autism
self-rated veritself.
sion
of71
4 me ^4 a 80ns with
., une qual va ria nce s.va ri a n ce for adults ha s no t been valida te d in a dul t p opula tio n s o f individu al
Volkma
s.71Journal r, F.ofR the . , LA ord, C . , Bailey,
merican A. ,Volkma
Statistical r, F.
A ssocia
4
R . , L^4ord, 8C 0 . ,.pthe
Bailey, A. , etdalet al (2pm0 0 ent
4 s wi th au ti sm.v a li d a t e d i n a du l t p o p u l a ti o n s o f i n di v i du a
tionJournal
Autism a nd of er Avamerican
sive Statistical
evelo A)(2 al0 dis
ssocia 0
4) l s w i t h a u ti s m .
tion,,
ord er s.Autism and p er va sive developmental
disorders. Jo urnalJo urn al of Child Psych olog y
We
andc hPsychiatryof
s l e r, D .We chsle r, D. (19
Child Psych 9 2)(1 9 9 2y) We
olog andc h DAVID H. SKUS E , MD, FRCP, FRC P s yc h, FRCP CH ; WILLIAM P. L . M A NDY, M A , In s titute o f C hil d H e
sler Intellige n4545,
Psychiatry,, ce Scale 135 forWe^ 17 c h0.,s l135
e r In^t e17 llig0. a lt h,DAVID H. SKUS E , MD, FRCP, FRC P s yc h, FRCP C H ; WILLIAM P. L . M A NDY, M A , In s titute o f C hil
e n ce S c al e fo r Childre nChildre n ( 3 rd UK e d H e a lt h, Univer sit y College London; JANE SCOURFIELD, P h D, MRCPsych, D ep ar tment of Psycholo
dn) . London: Psych olo gic al( 3 rd UK e dn) . gic al Me dicine,Univer sit y Colle ge London; JANE SCOURFIELD, Ph D, MRCPsych, D ep ar tment of Psyc
World He alth Org aniz ation (19 9 2)World He a lth Org
Lond on: Psycholo gic al Co rp o r atio n.Co r p o r holo gical Me dicine, Univ er sit y o f Wa le s Colle ge o f Me dicin e , C a rdiff, UKUniv e r sit y o f Wa le s C
aniz ation (19 9 2) Intern ationalIntern ational St a
atio n. Corre
olle g esp o foMen dicin
d e nce
e , C :a Pro
rdi ff,feUK
s s o r D avid Sku s e , B e h a vi o u r a l a n d Br ain S cie n c e s
t i s t ical C la s sif ic a t i o n o f Di s e a s e s a
n d R e la te d H e alt hStatistical Classif ication Unit , In s titute o f Chil d H e a lt h,Corre sp ondence : Profe ssor David Skus e, B eh avio ur al
Ye
of argin
Diseases - Allsopp,an dM. , Ric ed, He
Relate C . alth
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Pr o ble m T. ,Ye
s a nd Br ain S cience s Unit , Institute of Child He alth, 3 0 Guilford Stre et , London WC1N 1EH,
argin
( IC -^Allsopp , M.b ,leRice
m s, C . a, Karapurkar, T. metro
, et aletp UK. E- mail: dskus e3 0 Guilford Stre et , London WC1N 1EH, UK. E- mail: dskuse @@ich. ucl. a
(2 0 0D3)(2 10)Pro
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of D ^ 1in
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US ( F ir s t r e c e iv e d 2 9 July 2 0 0 4 , f in a l r e vi si o n 2 4 J a n u a r y 2 0 0 5, a c c e p t e d 2 8 J a n u
al
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olit a n are aeva
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a le n c e o f a utis m in a US m etr a r y 2 0 0 5 )( F ir s t r e c e iv e d 2 9 July 2 0 0 4 , f in a l r e vi si o n 2 4 J a n u a r y 2 0 0 5, a c c e p te
9289,
o p olit a 49^55.,
n a r e a 4. d28Ja nuary2005)
9 ^55.

