# Overview
The **Developmental, Diagnostic and Dimensional Interview (3di)** is an innovative computerised assessment for autism spectrum disorder and other psychiatric disorders of childhood. The **3di** includes the following features:
* a dimensional assessment of the severity of features associated with a diagnosis of autism
* allows an assessment for autism in as little as 45 minutes
* automatic production of comprehensive reports detailing information collected in the interview; the major reports are suitable for parents and referrers with limited editing
* excellent reliability and validity; criterion validity established in relation to the ADI-R for the ICD-10 ASD assessment
* high agreement with the ADI-R’s ASD algorithm
This online user guide covers modern versions of the 3di software from 2022 onwards. For older versions of the software, please consult the printed user guide provided during your training course, or the digital copy found in your 3di installation folder.
# Key concepts
## Questions
The 3di has a bank of around 900 questions. During a typical assessment you will administer just a small subset of these questions.
Questions are short and highly structured. There are several [question types](/using-the-software/question-types). All questions which contribute to the child's scores in the report have multiple choice or numeric answers. These are complemented by free-text answers which record qualitative information about the child's development for inclusion in the report, but you are free to skip these questions if you are interested only in the scoring tables.
It is always an option to mark a question as not applicable, or to leave it unanswered. The 3di handles missing information in a robust way.
You can [attach written notes](/using-the-software/conducting-an-interview#making-a-marginal-note-the-addnote-facility) of any length to a question, which will be included in your final report.
## Routes
To perform a single assessment, for example the brief Autism Spectrum Disorder assessment, only a small subset of the question bank needs to be answered. We call a subset of questions a [Route](/using-the-software/routes). Normally you select a Route at the start of the assessment and follow it to completion, although the 3di allows you to switch between Routes at any time.
While the [Interview Explorer](/using-the-software/conducting-an-interview#the-interview-explorer) shows every single available question, you will mainly use the [Route Explorer](/using-the-software/routes#opening-the-route-explorer), which displays just the questions on the currently selected route.
## Reports
The output of a 3di assessment comes in the form of a [Word report](/using-the-software/reports) which can be generated at any time.
Just as there are a range of questions and Routes, the full report contains many different components. If you fill in every single available question, the report will be fully populated. However in practice you will usually choose a shorter Route. You can then generate a report and delete any parts which are not relevant to your assessment.
# Using the software
# Frontend and backends
## The frontend and backends system
The **3di** system separates recorded data from the interviewing forms and reporting tools. The **frontend** provides the interview and reporting features: it’s the bit you see when you start up the **3di**. Patient data are recorded in a **backend**. There can be any number of backends – of which just one can be loaded at a time. However, *any number of cases may be stored in a single backend*. You do not need to create a new backend for each child, and indeed most users will only ever need to create a single backend to contain all cases.
The separation of frontend and backends has three important advantages:
* you can use separate backends for disparate sets of data (for the subjects in different studies, for example)
* you can benefit from software upgrades which add or improve retrieval and recording features simply by using a new frontend with your existing backends
* backends can be stored in a designated location, perhaps on a separate drive, to comply with institutional policies regarding backup and patient data security
## Selecting and creating backends
The selection and creation of backends are launched from the [**Main Menu**](/using-the-software/the-main-menu).
You will create a backend as part of your training course, and in many cases you won't need to think about backends again.
## The 3di installation folder
A complete **3di** installation has the following folder organisation:
{% hint style="warning" %}
Do not:
* delete, move or rename any provided folders immediately inside your **3di** installation folder (you *can* create others)
* make any changes inside the **Resources** folder
* create folders immediately inside the **Backends** folder
* delete, move or rename the **Cases** folder within a backend, or any of the numbered case folders within (but you *can* modify or delete generated Word reports)
{% endhint %}
The **3di** application file (frontend) sits at the top level of the 3di installation folder. In the above screenshot, it's the file named *3di5\_uk\_251219*. This is the file you double-click to launch the program.
