TUESDAY, April 26, 2022 (HealthDay News) — Differential item functioning (DIF) is minimal across race and sex in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), according to a study published online April 26 in JAMA Network Open.

Luther G. Kalb, Ph.D., from the Kennedy Krieger Institute in Baltimore, and colleagues conducted a cross-sectional study of children who were evaluated for autism spectrum disorder between 2014 and 2020 to examine DIF of ADOS-2 across child race and sex. Item-level biases across ADOS-2 harmonized algorithm items were examined across three modules. Data were included for 6,269 children (25.9 percent Black/African American, 50.3 percent White, and 79.4 percent male).

The researchers found that 16 of 140 (11 percent) ADOS-2 diagnostic items had a significant DIF. Eight items had a significant DIF for race, including six that involved social affect. No single item demonstrated DIF consistently across all three modules examined. Most of the items with DIF had greater difficulty and poorer discrimination in Black/African American versus White children. Five items showed significant DIF for sex; DIF was split between social affect and repetitive/restricted behaviors. Across all five algorithms, hand mannerisms had evidence of DIF, with generally greater difficulty. Two items had moderate-to-large magnitude of DIF: hand mannerisms for female children and repetitive interests among Black/African American children.

“The findings of this cross-sectional study suggest minimal overall item-level bias of the ADOS-2,” the authors write.

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