Judith Gould

Durham University, Durham, England, United Kingdom

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Publications (24)72.44 Total impact

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    ABSTRACT: A set of 14, mostly social-communication items has been identified from the DISCO.•An algorithm applied to this set discriminated ASD from non-ASD cases.•Excellent agreement with outcome on DISCO algorithms for both ICD-10 and DSM-5.•Good sensitivity for children, adolescents, and adults.•An interview based on these items could highlight cases for full diagnostic assessment.
    Research in Autism Spectrum Disorders 01/2015; 9. · 2.96 Impact Factor
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    ABSTRACT: The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Highly discriminating, ‘essential’ behaviours were identified from the published DSM-5 algorithm developed for the Diagnostic Interview for Social and Communication Disorders (DISCO). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. An adjusted essential item set (54 items; Study 2) had good sensitivity when applied to individuals with higher ability and performance was comparable to the published full DISCO DSM-5 algorithm. Investigation at the item level revealed that the most highly discriminating items predominantly measured social-communication behaviours. This work represents a first attempt to derive a reduced set of behaviours for DSM-5 directly from an existing standardised ASD developmental history interview and has implications for the use of DSM-5 criteria for clinical and research practice.
    Research in Autism Spectrum Disorders 06/2014; 8(6):701–715. · 2.96 Impact Factor
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    ABSTRACT: Background: One in four children with ASD are reported to meet diagnostic criteria for Oppositional Defiance Disorder or Conduct Disorder and aggression affects 53% of individuals with ASD. The Diagnostic Interview for Social & Communication Disorders (DISCO) is a semi-structured diagnostic interview, that focuses on symptoms relevant for an ASD diagnosis (social communication and repetitive, restricted behaviours) and items measuring other behaviours necessary for a broader range of co-morbid conditions such as attention deficit hyperactivity disorder (ADHD), pathological demand avoidance (PDA), Catatonia, Tic disorders, developmental coordination disorder (DCD) and a range of maladaptive behaviours. Objectives: The aims of the current study were to: establish the reliability and factor structure of the maladaptive scale of the DISCO; compare the rates of challenging behaviours in individuals with ASD in comparison to clinical and typically developing controls; and determine the relationship between maladaptive behaviours and core features of ASD. Additional analyses assessed the correlations between maladaptive behaviours and DISCO defined co-morbid conditions. Methods: Two UK datasets were used. Sample 1 - 36 individuals with ASD, 31 clinical comparison controls (18 individuals with an intellectual disability 17 with a language impairment) and 15 typically developing controls. Sample 2 -200 DISCO interviews of individuals referred to a UK national ASD assessment centre. Results: The 16 maladaptive behaviour items in the DISCO created a reliable scale (Cronbachs α = .92,), the maladaptive total score was significantly higher in the ASD group than the clinical or typical control groups. Maladaptive behaviours were significantly predicted by core ASD domain scores as measured using the DISCO. Principal Components Analysis resulted in a two factors solution: behaviours affecting other people (ten items; e.g. behaviour in public places, wanders, lack of co-operation) and communicative disruptive behaviours (six items; e.g. interrupts conversations, talks to strangers). Scores for both factors significantly differed between the diagnostic groups. Regression analyses revealed the first factor was significantly predicted by social interaction score; the second by both communication and repetitive behaviour scores as well as age.Maladaptive behaviour score was positively associated with the number of co-morbid conditions as identified using the DISCO. Both maladaptive factors were positively related to PDA, catatonia and ADHD scores, whereas TIC disorder scores were related to “behaviours affecting other people” only and scores for DCD were related with the “communicative disruptive” factor only. Conclusions: This data support the prevalence of maladaptive behaviours in ASD and identifies sub-groups of these behaviours that have different associations with the core features of ASD. Individuals with high rates of maladaptive behaviours also appear to have more behaviours associated with co-morbid clinical conditions. The DISCO is a semi-structured interview that provides a framework for collecting parent/carer information on behaviours relevant for a diagnosis of ASD and a much broader range of behaviours required when considering possible co-occurring conditions. This diagnostic tool has potential benefits for clinical and research practice.
    2014 International Meeting for Autism Research; 05/2014
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    ABSTRACT: BACKGROUND: Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the 'sub domain' level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels. METHODS: A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190). RESULTS: Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level. CONCLUSIONS: This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level.
