Journal of Child Psychology and Psychiatry 43:3 (2002), pp 307±325

The Diagnostic Interview for Social and

Communication Disorders: background, inter-rater
reliability and clinical use
Lorna Wing,1 Susan R. Leekam,2 Sarah J. Libby,3 Judith Gould,1 and Michael
Larcombe4
1
Centre for Social and Communication Disorders, UK; 2University of Durham, UK; 3University of East Anglia, UK;
4
University of Plymouth, UK

Background: 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 pro®le of each individual's pattern of development and behaviour, the DISCO
also enables identi®cation of speci®c features found in autistic spectrum disorders that are relevant
for use with established diagnostic systems. Method: 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. Results: Inter-rater reliability for the items in the interview
was high (kappa coef®cient or intra-class correlation at .75 or higher). This level of agreement was
achieved for over 80% of the interview items. Keywords: Diagnosis, diagnostic interview, autism
spectrum, reliability.

The purpose of this paper is to describe the devel-
opment of the Diagnostic Interview for Social and
Communication Disorders (DISCO) and to report its
inter-rater reliability. The DISCO is a semi-struc-
tured interview schedule designed to collect infor-
mation on development and behaviour. Its purpose
is to assist clinicians in the diagnosis, differential
diagnosis and management of autistic spectrum and
other developmental disorders affecting social inter-
action and communication.
Autistic spectrum disorders include a wide range
of conditions having in common a triad of impair-
ments of social interaction, communication and im-
agination. This triad is associated with a narrow,
repetitive pattern of activities and interests (Wing,
1988; Wing & Gould, 1979). The spectrum includes,
but is wider than, the sub-groups in the category of
`pervasive developmental disorders' as de®ned in the
tenth edition of the International Classi®cation of
Diseases (ICD-10 research criteria) (World Health
Organisation, 1993) and in the fourth edition of the
American Diagnostic and Statistical Manual (DSM-
IV) (American Psychiatric Association, 1994). The
relationship between autistic spectrum disorders
and pervasive developmental disorders and the rea-
sons for preferring the former term are presented in
detail by Wing (1997).
Autistic spectrum disorders can be identi®ed
only on the basis of patterns of developmental and
behavioural features. However, the sets of features
that in theory de®ne sub-groups within the spectrum
in practice overlap with each other. Furthermore,
with the exception of autistic social impairment,
Ó Association for Child Psychology and Psychiatry, 2002.
Published by Blackwell Publishers, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA
which is by de®nition the fundamental feature of
autistic disorders, none of the items on which the
diagnoses are based is found exclusively in individ-
uals with autistic spectrum disorders. Each can oc-
cur in other developmental conditions and can be
seen even in typical development, especially in the
early years (Leekam, 1996; Wing, 1969, 1971).
The various sets of diagnostic criteria that have
been published, including ICD-10 and DSM-IV,
rely on a `categorical' rather than a `dimensional'
principle. That is, diagnosis and differential diag-
nosis depend upon identifying a certain number
and degree of severity of untypical developmental
and behavioural features. The items included
in the different systems were originally based on
descriptions given by the clinicians who ®rst con-
ceptualised that a particular cluster of features
could be regarded as a syndrome (for example,
Kanner, 1943; Asperger, 1944, 1991). These descrip-
tions have subsequently been modi®ed through the
clinical experience of workers in the ®eld. None of
the suggested `syndromes' has been independently
validated in terms of aetiology, neuropathology or
underlying psychological dysfunction. Attempts to
validate, for example, through ®eld trials such as
the one reported by Volkmar, Cicchetti, Bregman,
and Cohen (1992) are inherently circular because
they are based on clinical judgements and not
upon any independent criteria.
Although the internationally accepted standard-
ised diagnostic and classi®cation systems are useful
for research studies requiring narrowly de®ned
groups of participants, clinical work aimed at
308 Lorna Wing et al.
helping individuals demands a different, `bottom-up'
approach. Most clinicians working with children or
adults see a wide range of different conditions
among which autistic disorders may form only a
small proportion. For this type of clinical work the
aim is to obtain a detailed developmental history
from infancy onwards, covering the acquisition of
practical and social skills and patterns of behaviour
emerging over the years. The features that are likely
to occur in autistic spectrum disorders can then be
seen in the full developmental context and their
signi®cance more accurately evaluated. Compiling
this type of life history highlights the inter-relation-
ship of developmental level and overt behaviour and
how these affect each other in different ways at dif-
ferent stages of life (Eisenmajer et al., 1998). Lord
(1997), in her detailed review of diagnostic instru-
ments for autistic spectrum disorders, pointed out
the need for instruments that address diagnoses
beyond typical autistic spectrum disorder. The
DISCO attempts to achieve this goal.
The origins of the DISCO
The earliest origins of the DISCO are to be found in a
study comparing children with autism with children
with other disabilities or with typical development
(Wing, 1969, 1971; Wing & Wing, 1971). The
`Childhood Behaviour Schedule', a questionnaire
sent to parents by post, was designed for this study.
It elicited information concerning the social, lan-
guage, imagination and motor impairments and the
odd responses to sensory input and stereotyped
behaviour found in autism, which are covered in
much more detail in the DISCO.
In the early 1970s Wing and Gould (1978, 1979)
carried out a study of autistic disorders among
children in the former London Borough of Camber-
well. Lotter (1966, 1967) had previously completed a
study of the prevalence of typical autism as des-
cribed by Kanner (1943). He looked speci®cally for
children showing the narrow criteria for this condi-
tion suggested by Kanner and Eisenberg (1956). In
contrast, the aim of the Camberwell study was to
identify children with any of the features of autism
and to see if any patterns could be discovered among
the clinical pictures thus found. Lotter's study was
`top down', whereas the Camberwell study was `bot-
tom up'.
In order to study the range of developmental and
behavioural patterns in the children in the Camb-
erwell study, an interview schedule was required
that covered developmental skills and impairments
as well as behaviour. At the time a number of
schedules purporting to diagnose autism had been
published. Some were checklists completed by in-
formants and others were behaviour observation
scales. Freeman and Ritvo (1981) published a de-
tailed and critical review of such diagnostic sys-
tems. They pointed out that these systems varied
according to the theories of the nature of autism
held by their respective authors. None of those
published was suitable for the Camberwell study
because none covered a range of developmental
domains as well as behaviour. Moreover, none of
them was organised in a systematic, domain-
speci®c fashion. All of them were designed to
identify typical autism rather than to record clinical
pictures in children with varying numbers of aut-
istic features.
For the foregoing reasons the Handicaps, Beha-
viour and Skills schedule (HBS) was developed for
the Camberwell study (Wing & Gould, 1978, 1979).
This was a semi-structured interview schedule that
covered developmental skills including social in-
teraction, verbal and non-verbal communication as
distinct from formal language, and imagination. It
also included a wide range of behaviour items, es-
pecially those found in autistic disorders. The re-
sults of this study led to the formulation of the
hypothesis of a spectrum of autistic disorders,
which included Kanner's (1943) classic autism,
Asperger syndrome (Asperger, 1944, 1991; Ehlers
& Gillberg, 1993; Wing, 1981), the group of `loners'
described by Wolff (1995), and others with mixtures
of features from all these groups (Wing, 1996). It
was suggested that disorders in the spectrum all
had in common a triad of impairments of social
interaction, communication and imagination, as-
sociated with a narrow, repetitive pattern of activ-
ities. The elements of the triad and the repetitive
behaviour could all be manifested in a wide range
of different ways.
When the Elliot House Centre for Social and
Communication Disorders was set up by the
National Autistic Society (UK) in 1990, a schedule
for clinical assessment as well as research was re-
quired. Both children and adults were referred to
Elliot House and the clinical pictures seen included
the whole autistic spectrum and other develop-
mental disorders on the borderlines of the spec-
trum. Individuals with any level of ability from
profound learning disability to superior cognitive
skill were seen. Some who were referred had asso-
ciated physical or psychiatric conditions or other
developmental disorders such as dyslexia and dys-
praxia. The schedule used had to be relevant for all
these variations in the clinical pictures. The HBS
schedule had been designed for use with children. It
recorded information concerning current levels of
developmental skills and current behaviour. It
did not have a historical perspective. For these
reasons it was not suitable for use in the Elliot
House centre.
Other instruments that had been published after
the Camberwell study was completed were consid-
ered. The Autism Behaviour Checklist (ABC) de-
signed by Krug, Alrick, and Almond (1980) was
widely used. However, it was brief, it required yes or
no answers and was designed to identify autism
 Diagnostic Interview for Social and Communication Disorders
only. The Childhood Autism Rating Scale (CARS)
developed by Schopler, Reichler, and Renner (1986)
was completed by observation of a few crucial as-
pects of behaviour. It was mainly concerned with the
diagnosis of autism and was intended for use with
children.
The Autism Diagnostic Interview (ADI) designed by
Rutter and his colleagues (Le Couteur et al., 1989),
later revised (ADI-R) (Lord, Rutter, & Le Couteur,
1994) was the most obvious possibility. This is a
semi-structured parent interview covering in sys-
tematic fashion developmental and behavioural
items relevant for the diagnosis of autism, which is
coded for computer analysis. It can be used with
adults as well as children. As noted by Lord et al.
(1994), the original ADI was designed for research
purposes but came to be used also for clinical work,
which was one of the reasons why it was revised. It
provides a diagnostic algorithm for the ICD-10 and
DSM-IV de®nition of autism. The aim at Elliot House
was to develop an instrument that would enable
diagnoses to be made of autistic spectrum disorders
but, more importantly, would help to answer two
questions. First, `What is this person's pattern of
development and behaviour?' and second, `What are
this person's needs?' A new semi-structured inter-
view schedule, the Diagnostic Interview for Social
and Communication Disorders (DISCO), was devel-
oped based on the HBS but more detailed and wide-
ranging, covering past history as well as the present
clinical picture and suitable for all ages and levels of
ability.
The DISCO differs from the ADI in various ways
of which the following are the most important. The
ADI was designed primarily as a diagnostic in-
strument whereas the DISCO was designed to ob-
tain systematically information needed to compile
an individual's developmental history from birth
and a description of their current pattern of beha-
viour. Both the ADI and the DISCO record untypi-
cal behaviour in the past and currently. For many
items the ADI speci®es that the coding of past be-
haviour refers to that seen at 4±5 years of age. The
DISCO records the age of onset of deviant devel-
opment but for each individual item of untypical
behaviour it rates the worst manifestation at
whatever age it occurred. As can be seen by com-
paring the lists of items in Le Couteur et al. (1989)
and Lord et al. (1994) with those in the Appendix to
the present paper, the ADI includes some develop-
mental items but the DISCO covers a wider range of
developmental domains. These include aspects of
self-care, independence, visuo-spatial and other
skills. It also includes more detail on untypical
responses to sensory stimuli, motor stereotypies,
repetitive routines and emotional disturbance, and
has sections on catatonia, psychiatric disorders,
dif®culties related to sexual behaviour and forensic
problems.
309
Development of the DISCO
The choice of items for the DISCO was guided by
the following considerations. First, items relevant
for the basic diagnostic criteria for autistic spec-
trum disorders, that is, items concerning social
interaction, communication, imagination and a
narrow repetitive pattern of activities, were inclu-
ded. Experience with children and adults referred
to Elliot House showed the wide variation in the
ways in which these impairments could be mani-
fested (Wing & Gould, 1979; Wing, 1996). During
the course of the DISCO development the relevant
sections were expanded to ensure that these vari-
ations were covered.