In the installation folder you will see several subfolders. **PreEntry** and **Reference** contain various files provided by us which may be useful for reference and other purposes as described on the training course. **Resources** is part of the 3di software and should be ignored.
The **Backends** subfolder in the installation folder is special. This is known as the **backend source** – a folder containing one or more subfolders, one per backend. Backends store all of your clinical data: interview responses plus any reports you generate. It is possible to have more than one backend source (for example, you might store backends on a removable drive) and more than one backend within the same backend source (for example, to separate cases between two different clinics). However, the overwhelming majority of users will only use the default backend source folder, and a single backend within it. Switching between backends and backend sources is described in [the main menu](/using-the-software/the-main-menu#select-and-open-backend).
For each of your backends, there is in the **backends source** a folder bearing the backend’s name which stores:
* the **backend (data) file**, which has a systematically related name: if a backend folder is called *xyz*, then it contains a backend data file called *3di2\_xyz\_be*
* a **Cases** folder containing all the output documents generated for each patient.
Output documents are themselves organised into folders with 6-digit names based on each patient’s system-assigned Case\_ID. Thus the folder *000080* stores all output documents relating to patient 80. A patient’s Case\_ID appears at the top-right of the **3di** [Case Manager](/using-the-software/starting-an-interview#open-the-case-manager).
There is no need to navigate your file system to find a patient’s output documents: the **Case Manager** provides a **Go to documents folder** button which opens a window displaying the relevant folder.
After installing the **3di** you might link the frontend to the **Training5** backend, or ask the system to [create](/using-the-software/the-main-menu#create-and-open-backend) and link to a new backend.
You can create a backend in the provided **Backends** folder or elsewhere on your hard disk or removable drives (such as USB pen drives). If you choose one of these alternate locations, the **3di** will generate a **Backends** source folder to contain your new backend and any further backends you subsequently create there.
## Move or copy a backend
{% hint style="info" %}
Close the **3di** before attempting to move a backend
{% endhint %}
For simplicity, we recommend you always use the single backend that you created on your training course, which will be located in the default Backends folder within your 3di installation folder.
However, the need can arise to move or copy a backend from one Backends folder to another Backends folder, which can be accomplished by the usual means in Windows Explorer. Because all patient reports generated by the **3di** are stored in subfolders of a backend folder, moving or copying a backend subfolder moves or copies those reports also.
Other than for backup purposes, it is not a good idea to *copy* a backend. There is a risk that some new patients will be added to one backend, and other new cases to the copy – and then there will be two backends with the same name but different content. Even worse, a patient who was in the backend at the time of copying may be edited in either the original or the copy – there are then two “versions” of the same case!
# Starting the 3di
Use the shortcut on your Desktop called 3di5\_run**.** Alternatively, run the corresponding entry also named 3di5\_run in the Start menu.
The **3di** will open displaying the [Main Menu](/using-the-software/the-main-menu):
When you first use the **3di**, the system may not be linked to a [backend](/using-the-software/frontend-and-backends) for data storage. If the Main Menu indicates *no backend*, then to get started you will need to [select](/using-the-software/the-main-menu#select-and-open-backend) an existing backend or [create](/using-the-software/the-main-menu#create-and-open-backend) a first backend for your own use.
Once a backend is in place, you can open the [Case Manager](/using-the-software/starting-an-interview#open-the-case-manager) and proceed to enter and interview a patient.
## The 3di toolbar
The 3di toolbar appears on the *Add-ins* tab of the Access ribbon at the top of the screen. This is how you navigate the main parts of the software.
The 3di toolbar
The buttons on the toolbar are illustrated and explained in the following pages.
To free up more space on screen, the ribbon can be set to automatically hide. Double-click the tab title where it says *Add-ins*. Double-click again to bring it back. Alternatively you can achieve the same thing via the menu which appears after you click the arrow icon in the bottom right corner of the ribbon.