    Journal of Child Psychology and Psychiatry 05/2013; · 5.42 Impact Factor
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    ABSTRACT: Background: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a semi-structured parent interview that assesses the broad range of symptoms present in individuals with ASD, including the presence of sensory features. Research using the DISCO has reported that sensory features are reported in a high percentage of individuals with ASD. Sensory atypicalities are widely present in individuals with ASD but frequency estimates vary according to type of report and tool used. The DISCO differs from other techniques, such as the Sensory Profile, as it is based on sensory modalities. Objectives: The objective was to assess the frequency of self-reported sensory atypicalities in high functioning adults using a new questionnaire developed from the DISCO. The association between responding to this questionnaire and responding to the Sensory Profile was analysed. The research also analysed the association between responses to the new sensory questionnaire responses and responses to a different self-report questionnaire, measuring autistic traits; the AQ. Methods: A new ‘Sensory Preferences Questionnaire’ was developed from the sensory items in the DISCO (see Leekam et al., 2007) and its reliability tested. Twenty three individuals with a clinical diagnosis of high functioning autism or Asperger Syndrome completed the ‘Sensory Preferences Questionnaire’, AQ and Sensory Profile. Results: Results revealed a significant difference between ASD and control participants on the ‘sensory preferences questionnaire’, with higher scores for the ASD group. Significant associations were also found between this measure and both the AQ and Sensory Profile. Conclusions: It is argued that the sensory items from the DISCO provide a good measure of autism specific sensory problems.
    2012 International Meeting for Autism Research; 05/2012
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    ABSTRACT: Background: The Diagnostic Interview for Social & Communication Disorders (DISCO) is a semi-structured diagnostic interview conducted with parents or caregivers that assesses the broad range of symptoms present in individuals with ASD. It covers all ages and levels of development. The DISCO allows measurement of both symptoms relevant for a diagnosis (social communication, social interaction and repetitive or restricted behaviours) as well as a number of symptoms that are associated with ASD, using a three scale severity rating (no/minor/marked problem). Such associated symptoms include sensory atypicalities emotional problems, motor atypicalities and impaired daily living skills (such as feeding, dressing & washing). Objectives: The aim of the current study was to establish the prevalence of associated symptoms in individuals with ASD in comparison to clinical and typically developing controls as well as determine the relationship between associated and core features. Methods: DISCO interviews collected from parents of 200 individuals during clinical diagnosis were analysed. In addition an ASD sample of 33 (17 High Functioning Autism, 16 Low Functioning Autism) were compared against individuals with a developmental delay (DD;19) or language delay (LD;15) and typically developing (TD;15) individuals in order to assess the uniqueness of these symptoms to the ASD sample. Results: The frequency of associated problems in ASD was high, with 80% of the sample having at least 1 marked motor problem, 86.5% 1 marked impairment in their daily living skills, 92.5% at least 1 marked sensory atypicality and 85% 1 marked emotional problem. Comparisons between groups revealed significant differences in presence of associated symptoms between LD/DD and ASD groups for emotional and sensory atypicalities and between ASD and TD samples for impairments in motor behaviours and daily living skills. Regression analyses of the larger (n=200) sample were conducted to assess if the associated symptoms were uniquely related to any of the core symptoms of ASD that are required for diagnosis (social interaction, communication & repetitive behaviours). Specific significant associations were found between sensory processing atypicalities and all of the core features (separate significant associations with social interaction, communication & repetitive behaviours). There were also significant specific associations between social interaction score and emotional problems; and between repetitive behaviours score and impairments in daily living skills. Conclusions: The wider clinical implications highlight the need to screen individuals for associated as well as core ASD features. For example, assessment of emotional problems could provide indication of anxiety and depressive symptoms, which would require independent treatment. Including measures of associated symptoms will also improve both management and intervention plans for individuals with ASD. The DISCO already provides such measures as part of a developmental history interview and should be considered in clinical practice for diagnosis as well as research of associated symptoms.