Second, when using the HBS schedule and al-
lowing parents to talk around the questions asked,
it had become clear that with children and adults
in the autistic spectrum there was often a marked
discrepancy between the apparent level of develop-
ment in different practical skills and the way those
skills were used in everyday life. For example,
many individuals preferred their parents to con-
tinue to wash and dress them even when they had
the necessary skills and were well past the age
when they should have become independent. Items
were included in order to record the level of devel-
opment in different domains. The hierarchies of
developmental levels in each domain were obtained
from standard publications on child development.
The main source was the Vineland Adaptive Beha-
viour Scales (Sparrow, Balla, & Cichetti, 1984).
Other sources supplementing the information from
the Vineland were Cooper, Moodley, and Reynell
(1978), Egan, Illingworth, and MacKeith (1969),
Grif®ths (1967), and Sheridan (1973, 1977). The
average ages at which a typically developing child
would be expected to achieve different steps in de-
velopment were also obtained from these publica-
tions. They were noted in the DISCO beside each
step in each developmental hierarchy. These items
were included in the DISCO to help in assessment
of needs and also in order to facilitate the rating of
the untypical behaviour items related to develop-
mental domains.
Third, clinical experience showed the frequency of
many other untypical behaviours associated with the
autistic spectrum but not speci®cally related to de-
velopmental domains or diagnostic criteria. These
included odd responses to sensory stimuli, emotional
disturbance, problems of attention and level of ac-
tivity, `challenging' behaviour and, in adolescents
and adults, catatonic phenomena (Wing & Shah,
2000), psychiatric disorders, dif®culties associated
with sexual behaviour and forensic problems. It was
decided to include sections on these subjects because
of the relevance for understanding the problems ex-
perienced by families and other carers and assess-
ment of the needs of the individuals concerned.
310 Lorna Wing et al.
Uses of the DISCO
The DISCO was designed to obtain, systematically,
information needed to compile an individual's clin-
ical history from birth and a description of their
current clinical picture. This information can be
used to make a clinical diagnosis of a condition
within the autistic spectrum, a developmental dis-
order on the borderlines of the spectrum, a psychi-
atric disorder or any combination of these
conditions. It can be used as a guide for recom-
mendations concerning education, occupation, leis-
ure and care. For example, for a child of school age,
information concerning discrepancies in develop-
mental levels reached in different domains would
provide a guide to the starting points for teaching in
different areas.
The schedule can also be used for research. For
this purpose, provisional algorithms have been writ-
ten. These include three of the sets of standard in-
ternational diagnostic criteria for pervasive
developmental disorders and their sub-groups; DSM-
III-R (American Psychiatric Association, 1987), ICD-
10 (World Health Organisation, 1993) and DSM-IV
(American Psychiatric Association, 1994). In addi-
tion, algorithms have also been written for three
diagnostic categories based on Kanner's criteria for
early infantile autism (Kanner & Eisenberg, 1956),
Wing and Gould's (1979) criteria for autistic spec-
trum disorder and Gillberg's criteria for Asperger
syndrome (Ehlers & Gillberg, 1993). A comparison
between the DISCO 9 algorithms for the ICD-10 cri-
teria for Asperger syndrome and for Gillberg's criteria
for this syndrome (Ehlers & Gillberg, 1993) has been
published (Leekam, Libby, Wing, Gould, & Gillberg,
2000). The accompanying paper (Leekam, Libby,
Wing, Gould, & Taylor, 2002) describes a study of the
DISCO algorithms for ICD-10 childhood autism and
the Wing and Gould autistic spectrum disorder.
Administration of the DISCO
In their examination of techniques of interviewing
parents about their children, Cox and Rutter (1985)
quoted experimental evidence to show that system-
atic questioning obtained fuller and more detailed
information than free reporting of children's symp-
toms. The DISCO schedule is investigator based;
that is, the task of the interviewer is to elicit enough
information from the informant to make a judgement
as to the most appropriate rating for each item
(Wing, Cooper, & Sartorius, 1974). Instructions for
the interviewers and suggestions for introductory
questions are provided for each item but the wording
is not ®xed. The questioning has to be adapted in the
light of the level of functioning of the child or adult
concerned gained from prior information or during
the course of the interview, and the cultural back-
ground of the informant. Following the introductory
questions the replies determine how the questioning
should proceed. Informants are encouraged to des-
cribe examples of behaviour or to relate illustrative
anecdotes.
As pointed out by Cox and Rutter (1985), the re-
call of the timing of events is much less reliable than
the memory of their occurrence. Angold, Erkanli,
Costello, and Rutter (1996) found that, with symp-
toms that had lasted a year or more, the recall of the
date of onset was usually uncertain. Dating aspects
of behaviour that occurred long in the past is likely
to be even more inaccurate. The DISCO does ask for
details of past as well as current behaviour but,
apart from a few items concerning developmental
skills and any setbacks, the ages when they oc-
curred are not coded (see Appendix). The instruc-
tions to the interviewer are to code behaviour that
the informant remembers easily and clearly. If the
informant has to search their memory and remains
uncertain the item should be coded as absent (for
untypical behaviours) or not known (for delays in
the development of a particular skill). Parents are
encouraged to bring any records they may have of
their child's development and any photographs and
videos of their early years, which are often most
helpful in establishing dates of developmental mile-
stones. Photos or videos may also show odd facial
expressions or postures, particularly of the arms
and hands.
The collection of the information required for the
DISCO should not be con®ned to the interview
alone. Ratings should be checked and if necessary
changed in the light of information from psycholo-
gical assessment, structured and unstructured ob-
servations of the child or adult concerned,
interviews with other informants such as teachers
and any available case records. The reasons for any
marked discrepancies should be investigated as far
as possible. At Elliot House, with the family's per-
mission, professionals working with the child or
adult concerned are encouraged to take part in the
assessment. This has been found to be valuable not
only for obtaining the DISCO information but also
for planning and implementing services for the
person concerned.
More details concerning administration of the
DISCO are given in the section on methods of rating,
below.
Study of inter-rater reliability
Inter-rater reliability for the coding of DISCO items
was tested in the study reported below. This was
carried out together with a study of the ability of the
DISCO to discriminate between autistic disorders
and other developmental disorders, reported in the
accompanying paper (Leekam et al., 2002).
The version of the DISCO used in these studies
was DISCO 9. The results were used to indicate the
changes needed to improve the reliability of the
 Diagnostic Interview for Social and Communication Disorders
ratings in order to produce DISCO 10, in current
use.
Method
The contents of the DISCO. All the items in DISCO 9
are listed in the Appendix. For the statistical analysis
presented in this paper, the items were grouped under
four main headings (see Tables 3±6)
1 Infancy (the ®rst year).
2 Age of recognition of deviant development and set-
backs in development.
3 Developmental skills. Fifteen different developmental
domains were covered. The items were of three kinds:
Type a) concerned the current level of function in
each domain
Type b) concerned delay in reaching milestones rele-
vant for the domain
Type c) rated untypical behaviour in relation to the
domain, such as unwillingness to use a skill despite
evidence of its presence. (`Domestic skills' was the
only domain for which no untypical behaviour was
included.)
Type a) and Type b) items are grouped together in
sections under the heading `Developmental' as shown
in Tables 3 and 4. Type c) items are also shown
in sections under the heading `Developmental' in
Tables 5 and 6.
4 Untypical behaviour not directly related to a speci®c
developmental domain. The items of this kind used
in the study were grouped into 11 sections under the
heading `Other' as shown in Tables 5 and 6. Quality
of social interaction was classi®ed as aloofness,
passivity, active but odd approaches to other people,
or social interaction appropriate for overall level
of development (Wing & Gould, 1979). In clinical
use the rating of this item should be based on the
interviewer's judgement, using information derived
from the rest of the interview, observation of the
child or adult concerned, other informants and case
records.
The sections concerning adult psychiatric illnesses,
dif®culties related to sexual behaviour and forensic
problems were not used in this study because they were
unlikely to be relevant for children in the age ranges
participating in the study. Catatonic features had been
noted in a number of adolescents and adults seen at
Elliot House (Wing & Shah, 2000). These were much
less common in children so it was decided to rate only
the three items from the section on catatonia that had
been observed in more than one child previously seen at
Elliot House.
Methods of rating. Each item was rated using a
numerical code. There were three rating scales, one
for each type of developmental item (Types a, b and c
de®ned above). As described above, for the ratings of
current levels of development (Type a), recognisable
steps in development of the relevant skill were arranged
in chronological order according to the average ages
when they are expected to be achieved, up to the level of
311
full achievement. Each step was numbered in serial
order, with the average age of achievement in typical
development noted beside the number. The number of
the step currently achieved by the individual concerned
was entered on the coding sheet and used for the
computer analysis.
Items concerning developmental delay (Type b) were
coded numerically on a three-point scale marked as
delay, minor delay or no problem. The exceptions to this
were walking, toilet training, saying meaningful words,
and meaningful phrases, for which the actual ages of
achievement were recorded if known. For certain items
used in the ICD-10 algorithm for Asperger's syndrome,
the rating concerned whether the individual had ac-
quired the relevant skill by three years of age. For older
children and adults the `not known' code may have to be
used. Any developmental setbacks were also recorded
as ages when they occurred.
The items dealing with untypical behaviour (Type c),
including those directly related to developmental do-
mains but excluding those observed in the ®rst year of
life, were scored twice (see Tables 5 and 6 and the
Appendix). The ®rst rating coded whether the behaviour
described had ever been present and its most severe
manifestation, and the second coded whether it was
currently present. The same three-point numerical code
was used for each rating. This indicated whether the
untypical behaviour, at the time it was present (`ever' or
`currently'), was severe, minor or not present. The
severe rating was used when a behaviour was observed
every day; or if it occurred whenever carers' strategies
were not in use (e.g., self-injury if no protective clothing
was worn); or if it occurred whenever the opportunity
arose (e.g., inappropriate reaction to visitors). For some
behaviours that occurred less frequently but were
severe when they did occur, such as major physical
aggression, the severe coding was also used. The minor
coding was used if the behaviour occurred sometimes.
For a few items that did not ®t these general rules,
speci®c instructions were included in the DISCO
manual.
For some of the items there was the possibility that
they would not be applicable. For example, if someone
had no speech then the items on untypical speech,
such as reversal of pronouns, could not be rated. If a
child was too young to have reached the level of
development necessary for a particular skill (e.g., tying
shoe laces, using money, as indicated by the average
ages for typically developing children shown with the
item on current developmental level), the rating of
delay in development would not be applicable. If a
child was too young to understand a social rule (e.g.,
not making embarrassing remarks in public), this
would be rated as not applicable in the section on
maladaptive behaviour. For these items, ages by
which the untypical behaviour would be considered
inappropriate were suggested in the instructions to
the rater. However, the age rule could not be rigid
because the rater had to take into account the social
culture in which the person concerned was living.
Another possibility was that the information needed
could not be obtained. Numerical codes were assigned
for `not applicable' and `not known' and were available
for all items.
312 Lorna Wing et al.

