Adaptasi Cross-Cultural dan Validasi Autism Mental Status Exam (Amse) Versi Indonesia: Mengisi Kesenjangan Dalam Diagnosis Autism Spectrum Disorde

PENGEKUTEN TIMBUL MARUDUR, Prof. dr. Retno Sutomo, PhD, SpA. (K),

2025 | Tesis-Subspesialis | SUBSPESIALIS ILMU KESEHATAN ANAK

Latar Belakang: Diagnosis autism spectrum disorder (ASD) di banyak negara berpenghasilan rendah-menengah(LMIC) terkendala oleh keterbatasan akses terhadap instrumen diagnosis standar emas, seperti seperti Autism Diagnostic Observation Schedule-2 (ADOS-2), karena kendala biaya, pelatihan, dan lisensi. Autism Mental Status Exam (AMSE) adalah instrumen observasional terstruktur yang ringkas, dirancang untuk mendukung pengambilan keputusan diagnostik di setting spesialistik ketika instrumen baku emas tidak tersedia.

Tujuan: Mengadaptasi AMSE ke dalam bahasa Indonesia (AMSE-INA) dan mengevaluasi reliabilitas serta validitas diagnostiknya pada populasi anak di Indonesia.

Metode: Studi potong lintang ini terdiri dari dua fase: (1) adaptasi lintas budaya yang ketat mengikuti panduan Beaton et al., dan (2) validasi psikometrik yang melibatkan 174 anak (usia 18 bulan-18 tahun) yang dirujuk ke Poliklinik Tumbuh Kembang Pediatri Sosial Rumah Sakit Sardjito. Semua subjek dinilai menggunakan AMSE-INA, Childhood Autism Rating Scale-2 (CARS-2 ST) versi Indonesia  dan diagnosis klinis estimasi terbaik (BECD)  berdasarkan kriteria DSM-5. Reliabilitas (konsistensi internal, inter-rater, test-retest), validitas (konten, konkuren, diskriminan) dan akurasi diagnostik (analisis ROC) dievaluasi secara statistik

Hasil: MSE-INA menunjukkan reliabilitas inter-rater yang sangat baik (ICC=0,97) dan reliabilitas test-retest yang sangat baik (ICC=0,96). Konsistensi internal sedang (?=0,66), sesuai dengan konstruk multidimensinya. Validitas konten sangat baik (I-CVI=1,00). Validitas konkuren dengan CARS-2 ST kuat (r=0,85, p<0>setting spesialistik: sensitivitas 88,9%, spesifisitas 94,7%, PPV 95,7%, NPV 86,6%. 

Kesimpulan: AMSE-INA merupakan instrumen pra-diagnosis ASD yang andal, valid, dan sesuai konteks budaya Indonesia. Alat ini dapat mendukung klinisi di setting spesialistik dalam menegakkan diagnosis akurat ketika instrumen baku emas tidak tersedia, sehingga berpotensi meningkatkan akses intervensi dini. 

Background: In many low- and middle-income countries (LMICs), diagnosis of autism spectrum disorder (ASD) is hindered by limited access to gold-standard instruments, like the Autism Diagnostic Observation Schedule-2 (ADOS-2), due to cost, training, and licensing barriers. The Autism Mental Status Exam (AMSE) is a brief, observational tool designed to structure clinical observation and support diagnostic decision-making in specialist settings where comprehensive assessments are unavailable.

Objective: To adapt the AMSE into Indonesian (AMSE-INA) and validate it as a pre-diagnostic tool for use by specialists in secondary/tertiary care settings in Indonesia, where access to gold-standard instruments is constrained

Methods: This cross-sectional diagnostic accuracy study comprised two phases: (1) rigorous cross-cultural adaptation following Beaton et al. guidelines, and (2) psychometric validation involving 174 children (aged 18 months–18 years) referred to a developmental specialist clinic. All participants underwent assessment with the AMSE-INA, the Indonesian version of the Childhood Autism Rating Scale-2 (CARS-2 ST), and a best-estimate clinical diagnosis (BECD) based on DSM-5 criteria by an experienced consultant blinded to AMSE scores. Reliability (internal consistency, inter-rater, test-retest), validity(content, concurrent, discriminant), and diagnostic accuracy (ROC analysis) were evaluated.

Results: AMSE-INA demonstrated excellent inter-rater reliability (ICC=0.97) and test-retest reliability (ICC=0.96). Internal consistency was moderate (?=0.66), consistent with its multidimensional construct. Content validity was excellent (I-CVI=1.00). Concurrent validity with CARS-2 ST was strong (r=0.85, p<0>

Conclusion AMSE-INA is a reliable, valid, and culturally appropriate pre-diagnostic tool that can assist specialists in establishing an accurate ASD diagnosis in resource-limited settings. By providing a structured observational framework, it bridges the diagnostic gap when gold-standard tools are in

Kata Kunci : Autism spectrum disorder, autism mental status exam, pre-diagnostic tool, cross-cultural adaptation, validation, resource-limited specialist settings