### Tidy up the ribbon
Furthermore, you can edit the ribbon so that only the relevant 3di buttons are shown, as in the above screenshot. This only needs to be done once and we follow these steps on the training course. If you wish to repeat this in future, the steps are as follows:
1. Right-click anywhere on the ribbon and click 'Customise the Ribbon...'
2. On the right-hand side of the dialog, unselect every tab *except* the one called 'Add-ins', then click OK.
# The main menu
## Displaying the Main Menu
The **Main Menu** is displayed when the **3di** opens, and cannot be closed or minimised. If the **Main Menu** has become hidden behind other objects on the screen, you can bring it to the front in two ways:
* click the Main Menu button on the **3di** toolbar
* *or* press **\** (think of **M**-enu)
The main menu shows the name of the current backend or 'no backend' if none is loaded.
## Using the Main Menu buttons
### Select and open backend
>
Recall from [frontend and backends](/using-the-software/frontend-and-backends) that patient cases are stored in a **backend**, and that each backend subfolder lives in a **backends source** folder.
#### To select a backend from the Backends folder already shown in *Current source of backends*:
1. select the backend in ***Backends in source***
2. click the button ***Open selected backend***
#### To select a backend from an existing but different backends source (for example, a folder on a removable drive):
1. click the button ***Browse for new source***
2. navigate to the required existing **Backends** folder and ensure it is highlighted
* click ***OK*** in the browse dialog
* notice that the new **Backends** folder is now displayed in ***Current source of backends***, and that there is a new list of available backends in ***Backends in source***
* select the desired backend in ***Backends in source***
* click the button ***Open selected backend***
### Create and open backend
>
The exact procedure depends upon where you wish to create your new backend: you will need to choose one of the possibilities numbered **i)** to **iii)** below.
However, **naming your backend** is a part of all three procedures, and should take account of the following:
* the name may have up to 10 characters drawn from A-Z, a-z, 0-9
* the name must not be amongst any listed in ***Backends in source***
* although *different* Backend sources can contain identically named backends, the potential for confusion is minimised if backend names are unique
If your chosen procedure is successful, the **Main Menu** will display the name of your new backend; otherwise error messages will suggest possible problems and the **Main Menu** will display **‘no backend’**.
Choose whichever one of the following three possibilities matches your need:
#### **i) If you wish to create your new backend in the Backends folder already shown in *****Current source of backends*****:**
* enter a name for your backend in ***Enter name for new backend***
* click the button ***Create (and open) backend in current source***
#### **ii) If you wish to create your backend in an *****existing but different***** Backends source folder (for example, a folder elsewhere on your hard disc or on a removable drive):**
* click the button ***Browse for new source***
* navigate to the required existing **Backends** folder and ensure it is highlighted
* click **OK** in the browse dialog
* notice that the new backends folder is now displayed in **Current source of backends**, and that there is a new list of backends in **Backends in source**
* enter a name for your backend in **Enter name for new backend**
* click the button **Create…**
#### **iii) If you wish to create your backend in a *****newly created***** Backend source folder (for example, a folder elsewhere on your hard disc or on a removable drive):**
* click the button **Create new source**
* navigate to the folder which is to *contain* your new Backends folder and ensure it is highlighted
* click **OK** in the browse dialog
* notice that the new backends folder is now displayed in **Current source of backends**, and that there is an empty list of backends in **Backends in source**
* enter a name for your backend in **Enter name for new backend**
* click the button **Create…**
* note that in the example above, a **Backends** folder will be created in the **Research** folder, and within that will be created the folder for your new backend
### Add and interview patients
>
This button opens the [Case Manager](/using-the-software/starting-an-interview#open-the-case-manager) form. Refer particularly to:
* [Enter a patient](/using-the-software/starting-an-interview#enter-a-patient)
* [Interview a patient](/using-the-software/starting-an-interview#interview-a-patient)
### Routes: create and manage
>
This button opens the **Routes** page of the **Main Menu** where there are further buttons which open the [Route Editor](/using-the-software/conducting-an-interview#creating-custom-routes-with-the-route-editor) and the [Route Manager](/using-the-software/conducting-an-interview#the-route-manager).