Some problems were encountered in incorporating
diagnostic criteria from ICD-10 into the DISCO be-
cause ICD-10 did not include speci®c instructions or
guidelines. For example, it would be dif®cult to decide
how to rate the age of onset of meaningful speech
(single words and combining words) if a child started
to speak and then stopped but began to speak again
later. In such cases, arbitrary rules to deal with each
speci®c instance had to be included in the DISCO. (In
the example given, it was decided to enter the age
when the child ®rst began to speak.)
Participants. The parents of 82 children, 50 school-
age children aged 80 to 140 months and 32 pre-school
children aged 34 to 67 months, participated in this
study. There were four participant groups; children
diagnosed as having autistic spectrum disorder (18 low
functioning and 18 high functioning, total 36 partici-
pants), learning disability (17 participants), or speci®c
language disorder (14 participants), and a group with
typical development (15 participants). The children with
disabilities were recruited from clinics and special
schools in London, Kent and Sussex. They had been
diagnosed by clinicians working in these areas and
none had been assessed or diagnosed by members of
the research team. The typically developing children
attended schools and nurseries in the local area. The
parents of all the children were given a full explanation
of the aims and methods of the study and had access,
on request, to feedback of the results.
The characteristics of the children and results of
psychometric tests are shown in Table 1. For the inter-
rater reliability study, information across all the groups
was combined. Further details concerning the children
and the procedure for obtaining psychometric informa-
tion are given in the accompanying paper (Leekam
et al., 2002). The tests used are shown in Table 1.
Interviewers. Two members of the team based at the
University of Kent (SRL and SJL) conducted and coded
the interviews. They were non-clinical researchers who
had undergone three months' training on how to use
the DISCO. Training included coding at least ®ve
diagnostic interviews with one or other of the clinicians
who designed the DISCO (LW and JG). In addition,
before the study, each researcher independently con-
ducted at least four interviews with parents, which were
recorded and rated by the clinicians. High levels of
agreement (86% and 85% of items respectively) were
reached between each coder and clinician.
Preparations for the interviews. Another member of
the team, based at the Centre for Social and Commu-
nication Disorders, Bromley (ML), made pre-interview
contact with the parents. Because of the discrimin-
ation aspect of the study, he asked them not to reveal
to the interviewers their child's diagnosis, the school
they attended or any other information that might
have given away the diagnosis. One interviewer (SJL)
was blind to the diagnoses of all the children and knew
only the parents' names and addresses before each
interview began. The other (SRL) was blind to the
diagnoses of the 50 school-age children. The pre-
school children were simultaneously involved in
another study organised by SRL. She met them and
their families for about 15 minutes only, to greet them
before they were tested by other researchers. She was
aware of these children's diagnostic groups for the pur-
pose of the other study but had no other information
about their diagnostic pro®les. Two parents of school-
age children and one parent of a pre-school child also
accidentally revealed their child's diagnosis during the
interview.
Most of the interviews for the school-age children
were conducted in the parents' homes, while the

Table 1 Characteristics of the children

Autistic low Learning Autistic high Language Typically

functioning disabled functioning disorder developing

A Characteristics of school-aged children

Chronological age* 106 (80±133) 112.9 (86±140) 107.5 (80±131) 107.9 (80±136) 107.6 (83±135)
(months) N = 11 N=9 N = 11 N=9 N = 10
Male/Female ratio 11:0 5:4 9:2 5:4 6:4
Non-verbal IQ* 54.3 (12±80) 50.0 (14±73) 92.4 (64±140) 95.6 (77±117) 107.6 (92±121)
(Leiter or Bayley) N = 11 N=8 N = 11 N=8 N = 10
Language age* 28.8(10±75) 51.2 (12±87) 89.9 (52±186) 95.4 (62±138) 119.1 (78±186)
(Reynell, WOLD or McArthur) N = 10 N=8 N = 11 N=9 N = 10
(Expression ± months)
Language age* 27.5(8±81) 44.5 (8±87) 84.4 (42±168) 81.4 (24±120) 115.8 (290±156)
(Comprehension ± months) N = 10 N=8 N = 11 N=9 N = 10
B Characteristics of pre-school children
Chronological 49.9(34±58) 51.2 (40±62) 55.4 (35±67) 55.2 (49±62) 53.0 (51±56)
Age* (months) N=7 N=8 N=7 N=5 N=5
Male: Female ratio 6:1 4:4 6:1 4:1 3:2
Non-verbal IQ* 44.0(21±95) 41.7 (20±78) 112.0 (85±129) 86.8 (58±116) 110.6 (81±138)
(Leiter or Bayley) N=7 N =9 N=7 N=5 N=5
Language age* 17.8 (8±39) 22.5 (8±34) 32.4 (12±57) 45.6 (33±67) 62.0 (42±77)
(Reynell, WOLD or McArthur) N=7 N=8 N=7 N=5 N=5
(Expression ± months)
Language age* 12.8 (8±19) 15.3 (9±30) 31.4 (12±61) 35.2 (17±56) 55.6 (33±83)
(Comprehension ± months) N=7 N=8 N=7 N=5 N=5

