A 4-year-old girl with suspected Autism Spectrum Disorder is being evaluated in a tertiary child psychiatry center. The clinician has already administered the ADOS and is now seeking to obtain detailed developmental and behavioral history from the parents to strengthen diagnostic confidence. Which structured parental interview tool is most appropriate for this purpose?

Explanation

## Structured Parental Interview for ASD Diagnosis **Key Point:** The Autism Diagnostic Interview–Revised (ADI-R) is the gold-standard, criterion-referenced structured parental interview that captures developmental history and behavioral patterns consistent with ASD diagnostic criteria. ### Role of ADI-R in ASD Diagnosis The ADI-R is a semi-structured, clinician-administered interview (~90–150 minutes) that: - Collects detailed developmental history from birth through present - Probes three core diagnostic domains: **reciprocal social interaction**, **communication and language**, and **restricted/repetitive behaviors** - Generates calibrated diagnostic algorithms aligned with DSM-5 and ICD-11 criteria - Has high sensitivity (>90%) and specificity (>85%) for ASD - Is recommended alongside ADOS for comprehensive diagnostic assessment ### Diagnostic Assessment Framework for ASD ```mermaid flowchart TD A[Suspected ASD]:::outcome --> B[Administer ADOS]:::action A --> C[Administer ADI-R]:::action B --> D[Observational assessment<br/>of social communication<br/>& restricted behaviors]:::outcome C --> E[Parental retrospective history<br/>of development & behavior]:::outcome D --> F{Both ADOS & ADI-R<br/>meet ASD criteria?}:::decision E --> F F -->|Yes| G[Confirm ASD Diagnosis]:::outcome F -->|No| H[Consider differential<br/>diagnoses]:::action ``` **Clinical Pearl:** The ADI-R is particularly valuable for identifying early developmental signs (e.g., delayed speech onset, reduced joint attention by 12–18 months, repetitive play patterns) that may not be directly observable during a single clinic visit. **High-Yield:** Convergent evidence from BOTH ADOS (current observation) AND ADI-R (developmental history) significantly strengthens diagnostic confidence and reduces false positives. ### Comparison of Parental Assessment Tools | Tool | Purpose | Diagnostic Value | |------|---------|------------------| | **ADI-R** | Structured developmental history & behavior interview | Gold standard for ASD diagnosis | | **CBCL** | Broad behavioral/emotional screening | Non-specific; screens for behavioral problems | | **Conners Rating Scale** | ADHD symptom screening | Specific to ADHD, not ASD | | **DCDQ** | Motor coordination screening | Specific to developmental coordination disorder | **Warning:** The CBCL and Conners scales are useful for identifying comorbid behavioral or attentional problems but do NOT assess core ASD diagnostic criteria (social reciprocity, communication, restricted interests).