APPENDIXAP P END IX S o cial and Communic

ation Disorder s Che cklistS o cial an d
Communic ation Disorder s Che cklist
The S ocial and Communication Disorder s Che cklist (SCD C) wa s devis ed to be simply and quickly rate d, comprising just 12 questions. Nine of the
se serve to m e a s u r eThe S ocial a nd Communication Disorder s Che cklist (SCD C) wa s devised to b e simply and quickly rate d, comprising just 12
questions. Nine of these ser ve to m e a s ur e abnormalities in those a sp ects of the autistic triad th at reflect ‘reciprocal s ocial inter ac tion skills’ and
‘communicationabnormalitie s in tho se a sp ects of the autistic triad th at reflect ‘reciprocal social inter ac tion skills’ a nd ‘communication skills’.
Items 4, 5 and 6 mea sure b ehaviouralskills’. Ite m s 4 , 5 a n d 6 m e a s ure b e h avi o ur a l p r o ble m spro blem s in a more gener al sense, and ref
lect func tion al impairment . Each item on the scale is rate d a ccording to whether the b ehaviour h a s b e en se en over the p a st6months,in a more
general sense, and ref lect func tion al impairment . Each item on the sc ale is rated according to whether the b eh avio ur ha s b een seen over the pa
st6months, and if so whether the a sso ciated st atements are ‘quite or sometimes true’ or ‘very or often true’. Corre sponding scores of 0, 1 and 2
Checklis
apply, s o the ma ximum p o s sible s corea n d if s o wh eth er th e a s s o ciate d s t ate ment s a re ‘quite or s o metime s tr u e’ o r ‘v er y o r o ften
tChecklis
tr
Forue’.
e aCo
c hrre
itespm,o ple
n din g score
a se mark sthe
of 0, 1 athat
b ox nd 2baepstply, s o thees ma
describ ximum
y our p obsesible
c hild’s s core
h aviour is 24.
over The
t he p ainstrument wa sis 24.
st 6 m onths.For e a The instrument
c h ite m, ple a wa s
se mark
originally
t b ox that
the develop
b e steddetoscrib
me aesure social-o
s your c hild rigin
’s b eally
h adviour
e v elo p ethe
over d top m e a6 sure
a st s o cial
m onths. Not- btrueNot
e h avio ur dQuite
true e f icit
o rs sometim
in Turn er’s
e ssyn dro m eo (rSku
trueQuite s eb
s ometime
ehaviour
s true Verydeforicit s in
ofte Turner’s syndrome
n trueVery (Skuse et alet al, 19 97)., 19 97).
or often true
1.1. Not aware of other p e o ple’s fe elingsNot a ware of other p e ople’s fe elin gs &&
&
2 &. & 2& . D o e s n o t r e a l i s e w h e n o t h e r s a r e u p s e t o r a n g r y D o
e
3 . 3 s. D n oo et s r n o et n a ol t ii cs e e t wh h e ee ff n e co tt ho ef rh si s / a h re e
r b ue ph as vei ot u r o o rn oa t h e nr m g er my b e &r & s & o f& t &
h e& f a m
i4l .y 4D . o Be se n h o t an v oi toi c eu t r h eo e fff t ee cn t d oi f s hr i s u/ ph et rs b f e a hm ai vl i yo ul i r f eo Bn oe t h h e ra mve imob u er r so of ft et h en f a
m
d ily &&&&&&
5 i. s5 r. u Vp et sr y f d ae mm i al y n ld i i f ne g& &o & f& &o & t h e r p e o p l e ’ s t i m e V e r y d e m a n d i n g o f
o . t6 h. eDr i p ff e io cp ul el t’ s t to i mr ee a & s& o& n& &w &i t
6 h w h e n u p s e t D i ff i c u l t t o r e a
s
7 . o7 .n D w o ie t s nho t w s e he e mn t o u up nsd e e rt s & t a& n& d& s& o& c i a l s k i l l s , e . g . p e r s i s t e n t l y i n t e r r u p t s c o n v e r s
a t.i o8 n. s DD o e
8 o s e n o st s n eo et mp t oi c u nkd e ru s tp a no d ns ob c oi a d l s yk i l ll s a, e n
. g
g . u pa eg r es i D
s t e on t l ey i n
s t enr rou tp t ps c io cn v ek r s
a
u t i o n s & &n & &b& &o
9 . 9 p. D o o e s n o t a dp p y e la ra t o n u ngd u e ra sg te a &n &d &h o&w& t & o b e h ave when o u t (e. g. in shop s , o r o ther
1p 0 e. 1o 0p .l e ’Ds hoo m e e s s )nD oo t e rse na ol ti sa e p i pf es /a h
r et o ouff n ed n
e rd s
s t pa n e d ohp ol we two i b t he hh earv/e hw ihse nb o eu th ( ea . vgi . o iun r D o
e s h o p s ,o to r r o teh ear l p e o p l e ’ s h o moe ff s )e n & & & & & &e o p l e w i t h h e r / h i s b e h a v i o u r & & & & & &
1 1s . 1n 1 . D o e i s se ni f os t/ hr e e s p o n dd s wp h e n t o l d t o d o s o m e t h i n g D o e s n o t r e
s p
1 2 o . 1n2d . w Ch ea n n t n o ol d
t ft oo l l do ow sa o cmo emt m h i an ng d& & u &n &l e& s&s i t i s c a r e f u l l y w o r d e d C a n n o t
f o l l o w a c o m m a n d u n l e s s i t i s c a r e f u l l y w o r d e d & & & & & &
D o you h ave a ny o th er comment s o r concerns ? ( If yes, ple a
se de scrib e .)D o you h av e a ny other c omment s o r concerns ?
( If yes, ple a se de scrib e.)

57
257
2