* For each of these variables, the mean score, the range of scores and the number of participants receiving the test are shown.
 Diagnostic Interview for Social and Communication Disorders
interviews for the pre-school group were conducted at
the University of Kent at Canterbury.
Design and procedure. Both interviewers were pre-
sent throughout each interview. The design was coun-
terbalanced so that half of the interviews within each of
the three age bands were conducted by each of the two
researchers. At each interview, one researcher conduc-
ted the interview and coded the parent's responses
while the other listened and coded the responses, but
remained silent during the course of the interview. The
researchers each completed the DISCO coding sheets
without conferring and, after each interview, sent the
coding sheets to the Centre at Bromley for ML to enter
the data.
The interview took approximately three hours to
complete. With the exception of the pre-school children,
mentioned above, who were seen by SRL before the
interview, the interviewers did not see the children
before or during the interview. Because one researcher
was blind to the diagnoses of only the older children,
tests of inter-rater reliability were conducted separately
for the school-age and the pre-school children.
For the sake of clarity, each of the skills or behaviours
rated will be referred to as `items'. The codes for each of
the two age groups, and for the `current' and `ever'
divisions of the untypical behaviours will be referred to
as `ratings'.
As shown in the Appendix, there were 319 items
included in the interview for the study. There were 130
items concerned with developmental skills and 189 for
untypical behaviour. As described above, the latter
were rated twice, giving a total of 378 ratings for
untypical behaviour and a grand total of 508 ratings.
However, as already explained, some ratings were not
applicable for all or most children in one or both age
groups and/or for one or both of the current and ever
ratings. When there were less than 12 children for
whom a rating was applicable, that rating was exclu-
ded from the analysis. There were also some items for
which only a very small number of children were rated
as having the relevant untypical behaviour. This
Table 2 Number of DISCO ratings and level of inter-rater reliability
School-age children
Kappa or percentage Infancy, age of Untypical
agreement recognition and behaviour ratings
developmental ratings
No. (%) No. (%)
High Kappa or intra-class 105 (90.5) 292 (83.4)
correlation => .75
K or R <.75
0.70±0.74 6 (5.2) 29 (8.3)
0.60±0.69 3 (2.6) 22 (6.3)
0.50±0.59 2 (1.7) 3 (0.9)
0.40±0.49 ± 4 (1.1)
0.30±0.39 ± ±
0.20±0.29 ± ±
TOTAL 116 (100) 350 (100)
Not applicable 14 28
Grand Total 130 378
313
applied particularly to the items concerned with
setback in aspects of development and those related
to special skills sometimes seen in autism, such as the
ability to compose music (true of one child in this
study). Items for which three or fewer children were
rated as having the relevant pattern of development,
behaviour or skill were not considered suitable for
statistical analysis (see Appendix.).
Table 2 shows that 42 ratings were not applicable or
not analysed for the school-age children and 96 for the
pre-school group When the `not applicable' or `not
analysed' ratings were excluded, for the school-age
children there were 116 ratings for developmental items
and 350 for the items concerning untypical behaviour.
The numbers for the pre-school children were 100 and
312 respectively (see Table 2).
Statistical analysis. The levels of agreement between
the interviewers were tested by using unweighted
Cohen's kappa for items with two or three codes. For
items with four or more codes, intra-class correlations
were calculated. Agreement was considered to be high if
Cohen's kappa or the intra-class correlation was equal
to or greater than .75.
Results
There were two stages to the analysis of the items.
First, the inter-rater agreement on whether an item
was considered to be not applicable or not known
for a particular child was tested. As noted above,
some ratings were excluded from the analysis be-
cause the great majority of the children had `not
applicable' codes. However, for some items that
were included, there were some children for whom
the `not applicable' or `not known' codes had to
be used. These ratings were examined separately
because the `not applicable and `not known' codes
were conceptually different from the positive
ratings of a child's behaviour. Sometimes a
Pre-school children
Infancy, age of Untypical
recognition and behaviour ratings
developmental ratings
No. (%) No. (%)
89 (89.0) 261 (83.7)
3 (3.0) 19 (6.1)
5 (5.0) 21 (6.7)
1 (1.0) 3 (1.0)
1 (1.0) 4 (1.3)
± 3 (1.0)
1 (1.0) 1 (0.3)
100 (100) 312 (100)
30 66
130 378
314 Lorna Wing et al.

judgement had to be made whether the `not ap- Table 3 School-age children. Number of ratings with high
plicable' or, in some cases, the `not known' code inter-rater agreement for infancy, age of recognition, and
developmental skills
should be used. For example, if a child had only a
few single words the interviewer had to decide how Total no. No. of items with
the item on echolalia should be rated. The DISCO DISCO sections* of items high agreement #
instructions note that if there is insuf®cient speech
INFANCY 25 21
the item on echolalia should be coded as `not ap-
AGE OF RECOGNITION 2 2
plicable'. Since it is not possible in practice to de- DEVELOPMENTAL:
®ne precisely `suf®cient speech', the interviewers Gross motor skills 7 7
had to make a judgement. From among the ratings Self-care: Toilet training 5 5
that were analysed there were `not applicable' and/ Feeding 6 6
Dressing 6 6
or `not known' codes used for some children for
Personal hygiene 3 3
167 ratings for the school-age group and 135 for Domestic skills 4 4
the pre-school group. The inter-rater agreement for Independence 3 3
non-applicability was high (as de®ned above) for Communication:
over 85% of the relevant items for both the school- Receptive 5 5
Expressive 4 4
age and the pre-school children.
Non-verbal 8 7
The second stage of the analysis examined the Social interaction 3 2
absolute inter-rater agreement for each item calcu- Imitation 3 3
lated from the raw ratings that were deemed applic- Imagination 8 8
able by both raters. The Appendix shows the results Skills: Visuo-spatial 9 9
Other 15 10
of the 878 separate calculations of levels of agree-
ment. Table 2 summarizes these results, giving the TOTAL 116 (100%) 105 (83.00%)
numbers of ratings for which agreement was high * Items in these sections rated once only.
(k or r ˆ >.75) for school-age and pre-school children # Kappa or intra-class correlation => .75.
for infancy, age of recognition and developmental
skills and for untypical behaviour. The table also
shows the range of kappa or intra-class correlation Table 4 Pre-school children. Number of ratings with high
inter-rater agreement for infancy, age of recognition, and
values for the items for which agreement was not developmental skills
high as de®ned. Agreement was high for 90.5% of
developmental items for the school-age children and Total no. No. of items with
83.4% for the untypical behaviour items. For the DISCO sections* of items high agreement#
pre-school children the levels were 89.0% and 83.7% INFANCY 25 22
respectively. AGE OF RECOGNITION 2 2
Table 3 gives the results for the school-age DEVELOPMENTAL:
children for the items concerning infancy, age of Gross motor skills 6 6
recognition and the developmental domains. Ag- Self-care: Toilet training 5 5
Feeding 5 4
reement was high as de®ned for all items for 13 of Dressing 4 4
the 17 developmental areas listed. There were only Personal hygiene 2 1
11 items in total (9.5%) with lower levels of agree- Domestic skills 3 3
ment. The area with the largest proportion of items Independence 3 3
with lower agreements covered skills such as read- Communication:
Receptive 5 5
ing, writing, number work, drawing and so on. The Expressive 4 4
lowest level of kappa for the 5 items concerned was Non-verbal 8 7
.67 and three were between .70 and .74. One of Social interaction 3 1
the 3 items concerned with development of social Imitation 3 2
interaction, namely, lack of selective social attach- Imagination 6 4
Skills: Visuo-spatial 9 9
ment, had a lower level of inter-rater agreement Other 7 7
(k ˆ .54).
TOTAL 100 (100%) 89 (89.0%)
Table 4 shows the level of agreement for pre-
school children for items concerned with infancy, * Items in these sections rated once only.
age of onset of developmental problems, and # Kappa or intra-class correlation = > .75.
developmental skills. Agreement was high for 89%
of the items. There were 11 items (11%) with lev- Under the heading of `imagination', the items on
els of agreement below .75. For social interaction, `delay in developing pretend play alone' and `delay in
as with the school-age children, there was a asking questions about the world' were below the
problem with `lack of selective social attachment' high level of agreement (k ˆ .69 for both).
(k ˆ .42). The item `does not show preference The untypical behaviour ratings are shown for the
for carers (currently)' also showed low agreement school-age children in Table 5. Combining the `ever'
(k ˆ .27). and `current' ratings, agreement was high for 292
 Diagnostic Interview for Social and Communication Disorders 315