### Close 3di5
>
Using the **Close 3di5** button leaves Microsoft Access running, but with no file open. You may prefer to close the **3di** simply by closing the application window by clicking the **Close** icon at the top-right of the window – just as you would close down Microsoft Word or Excel.
# Starting an interview
## Open the Case Manager
* *either* click  on the **3di** **toolbar**
* *or* click **Add and interview patients** on the **Main Menu**
* *or* press **\** (think of **P**-atients)
The **Case Manager** is divided horizontally into three sections. The principal job of the bottom section, captioned **Reports and forms for current subject**, is to generate reports for the patient whose details are displayed in the top section. The middle section, captioned **Current interview**, shows the name of the patient for whom an interview is currently being run – or **None** if no interview is open.
## Enter a patient
To create a new record:
* *either* press **\**
* *or* click the new record icon: the right-hand icon with the asterisk amongst the navigation buttons at the foot of the **Case Manager** as shown below
Creating a new case in the Case Manager
* complete the top section of the form, noting that:
* **ForeNow** will be the name inserted in the text of the interview questions, and should therefore be any contraction of the patient’s forename which is generally used by the family
* **Patient number** requires the entry of a patient or hospital number – which will be rejected if it has already been entered for another patient
* **Interview date** is optional: if you leave it empty, it will be completed automatically when **Run interview** is clicked
* click **Save**
In general in the 3di, you do not need to click any button to save your work; your changes are saved continuously as you make edits. The **Save** button to save a new case is the only exception to this.
## Interview a patient
If you have just created a record for the patient in the **Case Manager**, after saving simply click **Run interview**.
Otherwise if you are starting or resuming an interview with a child whose record you created earlier:
1. Use the **Find** dropdown to move to the patient’s **Case Manager** record.
2. Click **Revisit interview** or **Run interview** (the single button displays the caption appropriate to the patient).
# Conducting an interview
## Overview
The interview uses a framework of numbered Sections, Subsections and Questions presented on a succession of forms. Questions are ordered to provide a logical progression; however, they can be completed in any order. There is no requirement that every question should be answered; and at several points blocks of questions will be skipped because they are excluded by answers you have just given.
The interview is built from 11 [Question Types](/using-the-software/question-types) which differ in the kind of information they capture, and how you enter your response.
Questions are disabled when your responses to other questions show them to be inapplicable.
Question status is reflected graphically on the interview forms, making it easy to spot questions which have not been answered, have become inapplicable, or are bookmarked.
Each time you finish answering a question and move to the next, your work is automatically saved, so there is no need to click the 'save' icon in the Access title bar.
The [Interview Explorer](#the-interview-explorer) provides a tree view representation of the interview’s structure which shows at a glance the extent of progress with the interview and the whereabouts of questions you have chosen to bookmark, enables you to jump directly to any question, and enables you to find questions containing a specified word or phrase.
The [Route Explorer](/using-the-software/routes) offers the same features as the Interview Explorer, but in relation to any of several pre-defined routes through the interview – a route being a subset of questions drawn from many parts of the complete question bank with the aim of delivering an assessment for a specific disorder. Almost always, this is the way you will navigate the 3di's questions.
Tailored text ensures that the patient’s name, and the names of the parents, are inserted in the text of questions on the interview forms. This gives the questions a conversational rather than an impersonal feel.
## Navigating the interview
With the exception of Repeating Answer questions, you can move from question to question using the keyboard:
* **\** takes you to the next question
* **\** also takes you to the next question
* **\** takes you to the prior question
You can skip to any question by clicking either on the text of the question or on the place where you enter your response.
There are three special cases:
* From the last question on an interview form, tapping **\** or **\** takes you to a **Next question** button. To move to the first question on the next form, tap **\** or **\** or click the button with the mouse.
