Preliminary evidence of the validity process of the Autism Diagnostic Observation Schedule (ADOS): translation, cross-cultural adaptation and semantic equivalence of the Brazilian Portuguese version.

Maria Clara Pacífico,Cristiane Silvestre De Paula,Victor Santos Namur,Rosane Lowenthal,Cleonice Alves Bosa,Maria Cristina Triguero Veloz Teixeira

doi:10.1590/2237-6089-2018-0063

Abstract

To translate and back-translate the Autism Diagnostic Observation Schedule (ADOS) into Brazilian Portuguese, to assess its cross-cultural semantic equivalence, and to verify indicators of quality of the final version by analyzing the inter-rater reliability of the ADOS scores. This study had three stages: 1) translation and back-translation; 2) semantic equivalence analysis; and 3) pre-test to verify the agreement between mental health specialists and an ADOS senior examiner regarding the scoring procedure. Authorization to translate and carry out the cultural adaptation of the instrument was first obtained from the Western Psychological Services, publishers of the instrument. The main preliminary results pointed to good equivalence between the original English version and the final version and the Brazilian version following the cultural adaptation process. Some semantic differences were found between the original version and the back-translation into English, but they did not interfere with the first translation into Portuguese or into the final version. One of the limitations of the study was the small sample size; for that reason, the inter-rater reliability of the ADOS scores between the specialists and the senior examiner using the kappa coefficient was adequate for 7 out of 10 areas. We conclude that the creation of an official Brazilian version of ADOS will help to strengthen clinical and scientific research into ASD, and deter the use of other unauthorized versions of ADOS in the country.

Highlights

The diagnosis of autistic spectrum disorder (ASD) requires a careful evaluation of different abilities related to verbal and non-verbal communication, language, social interaction, social cognition and behavior patterns.[1]
Some semantic differences were found between the original version and the back-translation into English, but they did not interfere with the first translation into Portuguese or with the final version
The results of the agreement analysis between the scores assigned by the senior examiner and those given by each specialist were good in the language and communication area, and in the reciprocal social interaction and other abnormal behaviors areas

Summary

Introduction

The diagnosis of autistic spectrum disorder (ASD) requires a careful evaluation of different abilities related to verbal and non-verbal communication, language, social interaction, social cognition and behavior patterns.[1] ASD is one of the most severe disorders of child development due to its impact on adaptive functioning in all areas of daily living. A diagnostic evaluation of ASD, as with other neurodevelopmental disorders, requires the specialist to have accurate knowledge of both expected child developmental milestones and signs and symptoms of ASD and other neurodevelopmental conditions and neurological diseases, which are often comorbid with ASD.[5] The use of specific instruments to guide clinical judgment – either screening for indicators of the disorder or to aid in diagnosis – is essential. The M-CHAT was only translated into Portuguese, with no verification of its psychometric properties.[15]

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