    2012 International Meeting for Autism Research; 05/2012
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    ABSTRACT: Background: The diagnosis of ASD according to current international diagnostic criteria relies on impairments in social interaction, communication and restricted and/or repetitive behaviours. Recent research, however, has highlighted the high prevalence of sensory processing deficits in individuals with ASD and the detrimental impact such deficits have on individuals’ functioning. What is yet to be explored is the relationship these sensory impairments have with the core diagnostic features of ASD. Objectives: This study will explore the role sensory processing deficits may have in the expression of social, communicative and repetitive behaviours by looking for associations between them. One diagnostic tool that allows separate measures of sensory processing deficits as well as the core features is the Diagnostic Interview for Social and Communication Disorders (DISCO, Wing et al., 2002). Detailed knowledge about these relationships will be attained using the DISCO measures for both an overall measure of sensory processing and modality scores (vision, touch, audition, smell/taste, other oral, kinaesthetic and pain). It is predicted that the core features will have differential relationships with different modalities. Methods: The DISCO is a semi-structured interview, which was developed through clinical experience and as such measures a broad range of items including all the core features of ASD as well as associated features such as 25 items on sensory processing. The DISCO was completed by a parent/caregiver of 200 individuals (32-456 months) who all received an ICD-10 diagnosis of a Pervasive Developmental Disorder. Total scores for the core features, sensory and modalities were created using the number of items rated as a ‘marked abnormality.’ Results: Multiple regression analyses revealed social interaction and repetitive behaviours scores to be significant predictors of overall sensory score. It was also found that the three core features had different associations with the different modalities. Social interaction was a significant predictor of vision, touch, other oral, kinaesthetic and pain. Communication and repetitive behaviours significantly predicted smell/taste and audition and the repetitive behaviour score was also a significant predictor of vision, kinaesthetic. Conclusions: These preliminary results indicate sensory processing deficits may play an integral role in the expression of the ‘core’ features of ASD. Furthermore, the core features appear to differentially predict the different modalities. These associations cannot tell us the direction between these behaviours but by incorporating sensory items into diagnostic measures more can be learnt about the developmental direction. It is important to note the sensory items measured by the DISCO are purely sensory in nature and do not overlap with items measuring core features. The vision items, for example, measure ‘interest in shiny objects or bright lights’, which has no overt connection to social interaction, indicating the significant relationship is due to an underlying association between managing sensory input and autistic behaviours. This could lead to improved sensory interventions which should not only alleviate the distress but could potentially improve social-communicative functioning. This study promotes the use of the DISCO as it allows measurement of associated items as well as specific ASD behaviours all within one tool.
    International Meeting for Autism Research 2011; 05/2011
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    ABSTRACT: The DSM-V-committee has recently published proposed diagnostic criteria for autism spectrum disorders. We examine these criteria in some detail. We believe that the DSM-committee has overlooked a number of important issues, including social imagination, diagnosis in infancy and adulthood, and the possibility that girls and women with autism may continue to go unrecognised or misdiagnosed under the new manual. We conclude that a number of changes need to be made in order that the DSM-V-criteria might be used reliably and validly in clinical practice and research.
    Research in developmental disabilities 01/2011; 32(2):768-73. · 4.41 Impact Factor
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    ABSTRACT: Patterns of sensory abnormalities in children and adults with autism were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). This interview elicits detailed information about responsiveness to a wide range of sensory stimuli. Study 1 showed that over 90% of children with autism had sensory abnormalities and had sensory symptoms in multiple sensory domains. Group differences between children with autism and clinical comparison children were found in the total number of symptoms and in specific domains of smell/taste and vision. Study 2 confirmed that sensory abnormalities are pervasive and multimodal and persistent across age and ability in children and adults with autism. Age and IQ level affects some sensory symptoms however. Clinical and research implications are discussed.