* From the first question on an interview form, tapping **\** takes you to a **Previous question** button. You must then either click the button or tap **\** to move to the last question on the prior form – a further **\** won’t do the trick.
* If you are completing a Repeating Answer question, you can move to the next (or any another question) *only* by clicking on the text of the question or on the place where you enter your response
* exceptionally, if you’re moving to another Repeating Answer question you have to click where you enter your response
### The interview forms
The interview questions are spread across some 20 separate forms (windows). The numbering of sections and subsections in the interview, as illustrated in the Interview Explorer, does not directly correspond to the numbering of the forms. You will see the 20 forms minimised at the bottom of the screen when you begin the interview. Rather than trying to click on the forms directly, the correct way to navigate among them is to navigate a Route, or use the Interview Explorer and Route Explorer to find and jump between questions, or click the **Previous question** and **Next question** buttons found at the top and bottom of each form which take you to the next form in order.
### **Jumping to a question**
Although the interview questions are ordered to provide a natural progression, you can jump directly to any point in the interview by using the [Interview Explorer](#the-interview-explorer) or the [Route Explorer](#routes-and-the-route-explorer).
## Question status
Question completion and other aspects of question status are shown graphically on the interview forms.
* Questions where a **Don’t know (?)** button has been set are counted as answered (because no better reply can be got) – see **7.5.12**
* **Disabled questions** are counted as answered (because the answers to other questions have shown that they cannot sensibly or usefully be asked) – see **7.5.16**
* **Repeating Answer questions** (not illustrated) display a **green** question number when you have clicked **Mark as done**, and a **red** question number when you have clicked **Mark as to do**
* Question status is reflected in the [Interview Explorer](#the-interview-explorer) and [Route Explorer](#routes-and-the-route-explorer)
## The question menu
A right-click on a question number (eg **7.5.12**) in the interview opens a context menu relating to that question:
**Mark question** marks the question so that it appears in the interview with a yellow border around the question number and in the Explorers with a ‘folded corner’ icon.
**Show guidance** opens a Help file where detailed interviewer guidance on the question is given. See below.
**Unanswer question** reverts a question to the unanswered state. This applies to all question types except Repeating Answer.
### Question guidance
After clicking **Show guidance** in the question context menu, a separate help file will open with additional detail and tips on how to ask and interpret certain questions. Not every question appears in this file; when opened, it will scroll to the nearest question to that which you clicked on.
In practice while conducting the interview with parent or carer, you probably won't have time to refer to these notes. It might be better to familiarise yourself with their content in advance, or to use as a reference when writing up your report.
## Question IDs
Every question in the **3di** has a unique system Qid (question ID) as well as its number in the Section, Subsection and Question hierarchy. This Qid persists across different versions of the **3di** (which may change the order of some questions, for example). You will also see question Qids in your [Notes](#making-notes-on-any-question) documents: each note opens with details of the question on this pattern:
> 7.4.2 (Qid 176): How good is she at using a crayon or pencil for drawing purposes?
To determine a question’s Qid, hover the pointer over the question’s number within the interview. A tooltip will pop up showing the corresponding Qid. Below, question 10.2.1 has the Qid 983:
If you need the Qids of all questions, you could go to the **Case Manager** and generate a **Route Report** for **All questions**. Alternatively you could read the Qids from the [Route Editor](#creating-custom-routes-with-the-route-editor).
## Taking notes
The AddNote system provides the equivalent of a marginal note in a paper-based interview: you can record in a Word document supplementary material relating to any question.
Double-clicking a question number in the interview allows you to record a separate note in an automatically generated Word document. The first time you add a note in an interview, there may be a delay of a few seconds while Word opens the document.
The note is inserted in question order amongst any similar notes and sub-headed with the number and text of the question to which it applies. Where a note has already been recorded on a question, the cursor is placed at the end of the existing note.
