OBJECTIVE The two primary-seemingly contradictory-strategies for classifying child psychiatric syndromes are categorical and dimensional; conceptual ambiguities appear to be greatest for polythetic syndromes such as autism spectrum disorder (ASD). Recently, a compelling alternative has emerged that integrates both categorical and dimensional approaches (ie, a hybrid model), thanks to the increasing sophistication of analytic procedures. This study aimed to quantify the optimal phenotypic structure of ASD by comprehensively comparing categorical, dimensional, and hybrid models. METHOD The sample comprised 3,825 youth, who were consecutive referrals to a university developmental disabilities or child psychiatric outpatient clinic. Caregivers completed the Child and Adolescent Symptom Inventory-4R (CASI-4R), which includes an ASD symptom rating scale. A series of latent class analyses, exploratory and confirmatory factor analyses, and factor mixture analyses was conducted. Replication analyses were conducted in an independent sample (N = 2,503) of children referred for outpatient evaluation. RESULTS Based on comparison of 44 different models, results indicated that the ASD symptom phenotype is best conceptualized as multidimensional versus a categorical or categorical-dimensional hybrid construct. ASD symptoms were best characterized as falling along three dimensions (ie, social interaction, communication, and repetitive behavior) on the CASI-4R. CONCLUSION Findings reveal an optimal structure with which to characterize the ASD phenotype using a single, parent-report measure, supporting the presence of multiple correlated symptom dimensions that traverse formal diagnostic boundaries and quantify the heterogeneity of ASD. These findings inform understanding of how neurodevelopmental disorders can extend beyond discrete categories of development and represent continuously distributed traits across the range of human behaviors.

中文翻译：

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量化自闭症表型的最佳结构：维度模型、分类模型和混合模型的综合比较。


目的 对儿童精神综合征进行分类的两种主要策略（看似矛盾）是分类策略和维度策略。对于自闭症谱系障碍 (ASD) 等多神综合症来说，概念模糊性似乎最为严重。最近，由于分析程序的日益复杂，出现了一种引人注目的替代方案，它集成了分类方法和维度方法（即混合模型）。本研究旨在通过综合比较分类模型、维度模型和混合模型来量化 ASD 的最佳表型结构。方法 样本包括 3,825 名青少年，他们连续转诊至大学发育障碍或儿童精神科门诊。护理人员完成了儿童和青少年症状量表 4R (CASI-4R)，其中包括 ASD 症状评级量表。进行了一系列潜在类别分析、探索性和验证性因素分析以及因素混合分析。在转诊进行门诊评估的儿童的独立样本（N = 2,503）中进行了重复分析。结果 基于 44 个不同模型的比较，结果表明 ASD 症状表型最好被概念化为多维与分类或分类维混合结构。自闭症谱系障碍 (ASD) 症状的最佳描述是 CASI-4R 上的三个维度（即社交互动、沟通和重复行为）。结论 研究结果揭示了使用单一父母报告测量来表征 ASD 表型的最佳结构，支持跨越正式诊断边界并量化 ASD 异质性的多个相关症状维度的存在。 这些发现有助于理解神经发育障碍如何超越离散的发育类别，并代表人类行为范围内连续分布的特征。