Table 5 School-age children: Number of items with high inter-rater agreement for untypical behaviour

Total no. of untypical No. of items with high No. of items with high
DISCO sections* behaviour items agreement ± current# agreement ± ever#

DEVELOPMENTAL:
Gross motor skills 4 3 3
Self-care: Toilet training 3 3 3
Feeding 4 2 2
Dressing 2 2 1
Personal hygiene 4 2 4
Independence 0 0 0
Communication:
Receptive 2 2 2
Expressive 9 9 9
Non-verbal 6 6 6
Social interaction:
With adults 20 13 16
With peers 10 6 7
Social play 6 6 6
Imitation 2 0 2
Imagination 3 3 2
Skills: Visuo-spatial 3 2 3
Other 9 8 8
OTHER:
Motor stereotypies 11 10 10
Sensory stimuli:
Proximal 14 13 13
Auditory 3 3 3
Visual 4 4 4
Repetitive routines 18 11 14
Emotions 8 6 7
Activity pattern 6 4 4
Maladaptive behaviour 18 16 17
Sleep pattern 3 3 3
Catatonic features 2 2 2
Quality of social interaction 1 1 1
TOTAL 175 (100%) 140 (80.0%) 152 (86.9%)

* Items in these sections rated twice ± `current' and `ever'.

# Kappa or intra-class correlation = >.75.

(83.4%) of the 350 ratings. The `ever' ratings had 23
with lower agreement compared with 35 for the
`current' ratings. For the combined ever and current
ratings of untypical social interaction with adults,
29 (72.5%) of the 40 ratings showed high levels of
agreement. For interaction with peers, the propor-
tion was 13 (65.0%) out of 20. For repetitive
routines, 25 (69.0%) of 36 ratings showed high ag-
reement. For these aspects of untypical behaviour,
which are important for diagnosis, the levels of ag-
reement were lower than the average for all ratings
combined.
For the pre-school children (see Table 6), combi-
ning the `ever' and `current' ratings of untypical
behaviour, there was high agreement for 261
(83.7%) of the 312 ratings. The numbers of ratings
with lower agreement for the pre-school children
were 23 for the `ever' ratings and 28 for the `current'
ratings. As for the school-age children, social in-
teraction with adults (though not with peers) and
repetitive routines were the sections with fewer
ratings than the average with high levels of inter-
rater agreement. For the former, 24 (63.2%) out of
38 ratings were high and, for the latter, 24 (75.0%)
out of 32 ratings.
Discussion
When the DISCO was rated by two independent re-
searchers, the overall level of inter-rater reliability for
the items proved to be high. Agreement at the level of
kappa coef®cient or intra-class correlation ˆ >.75
was found for 397 of the total of 466 (85.2%) of all
ratings concerning the school-age children and 350
out of 412 (85.0%) of those concerning the pre-
school children.
For the developmental items in the school-age
children, the area with the largest proportion of
items with lower agreements covered skills such as
reading, writing, number work and drawing. These
items were not part of any diagnostic algorithm. In
any case, in clinical work, objective information
can usually be obtained from school records or
psychological testing. Of more concern, because of
their relevance for diagnosis, was the low agree-
316 Lorna Wing et al.

Table 6 Pre-school children: Number of items with high inter-rater agreement for untypical behaviour

Total no. of untypical No. of items with high No. of items with high
DISCO section* behaviour items agreement ± current# agreement ± ever#

DEVELOPMENTAL:
Gross motor skills 3 2 3
Self-care: Toilet training 3 3 3
Feeding 4 4 4
Dressing 0 0 0
Personal hygiene 2 1 1
Independence N/A N/A N/A
Communication:
Receptive 2 2 2
Expressive 9 8 7
Non-verbal 6 6 6
Social interaction:
With adults 19 11 13
With peers 7 5 6
Social play 3 3 2
Imitation 2 2 2
Imagination 3 2 3
Skills: Visuo-spatial 3 2 3
Other 6 4 4
OTHER:
Motor stereotypies 11 9 10
Sensory stimuli:
Proximal 14 13 12
Auditory 3 3 3
Visual 4 4 4
Repetitive routines 16 11 13
Emotions 8 7 7
Activity pattern 6 6 5
Maladaptive behaviour 16 15 14
Sleep pattern 3 3 3
Catatonic features 2 2 2
Quality of social interaction 1 0 1
TOTAL 156 (100%) 128 (82.1%) 133 (85.3%)

* Items in these sections rated twice ± for current and for ever behaviour.
# Kappa or intra-class correlation = >.75.

ment for the items related to development of at-
tachment to carers for both school-age and pre-
school children. The problem was lack of precision
in the instructions to the raters. The items were
intended to indicate in the `severe' code the aloof
indifference to the presence or absence of carers
characteristic of the child with typical childhood
autism, at least in the early years. The wording
needed to be revised with clear descriptions of the
manifestations of this behaviour. Under the head-
ing of `imagination', also crucial for diagnosis, the
items on `delay in developing pretend play alone'
and `delay in asking questions about the world'
had kappa values of .69 for pre-school children but
the levels of agreement for school-age children were
high.
For the untypical behaviours concerned with
social interaction with adults and, for school-age
children only, interaction with age peers, the
numbers of ratings with high levels of agreement
were smaller than the average for all ratings com-
bined. Examination of the instructions for the
interviewers showed that clari®cation of the word-
ing and provision of examples were required for
most of the items concerned. This highlights the
dif®culties inherent in operationalising subtle and
complex social behaviours as compared with other,
more speci®c aspects of behaviour covered by the
DISCO, such as spending long periods staring
at bright lights and shiny objects. For example, the
item on `awareness of other's feelings' infringed
the rule against combining two concepts, by in-
cluding bizarre responses to shows of emotion
as well as lack of awareness of feelings in other
people.
The other area in which there were fewer items
with high levels of agreement and which was also
important for diagnosis was repetitive routines. The
problem in this case was that dif®cult decisions often
had to be made concerning which item best des-
cribed the routine in question. For example, one
child was fascinated by electric fans, looked for them
in every house or shop he visited, stared long and
hard at any ceiling fans he saw, demanded electric
fans for every birthday and Christmas, and would
have carried one with him all the time if he could.
The DISCO rule was to rate speci®c types of un-
typical behaviour under one heading only. For this
 Diagnostic Interview for Social and Communication Disorders
child, the dilemma was whether to rate under
clinging to objects, collecting objects, or fascination
with speci®c objects. However, from the point of view
of diagnosis, the choice did not matter, because one
marked routine was enough to qualify for this part of
the diagnosis of an autistic disorder. As described in
the accompanying paper on diagnostic algorithms
(Leekam et al., 2002), there were high levels of inter-
rater agreement when social interaction items and
the repetitive routine items selected for the ICD-10
childhood autism algorithm were collapsed together
according to the algorithm rules.
The raters had no access to any other sources of
information concerning the children. One rater only
had met the pre-school children brie¯y and knew
their clinical diagnoses. Apart from this, the raters
had no opportunity to meet, observe and interact
with the children. More sources of information
would have made rating easier, especially in rela-
tion to social interaction. In these respects, the
conditions for the research interviews were quite
unlike those when using the DISCO in clinical
work. Despite this, the overall inter-rater agreement
was high.
It was possible that the fact that one interviewer
had met each of the pre-school children for 15
minutes before the study and knew their clinical
diagnoses, while the other had never seen them and
knew nothing about them, may have had some ef-
fect on the ratings. However, the pattern of inter-
rater agreements was very similar for the two age
groups.
In the parallel study of the ICD-10 childhood
autism and Wing and Gould autistic spectrum dis-
order algorithms, no systematic differences were
found between the two age groups either for the
ratings used in the algorithms or for the diagnostic
outputs (Leekam et al., 2002).
It is of interest that, in the case of the school-age
children, the inter-rater agreements were high for
more of the `ever' than for the `current' ratings of
untypical behaviour (35 compared with 23), whereas
the numbers were closer for the pre-school children
(28 versus 23). The oldest child in the school-age
group was 11 years 4 months old so the parents'
memories of the most severe untypical behaviour
were still relatively clear. Many children with autism
and other developmental disorders tend to improve
in skills and behaviour after they begin school.
Clinical experience with the DISCO interview indi-
cates that parents are usually very clear about what
a particular behaviour was like at its worst but tend
to be less clear when describing the degree to which
behaviour has subsequently improved. With the pre-
school children, there was less chance of a change
from `ever' to `current' ratings.
For the untypical behaviours, agreement was as
high for the ratings of `minor' as for `marked' prob-
lems, suggesting that the DISCO is appropriate for
317
high functioning individuals with social and com-
munication problems in subtle forms. Agreement
was also high for the developmental items and for the
untypical behaviours related to developmental
domains. These items are not dealt with in the same
detail in other diagnostic schedules known to the
authors. They are particularly helpful for assessing
an individual's speci®c problems and needs, what-
ever his or her diagnosis.
The study was limited in its scope. It did not
include adolescents and adults as participants so
the sections relevant for these age groups were not
examined. There were no tests of agreement of rat-
ings made at interviews of the same parents by dif-
ferent interviewers. Interviews of two different
informants concerning the same child in different
situations were also not carried out. These last
would be of interest in a clinical context but would
present particular problems for testing reliability
because of possible environmental effects on chil-
dren's behaviour (Wing & Gould, 1978).
Despite its limitations, the lessons learnt from
the study have been most helpful in indicating
where changes in the schedule were required.
However, items of untypical behaviour or special
skills that were rarely present in the children in
this study were retained. This was because, ®rst,
some are seen more often in older and more able
people with autistic disorders and, second, they
are of clinical relevance when they do occur. The
wider use of the revised schedule (DISCO 10) by
trained professional workers will, it is hoped, pro-
vide information that can help to further improve
the schedule and give more opportunities for its
use in clinical research, as suggested in the
accompanying paper on diagnostic algorithms
(Leekam et al., 2002).
Acknowledgements
This research was carried out while Susan Leekam
and Sarah Libby were employed at the University of
Kent, Canterbury, and Michael Larcombe at the
Centre for Social and Communication Disorders.
The research was supported by grant SPGS 262
from the NHS Executive and by a grant from the
Blond Trust. Grateful thanks are due to all the
parents and children who participated in this study.
We would also like to thank the staff of the agencies
who helped us to contact the families involved. We
also thank Colin Taylor, Hannah Farrimond, and
Chris Ramsden for their expert help with the pre-
paration of data.
Correspondence to
Lorna Wing, Centre for Social and Communication
Disorders, Elliot House, 113 Masons Hill, Bromley,
Kent BR2 9HT, UK. Email: lgwing@aol.com
318 Lorna Wing et al.
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Wing, L., & Gould, J. (1978). Systematic recording of All the items from the DISCO used in the study of
behaviours and skills of retarded and psychotic inter-rater agreement are listed in this Appendix.
children. Journal of Autism and Childhood Schizo- Developmental items have one rating for each age
phrenia, 8, 79±97. group. Untypical behaviour items have two ratings,
Wing, L., & Gould, J. (1979). Severe impairments of one under `current' and one under `ever', for each age
social interaction and associated abnormalities in group.
children: Epidemiology and classi®cation. Journal of The items under the headings `Algorithm items'
Autism and Developmental Disorders, 9, 11±29. are those used in any one or more of the algorithms
Wing, L., & Shah, A. (2000). Catatonia in autistic
for ICD-10, DSM-III-R, DSM-IV, Kanner's early
spectrum disorders. British Journal of Psychiatry,
176, 357±362.
infantile autism, Gillberg's criteria for Asperger
Wing, L., & Wing, J.K. (1971). Multiple impairment in syndrome, or Wing and Gould's autistic spectrum
early childhood autism. Journal of Autism and Child- disorder.
hood Schizophrenia, 1, 256±266.
World Health Organisation (1993). The ICD-10 classi®-
cation of mental and behavioural disorders. Diagnos-
tic criteria for research. Geneva: World Health
Organisation.
Wolff, S. (1995). Loners: The life path of unusual
children. London: Routledge.