    Journal of Autism and Developmental Disorders 06/2007; 37(5):894-910. · 3.34 Impact Factor
  • Lorna Wing, Judith Gould
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    ABSTRACT: Without Abstract
    Journal of Autism and Developmental Disorders 12/2006; 36(8):1141-2. · 3.34 Impact Factor
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    ABSTRACT: The Diagnostic Interview for Social and Communication Disorders (DISCO) is an interviewer-based schedule for use with parents and carers. In addition to its primary clinical purpose of helping the clinician to obtain a developmental history and description of the child or adult concerned, it can also be used to assist in providing a formal diagnostic category. In this study we compared two algorithms based on the ninth revision of the schedule (DISCO 9). The algorithm for ICD-10 childhood autism comprised 91 individual, operationally defined items covering the behaviour outlined in the ICD-10 research criteria. The algorithm for the autistic spectrum disorder, as defined by Wing and Gould (1979), was based on 5 DISCO items that represented overarching categories of behaviour crucial for the diagnosis of autistic disorders. The aim of the study was to examine the implications for clinical diagnosis of these two different approaches. Parents of 36 children with clinical diagnoses of autistic disorder, 17 children with learning disability and 14 children with language disorders were interviewed by two interviewers. Algorithm diagnoses were applied to interview items in order to analyse the relationship between clinical and algorithm diagnoses and the inter-rater reliability between interviewers. Clinical diagnosis was significantly related to the diagnostic outputs for both algorithms. Inter-rater reliability was also high for both algorithms. The ICD childhood disorder algorithm produced more discrepant diagnoses than the Wing and Gould autistic spectrum algorithm. Analysis of the ICD-10 algorithm items and combination of items helped to explain the reason for these discrepancies. The results indicate that the DISCO is a reliable instrument for diagnosis when sources of information are used from the whole interview. It is particularly effective for diagnosing disorders of the broader autistic spectrum.
    Journal of Child Psychology and Psychiatry 04/2002; 43(3):327-42. · 5.42 Impact Factor
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    ABSTRACT: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a schedule for the diagnosis of autistic spectrum and related disorders and assessment of individual needs. It enables information to be recorded systematically for a wide range of behaviours and developmental skills and is suitable for use with all ages and levels of ability. In addition to helping the clinician to obtain a profile of each individual's pattern of development and behaviour, the DISCO also enables identification of specific features found in autistic spectrum disorders that are relevant for use with established diagnostic systems. This paper describes the historical background of the DISCO, outlines its structure and reports the results of an inter-rater reliability study with parents of 82 children aged 3 to 11 years with autistic spectrum disorder, learning disability, language disorder or typical development. Inter-rater reliability for the items in the interview was high (kappa coefficient or intra-class correlation at .75 or higher). This level of agreement was achieved for over 80% of the interview items.
    Journal of Child Psychology and Psychiatry 04/2002; 43(3):307-25. · 5.42 Impact Factor
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    ABSTRACT: The skills of a total population of children with severe intellectual disability and/or autism from Camberwell, South London, UK, and the initial follow-up data, taken when the subjects were adolescents and young adults (Shah 1986), are described in the present study. Changes in skills over time are presented within the categories of communication, self-care, and educational and cognitive skills, as assessed by the Handicaps, Behaviours and Skills schedule. The results indicated that skills had improved in many areas between times 1 and 2, but that this improvement was more noticeable for the children who had been youngest at time 1. The implications of these results and predictions for a further follow-up study are discussed.
    Journal of Intellectual Disability Research 03/2000; 44 ( Pt 1):12-24. · 1.88 Impact Factor
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    ABSTRACT: In this study, algorithms designed for the Diagnostic Interview for Social and Communication Disorders (DISCO) were used to compare the ICD-10 criteria for Asperger syndrome with those suggested by Gillberg. Two hundred children and adults were studied, all of whom met the ICD-10 criteria for childhood autism or atypical autism. Only three (1 percent) met criteria for ICD-10 Asperger syndrome. In contrast, 91 (45 percent) met criteria for Asperger syndrome defined by Gillberg, which more closely resemble Asperger’s own descriptions. Results showed that the discrepancy in diagnosis was due to the ICD-10 requirement for ‘normal’ development of cognitive skills, language, curiosity and self-help skills. When comparisons were based on Gillberg’s criteria only, results showed the participants diagnosed as having Asperger syndrome differed significantly from the rest on all but two of Gillberg’s criteria. However, all of these criteria could be found in some of those not diagnosed as having Asperger syndrome. The results emphasize the differences between the two diagnostic systems. They also question the value of defining a separate subgroup and suggest that a dimensional view of the autistic spectrum is more appropriate than a categorical approach.