Manuscript accepted 22 October 2001

Inter-rater agreement for DISCO items

SCHOOL-AGE PRE-SCHOOL

INFANCY
Non-algorithm items
Concern at perinatal condition k = .77 k = .33
Poor sucking k = .77 k = .90
Vomited frequently k = .91 k = .85
Cried excessively k = .62 k = .77
Woke up screaming k = .82 k = .86
Did not sleep well k = .80 k = .93
Unusually good/quiet k = .59 k = .64
Did not demand social attention k = .92 k = .94
Lack of response to cuddling k = .90 k = 1.00
Poor eye contact k = .95 k = .83
Did not anticipate being lifted k = .96 k = 1.00
Lack of reciprocation in lap games k = .97 k = .88
Delay in waving bye-bye k = .85 k = .89
Limited babbling k = .94 k = .95
Limited pre-speech conversation k = .97 k = .94
Lack of response to speech k = .73 k = .85
Lack of intonation in babbling k = 1.00 k = .94
Lack of interest in environment k = .97 k = .74
No sharing of interests k = 1.00 k = 1.00
Did not look when other pointed k = .93 k = .94
Had a special interest k = .84 k = .77
Intensely attached to one parent k = .92 k = .84
Disliked care procedures k = .75 k = .91
Oversensitive to noise k = .80 k = .78
Odd movements of body or limbs k = .70 k = .77
AGE OF ANY SETBACK IN DEVELOPMENT
Algorithm items
Setback in language development 2 children 1 child
Setback in play development 3 children 2 children
Setback in social development r = .95 3 children
Non-algorithm items
Setback in motor development 2 children 1 child
Setback in toilet training 1 child 1 child
Setback in other self-care skills 1 child 1 child
320 Lorna Wing et al.

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

Setback in range of foods eaten 2 children 1 child

Setback in other adaptive skills none none
Setback in interest and curiosity 2 children 1 child
Age head growth arrested none none
Age of onset of disturbed behaviour r = .84 r = .82
Setback occurred after 24 months 1 child 1 child
Skills lost or not used? 1 child 1 child
Interviewers opinion of onset age 3 children r = .89

SCHOOL-AGE PRE-SCHOOL
Current Ever Current Ever
GROSS MOTOR SKILLS
Algorithm items
Clumsy k = .95 k = .97 k = .90 k = .90
Has immature gait k = .82 k = .86 k = .94 k = .88
Poor coordination in PE and games k = .70 k = .70 NA NA
Non-algorithm items
Ability to walk on level surfaces r = .99 r = .95
Ability to walk up and down stairs r = .88 r = .93
Ability to ride a bicycle or a tricycle r = .98 r = .93
Age sat up independently r = .85 r = .99
Age walked independently r = .99 r = .99
Age rode a tricycle r = .82 r = .99
Age rode a bicycle r = 1.00 NA
Climbs without concern for danger k = .95 k = .91 k = .74 k = .79
SELF-CARE
Self-care: Toilet training
Non-algorithm items
Incontinence during the day r = .93 r = .99
Incontinence at night r = .95 r = .96
Cleans and dresses self after the toilet k = .86 k = .76
Age clean and dry in day r = .90 r = .86
Age clean and dry at night r = .85 r = .91
Resists using pot or lavatory k = .75 k = .80 k = 1.00 k = .93
Smears k = 1.00 k = .89 k = .91 k = .91
Retention of faeces k = .86 k = .95 k = .89 k = .91
Self-care: Feeding
Non-algorithm items
Ability to feed self r = .99 r = .99
Ability to drink from a cup r = .97 r = .88
Delay in eating solid food k = .78 k = .83
Delay in giving up the bottle k = .82 k = .58
Delay in feeding self with spoon and fork k = .88 k = .92
Delay in using knife and fork k = .75 NA
Refuses food which is lumpy or hard to chew k = .64 k = .72 k = .80 k = .83
No interest in food k = .70 k = .74 k = .82 k = .85
Drinks excessive amount of ¯uids k = .93 k = .94 k = .75 k = .86
Refuses to feed self k = 1.00 k = .89 k = .87 k = .87
Self-care: Dressing
Non-algorithm items
Ability to dress self r = .99 r = .97
Ability to do up buttons r = .92 r = .92
Ability to tie laces k = .97 k = .84
Delay in pulling pants down and up k = .90 k = .83
Delay in independent dressing not buttons k = .84 NA
Delay in tying laces k = .92 NA
Unwilling to dress self k = .81 k = .73 NA NA
Excessively slow at dressing k = .96 k = .96 NA NA
Self-care: Personal hygiene
Non-algorithm items
Ability to wash self r = .97 r = .95
Delay in getting hands clean and dry k = .83 k = .72
Delay in bathing and drying self k = .83 NA
Dislikes being washed k = .73 k = .78 k = .75 k = .85
Unwilling to wash self k = .74 k = .77 NA NA
 Diagnostic Interview for Social and Communication Disorders 321

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

Lack of awareness of need for cleanliness k = .86 k = .86 NA NA

Dislikes sticky or dirty hands k = .80 k = .93 k = .66 k = .68
Self-care: Domestic skills
Non-algorithm items
Helping around the house r = .98 r = .91
Helping with cooking or other creative tasks r = .95 r = .88
Delay in fetching, carrying, taking a message k = .87 k = 1.00
Delay in doing a simple task alone k = .77 NA
Self-care: Independence
Non-algorithm items
Lack of understanding of danger r = .98 r = .95
Amount of supervision required r = .96 r = .93
Can stay at home alone NA NA
Delay in going into the garden alone k = .86 k = 1.00
Delay in going to local shops alone NA NA
Lack of common sense NA NA NA NA
COMMUNICATION
Communication: Receptive
Algorithm items
Level of understanding of language r = .97 r = .96
Limited appreciation of humour r = .94 r = .87
Takes language literally k = .95 k = .97 k = 1.00 k = 1.00
Delay in obeying instructions k = .86 k = 1.00
Non-algorithm items
Lack of understanding of future events k = .83 k = 1.00
Parents concerned about hearing k = .84 k = 1.00
Communication is one-sided k = .95 k = .81 k = .89 k = .76
Communication: Expressive
Algorithm items
Level of expressive language r = .98 r = .98
Age started to use meaningful words r = .97 r = .94
Age started to use phrases r = .78 r = .98
Speech absent or limited & no non-verbal communication NA NA k = 1.00 k= .73
Communication is one-sided k = .86 k= .87 k = 1.00 k= .76
Immediate echolalia k = .87 k= .92 k = .81 k= .87
Delayed echolalia k = .96 k= 1.00 k = .92 k= 1.00
Reversal of pronouns k = .87 k= .91 k = .91 k= .92
Idiosyncratic use of words or phrases k = .84 k= 1.00 k = .46 k= .46
Long winded pedantic speech k = 1.00 k= 1.00 NA NA
Content of speech is irrelevant k = 1.00 k= .92 k = .81 k= .91
Non-algorithm items
Intelligibility of speech r = .98 r = .94
Muddles sequence of words and phrases k = .90 k = 1.00 k = .90 k = .90
Talks to self k = .93 k = .93 k = .93 k = .93
Communication: Non-verbal
Algorithm items
Lack of imperative gestures r = .82 r = .78
Lack of joint referencing pointing k = .87 k = .89
Doesn't nod or shake head k = .95 k = .95
Lack of instrumental gestures k = .89 k = .89
Lack of descriptive gestures r = .87 r = .88
Lack of emotionally expressive gestures k = .77 k = .71
Odd tone of voice k = .84 k = .92 k = .89 k = .82
Uses different voices for no reason k = .88 k = .89 k = .89 k = .79
Facial expression absent or odd k = .76 k = .86 k = .92 k = .86
Non-verbal communication is absent or odd k = .85 k = .81 k = .82 k = .85
Non-algorithm items
Dif®culty understanding gestures r = .92 r = .91
Delay in sharing interests k = .73 k = .77
Good at copying accents, voices and noises k = .88 k = .88 k = .76 k = .76
Does not produce natural smile on request k = .92 k = .77 k = .78 k = .75
322 Lorna Wing et al.

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

SOCIAL INTERACTION
Social interaction: With adults
Algorithm items
Delay in selective social attachment k = .54 k= .42
Odd or no response to physical affection k = .75 k = .76 k= .90 k= .95
Eye contact poor k = .89 k = .90 k= .89 k= .76
Makes brief glances k = .90 k = .86 k= .94 k= .94
Blank unfocussed gaze k = .93 k = .82 k= .86 k= .76
Stares too long and hard k = 1.00 k = 1.00 k= .89 k= .89
Does not greet parents / carers k = .91 k = .91 k= .44 k= .76
Does not greet other people k = .74 k = .81 k= .74 k= .75
Unusual response to visitors k = .74 k = .82 k= .76 k= .76
Uses other people as mechanical aids k = .81 k = .93 k= .89 k= .89
Does not seek comfort when in pain or distress k = .72 k = .76 k= .65 k= .52
Does not seek social / physical comfort k = .68 k = .70 k= .84 k= .86
Does not give comfort to others k = .83 k = .90 k= .73 k= .72
Makes one sided social approaches k = .76 k = .76 k= .94 k= 1.00
Lack of awareness of others' feelings k = .73 k = .71 k= .74 k= .73
Laughs at others' distress k = .87 k = .96 k= .72 k= .66
Unusual response to change caused by injury k = .74 k = .76 k= .32 k= .26
Detached intellectual interest in injury or violence k = .62 k = .62 k= .69 k= .69
Does not share other's happiness k = 1.00 k = 1.00 NA NA
Sharing interests limited or absent k = .88 k = .48 k= .89 k= .85
Non-algorithm items
Does not show preference for carers k = .90 k = .27
Lack of separation anxiety k = .77 k = .89 k = .77 k = .78
Age sharing interests began r = .99 r = .99
Social interaction: With age peers
Algorithm items
No interest in other children k = .88 k = .93 k= .88 k= .90
Does not interacts with peers k = .94 k = .90 k= .89 k= .81
Inappropriate interactions with others k = .80 k = .84 k= .95 k= 1.00
No emotional response to peers k = .94 k = .65 k= .89 k= 1.00
Ignores conventions of peer interaction k = .72 k = .65 k= .74 k= 1.00
Uses other children as mechanical aids k = .86 k = .94 k= .73 k= .69
Lack of friendships with age peers k = .69 k = .89 NA NA
Friendship is not reciprocal k = .73 k = .92 NA NA
Non-algorithm items
Has a preference for older or younger children k = .43 k = .43 k = .83 k = .83
Bullied and teased by age peers k = .80 k = .87 NA NA
Social interaction: Social play
Algorithm items
No reciprocation in simple physical play k = .94 k = .76 k = .86 k = .62
Resists taking turns k = .90 k = .81 k = .89 k = .80
Extreme reaction to losing k = 1.00 k = .95 NA NA
No participation in group / team games k = .81 k = .78 k = .77 k = .77
No participation in organised social activities k = 1.00 k = 1.00 NA NA
Non-algorithm item
Does not play board games k = .92 k = .87 NA NA
IMITATION
Algorithm items
Did not imitate domestic activities in early childhood r = .98 r = .98
Does not imitate actions spontaneously k = .64 k = .79 k = .82 k = .79
Delayed imitation absent or odd k = .71 k = .87 k = .92 k = .92
Non-algorithm items
Delay in waving good-bye k = .90 k = .80
Delay in copying domestic activities k = .88 k = .68
IMAGINATION
Algorithm items
Lack of pretend play r = .98 r = .95
Delay in pretend play alone k = .83 k = .69
Pretend play is repetitive k = .91 k = .95 k = .79 k = 1.00
 Diagnostic Interview for Social and Communication Disorders 323

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

Non-algorithm items
Doesn't follow stories on TV r = .94 r = .90
Doesn't enjoy listening to stories r = .99 NA
Doesn't ask questions about the world r = .95 r = .95
Delay in imaginative play with peers k = .84 k = .84
Delay in asking questions about the world k = .80 k = .69
Delay in enjoying stories at 5 year old level k = .85 NA
Abnormal reaction to pets k = .86 k = .74 k = .67 k = 1.00
Curiosity limited or absent k = .89 k = .78 k = .90 k = 1.00
SKILLS
Skills: Visuo-spatial skills
Algorithm items
Poor hand-eye co-ordination r = .98 r = .91
Clumsy at ®ne motor tasks k = .88 k = .88 k = .93 k = .87
Non-algorithm items
Use of hands r = .76 r = .96
Visuo-spatial ability e.g., jigsaws r = .98 r = .83
Ability to use scissors k = .89 k = .89
Ability to make 3-D models r = .91 r = .91
Ability to draw r = .99 r = .99
Content of drawings r = .97 r = .89
Delay in completing a 10 piece jigsaw k = .93 k = 1.00
Delay in drawing a recognisable object k = .87 k = 1.00
Unusually dextrous and quick with hands k = .81 k = .82 k = .70 k = 1.00
Reluctant to use hands 1 child 3 childr. none 2 childr.
Reluctant to use pencils or crayons k = .71 k = .78 k = .90 k = 1.00
Skills: Pictures, reading and writing
Non-algorithm items
Ability to recognise scene in picture k = .95 k = 1.00
Reading ability r = .96 r = .99
Writing ability r = .99 r = .99
Delay in identifying objects in pictures k = .81 k = .83
Delay in reading ®rst book k = .76 NA
Delay in writing words without copying k = .74 NA
Does not look at a variety of pictures k = .86 k = .75 k = .80 k = .81
Fascinated with letters or words 3 childr. 3 childr. k = .80 k = 1.00
Not interested in reading k = .90 k = .90 NA NA
Not interested in writing k = .80 k = .76 NA NA
Speci®c reading / spelling impairment k = .72 k = .65 NA NA
Skills: Number, money, dates and time
Non-algorithm items
Numerical ability r = .99 r = .99
Understanding of money k = .84 k = .80
Ability to identify coins k = .84 NA
Knows the days, months and years k = .90 k = 1.00
Ability to tell the time k = .93 NA
Delay in doing simple addition k = .67 NA
Delay in identifying coins k = .69 NA
Delay in knowing the days of the week k = .74 NA
Delay in telling the half hours on the clock k = .70 NA
Skills: Special abilities above general level of development
Non-algorithm items
Special skills: Sings 1 child 1 child 1 child 1 child
Special skills: Plays musical instrument 1 child 1 child none none
Special skills: Composes music 1 child 1 child none none
Special skills: Numerical calculations 1 child 1 child none none
Special skills: Calendar calculations none none none none
Special skills: Visuo-spatial skills k = .87 k = .76 k = .81 k = .81
Special skills: Computers k = .90 k = .95 2 childr. 2 childr.
Special skills: Constructional k = .76 k = .76 2 childr. 2 childr.
Special skills: Drawing 3 childr. 3 childr. none none
Special skills: Maps 1 child 1 child none none
Special skills: Operating equipment k = .78 k = 1.00 none none
Special skills: Memory for verbal material 2 childr. 2 childr. k = .37 k = .37
324 Lorna Wing et al.