    Autism 03/2000; 4(1):11-28. · 2.27 Impact Factor
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    ABSTRACT: DSM-IV states that Asperger Disorder may be distinguished from Autistic Disorder by a lack of a delay in early language development. The aim of this study was to establish whether the presence or absence of early language delay would predict autistic symptomatology in children diagnosed with a PDD/autism spectrum disorder. Forty-six language-delayed and 62 normal language onset individuals (M age 11 years) were compared on ICD-10 research criteria and DSM-IV criteria, receptive language, and developmental history variables. Retrospective data were also obtained to determine whether language onset predicted autism symptomatology when young (
    Journal of Autism and Developmental Disorders 11/1998; 28(6):527-533. · 3.34 Impact Factor
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    ABSTRACT: Comprehensive data on the developmental history and current behaviours of a large sample of high-functioning individuals with diagnoses of autism, Asperger's syndrome, or other related disorder were collected via parent interviews. This provided the basis for a taxonomic analysis to search for subgroups. Most participants also completed theory of mind tasks. Three clusters or subgroups were obtained; these differed on theory of mind performance and on verbal abilities. Although subgroups were identified which bore some relationship to clinical differentiation of autistic, Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) cases, the nature of the differences between them appeared strongly related to ability variables. Examination of the kinds of behaviours that differentiated the groups suggested that a spectrum of autistic disorders on which children differ primarily in term of degrees of social and cognitive impairments could explain the findings.
    Journal of Child Psychology and Psychiatry 10/1998; 39(6):893-902. · 5.42 Impact Factor
  • Lorna Wing, Judith Gould
    Autism 01/1998; 2(1):87-91. · 2.27 Impact Factor
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    ABSTRACT: To determine what clinical symptoms clinicians have been using to distinguish between Asperger's disorder (AsD) and autistic disorder (AD). Parents of children and adolescents with high-functioning AD (n = 48) and AsD (n = 69) were given a structured interview based on DSM-III-R and ICD-10 diagnostic criteria. Information regarding early and current symptom presentation and family, developmental, and verbal mental age information were collected. Logistic regression analyses were conducted to determine which variables best predicted clinician's diagnosis. A number of clinical variables predicted diagnosis. Delayed language onset was the only variable of the family and developmental variables that predicted diagnosis. The AsD group was also significantly higher than the AD group in verbal mental age. Clinicians appear to be diagnosing AsD and AD on the basis of published research and case study accounts. The findings question whether DSM-IV and ICD-10 criteria adequately describe the AsD individual, particularly in the communication domain.
    Journal of the American Academy of Child & Adolescent Psychiatry 12/1996; 35(11):1523-31. · 6.97 Impact Factor
  • P Howlin, L Wing, J Gould
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    ABSTRACT: Although autism can occur in conjunction with a range of other conditions, the association with Down syndrome is generally considered to be relatively rare. Four young boys with Down syndrome are described who were also autistic. All children clearly fulfilled the diagnostic criteria for autism required by the ICD-10 or DSM-III-R, but in each case the parents had faced considerable difficulties in obtaining this diagnosis. Instead, the children's problems had been attributed to their cognitive delays, despite the fact that their behaviour and general progress differed from other children with Down syndrome in many important aspects. The implications, for both families and children, of the failure to diagnose autism when it co-occurs with other conditions such as Down syndrome are discussed. Some speculations about possible pathological associations are also presented.
    Developmental Medicine & Child Neurology 06/1995; 37(5):406-14. · 2.68 Impact Factor
  • L Wing, J Gould
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    ABSTRACT: The prevalence, in children aged under 15, of severe impairments of social interaction, language abnormalities, and repetitive stereotyped behaviors was investigated in an area of London. A "socially impaired" group (more than half of whom were severely retarded) and a comparison group of "sociable severely mentally retarded" children were identified. Mutism or echolalia, and repetitive stereotyped behaviors were found in almost all the socially impaired children, but to a less marked extent in a minority of the sociable severely retarded. Certain organic conditions were found more often in the socially impaired group. A subgroup with a history of Kanner's early childhood autism could be identified reliably but shared many abnormalities with other socially impaired children. The relationships between mental retardation, typical autism, and other conditions involving social impairment were discussed, and a system of classification based on quality of social interaction was considered.
    Journal of Autism and Developmental Disorders 04/1979; 9(1):11-29. · 3.34 Impact Factor