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

Special skills: Memory for routes 3 childr. 3 childr. k = .72 k = .72

Special skills: Memory for past events k = .86 k = .86 k = .90 k = .90
MOTOR AND VOCAL STEREOTYPIES
Algorithm items
Jumps up and down with excitement k = .88 k = .89 k = .88 k = .88
Makes unusual movements of hands or arms k = 1.00 k = 1.00 k = .79 k = .83
Midline hand stereotypies k = .93 k = .93 k = .53 k = .63
Spins self around k = .93 k = .93 k = .93 k = .94
Rocks whilst standing up k = .83 k = .83 k = 1.00 k = 1.00
Has complex twisting or rocking movements k = .67 k = .60 k = 1.00 k = 1.00
Non-algorithm items
Rocks sitting down k = .82 k = .87 k = .73 k = .76
Walks on tip toe k = 1.00 k = .91 k = .75 k = .80
Makes sudden jerky movements k = 1.00 k = .89 k = .88 k = .90
Makes shrieks and odd noises k = .84 k = .85 k = .83 k = .83
Makes odd facial grimaces k = .85 k = .91 k = .93 k = .93
RESPONSES TO SENSORY STIMULI
Responses to proximal stimuli
Algorithm items
Self-injury k = .91 k = .93 k = .83 k = .84
Stimulates self without injury k = .75 k = .77 k = .86 k = .72
Smells objects or people k = .89 k = .86 k = 1.00 k = 1.00
Unusual interest in the feel of surfaces k = .84 k = .79 k = .88 k = .94
Aimless and repetitive manipulation of objects k = .51 k = .68 k = .78 k = .80
Non-algorithm items
Smears, urinates to make puddles etc k = .84 k = .96 k = .90 k = 1.00
Places objects in mouth k = .91 k = 1.00 k = .95 k = 1.00
Scratches and taps surfaces k = 1.00 k = 1.00 k = 1.00 k = 1.00
Tears or breaks things in an aimless way k = .91 k = .91 k = .94 k = 1.00
Likes being spun around k = .93 k = .93 k = .84 k = .84
Indifference to pain, heat, cold k = .82 k = .79 k = .62 k = .65
Odd reaction to gentle touch k = .86 k = .86 k = .90 k = 1.00
Odd reaction to a ®rm touch k = .79 k = .80 k = .79 k = .92
Overbreathing k = .76 k = .80 k = 1.00 k = 1.00
Responses to auditory stimuli
Algorithm items
Fascination with sounds k = .87 k = .89 k = .89 k = 1.00
Non-algorithm items
Upset by certain sounds k = .87 k = .77 k = .79 k = 1.00
Has acute hearing k = .95 k = .95 k = .94 k = 1.00
Responses to visual stimuli
Algorithm items
Interested in bright lights and shiny things k = .89 k = .85 k = 1.00 k = 1.00
Interested in watching things spin k = .91 k = .94 k = .89 k = 1.00
Twists hands or objects near eyes k = .91 k = .93 k = 1.00 k = 1.00
Studies the angles of objects k = 1.00 k = 1.00 k = 1.00 k = 1.00
REPETITIVE ROUTINES AND RESISTANCE TO CHANGE
Algorithm items
Clings to objects k = .78 k = .90 k= .65 k= .67
Collects objects k = .79 k = .78 k= .44 k= .44
Fascinated with a speci®c object k = .77 k = .83 k= 1.00 k= 1.00
Arranges objects in patterns k = .86 k = .81 k= .88 k= .89
Interested in the parts of objects k = .60 k = .60 k= .81 k= .92
Complex repetitive activities with objects k = .70 k = .77 k= .79 k= .79
Interested in the abstract properties of objects k = .76 k = .82 k= .79 k= .79
Insists on sameness in the environment k = .60 k = .65 k= .69 k= .76
Insists on perfection k = .87 k = .92 k= .94 k= .94
Has unusual food fads k = .74 k = .73 k= .62 k= .66
Insists on sameness in routines k = .74 k = .79 k= .89 k= .86
Asks repetitive questions k = .90 k = .90 k= .91 k= .91
Talks about a repetitive theme k = .80 k = .77 NA NA
Clings to home k = 1.00 k = 1.00 k= 1.00 k= .91
 Diagnostic Interview for Social and Communication Disorders 325

Appendix Table Continued

SCHOOL-AGE PRE-SCHOOL

Acts out role of object, person repetitively k = .60 k = .76 k = 1.00 k = 1.00
Has repetitive activities related to special skill k = .65 k = .56 k = .44 k = 1.00
Collects facts on a speci®c subject k = .82 k = .82 NA NA
Fascinated with TV/ video k = .86 k = .86 k = .85 k = .84
EMOTIONS
Non-algorithm items
Lack of emotional expression k = .79 k = .77 k = .69 k = .69
Frequently unhappy for no reason k = .83 k = .80 k = 1.00 k = .88
Has mood swings k = .89 k = .88 k = .94 k = 1.00
Cries or moans for no reason k = .68 k = .78 k = .91 k = .92
Laughs for no reason k = .89 k = .87 k = .94 k = .95
Puzzled for no reason k = .96 k = .96 k = .89 k = .89
Frequently anxious k = .79 k = .81 k = .86 k = .86
Has an extreme fear of something k = .73 k = .66 k = .79 k = .78
ACTIVITY PATTERN
Algorithm item
Limited pattern of self-chosen activity k = .69 k = .73 k = .89 k = .95
Non-algorithm items
Limited attention span with self- chosen activities k = .79 k = .84 k = .89 k = .95
Limited attention span with activities chosen by others k = .75 k = .81 k = .86 k = .95
Rarely or never sits down k = .42 k = .73 k = .81 k = .74
Continually restless k = .81 k = .89 k = .90 k = .90
Hyperactive k = .83 k = .81 k = .84 k = .75
MALADAPTIVE BEHAVIOUR
Algorithm items
Dif®cult behaviour in public places k = .84 k = .89 k= 1.00 k= .86
Lack of personal modesty k = .89 k = .79 k= .67 k= .67
Doesn't understand psychological barriers k = .92 k = .93 k= 1.00 k= .77
Inappropriate approaches to strangers k = .91 k = .88 k= 1.00 k= 1.00
Makes embarrassing remarks in public k = 1.00 k = 1.00 NA NA
Interrupts conversations k = .80 k = .80 NA NA
Inappropriate response to others' emotions k = .69 k = .74 k= 1.00 k= .86
Demands carer's attention k = .86 k = .90 k= 1.00 k= .76
Non-algorithm items
Wanders off in public k = .79 k = .89 k = .89 k = .82
Destructive k = .57 k = .82 k = 1.00 k = .95
Noisy k = .85 k = .89 k = .97 k = .73
Has temper tantrums k = .87 k = .97 k = 1.00 k = .75
Aggressive k = .84 k = .93 k = 1.00 k = .85
Has objectionable personal habits k = .78 k = .78 k = 1.00 k = .88
Scatters or throws objects around k = 1.00 k = 1.00 k = 1.00 k = 1.00
Poor co-operation k = .89 k = .93 k = 1.00 k = .76
Needs constant supervision k = .79 k = .78 k = 1.00 k = .90
Demands carer's attention k = .86 k = .90 k = 1.00 k = .76
SLEEP PATTERN
Non-algorithm items
Has dif®culty falling asleep k = .90 k = .78 k = 1.00 k = .94
Has dif®culty remaining asleep k = .82 k = .81 k = 1.00 k = .84
Has night terrors or nightmares k = .93 k = .95 k = 1.00 k = .95
CATATONIC FEATURES
Algorithm items
Walks with head bowed and arms still k = .90 k = .90 k = 1.00 k = 1.00
Non-algorithm item
Hyperextends hands in unusual position k = .87 k = .94 k = .89 k = .90
Repeated approach and withdrawal 2 childr. 3 childr. 1 child 2 childr.
QUALITY OF SOCIAL INTERACTION
Algorithm item
Quality of social interaction r = .96 r = .96 r = .70 r = .88