Your notes are automatically integrated at appropriate points in [Reports](/using-the-software/reports) – unless you choose not to include notes using the **Edit report preferences** button in the **Case Manager**. Of course you can edit individual included notes, or remove them altogether. You can also read and edit your Notes file directly – although if you delete any bookmarks in the document the report generator will be unable to collect the related notes. If you wish to add to the Notes file material relating to questions not already represented in the file, then you can only do so safely by revisiting the patient’s interview and double-clicking the particular question numbers.
The Notes file is created in the patient’s [Case](/using-the-software/frontend-and-backends#the-3di-and-the-disc-filing-system) folder, with a filename on the pattern *Notes\_000080*, in which *000080* is the patient’s system ID written as six digits.
{% hint style="info" %}
You should save the Notes document when the interview is over to be sure of preserving the most recent changes and incorporating them into the report.
{% endhint %}
## The Interview Explorer
The Interview Explorer enables you to
* see a graphical representation of the structure of the entire interview
* move directly to any chosen question in the interview
* get immediate visual feedback on the progress of the interview
* identify and move directly to questions you have chosen to mark
* find questions containing a specified word or phrase
#### To open the Interview Explorer:
* click the button on the ribbon:
* *or* press **\** (think of **E**-xplorer)
With the **Question** **ID or Number** box you can jump to any question by entering either its **Qid** (eg 966) or the question number which gives its hierarchical position in the interview (eg 8.1.3), and then tapping **\**.
You can also jump to the first question in any subsection by entering just the section and subsection numbers. For example, entering **3.2** would take you to **3.2.1**.
Expanded view: some sections are expanded to show subsections, some subsections are expanded to show questions
Double-clicking a section folder takes you to the first question in its first subsection; double-clicking a subsection folder takes you to the first question in the subsection.
To go to the corresponding question in the interview, either double-click the question, or highlight the question and tap **\**.
**Green** icons denote answered questions, subsections and sections.
**Red** icons denote unanswered questions, subsections and section.
A **white** icon denotes a question which has become non‑applicable – it counts as answered.
A yellow ‘folded corner’ denotes a **marked** question. The device is echoed in the parent subsection and section icons.
## Handling over-long text
Where a question expects a text response you are limited to 255 characters – the equivalent of about 3 lines of text on an A4 page.
If your entry exceeds the limit, then when you attempt to move to another question a warning message displays the excess text and offers an option to have the whole entry copied to the **Notes** file. The copying of the problem entry is done in the background to avoid interrupting your interview. You will need to edit the text down below the character limit before proceeding to the next question.
{% hint style="info" %}
Where you do need to exceed the limit on text length it will often be best to proceed as follows:
* accept the option to have the whole of the entry copied to the **Notes** file
* delete ***all*** your typing in the text box and replace it with “see Notes file”
* double-click the question number, and complete your entry by adding to what has been copied across for you
This approach enables you to complete your text with the benefit of being able to see it all. It has the minor side-effect that for any text question whose content is included in a Report, that Report will include your “see Notes file” entry; such inclusions are easily found and deleted, of course.
{% endhint %}
## Closing the interview
To close the interview at any time, click the **Close interview** button on the Case Manager. The Case Manager may have disappeared behind open interview forms, in which case you can bring it to the front by clicking  on the **3di** **toolbar** [or other ways](/using-the-software/starting-an-interview#open-the-case-manager).
## Keyboard shortcuts
{% hint style="info" %}
**\** is a Windows shortcut. Holding down **\** and repeatedly tapping **\** cycles you through a series of icons representing each of your open windows, beginning with the icon for the window you used most recently. When you release **\** the window corresponding to the current icon is opened. You enter the **Notes** window from an interview form, so holding down **\** and giving **\** a single tap returns you to the interview.
{% endhint %}
## What if the 3di crashes?
If the computer or the 3di crashes while an interview is underway, almost certainly there will be no loss of data: responses are saved as each question is completed. Proceed as follows:
* ***either:*** if the computer has crashed, restart the computer and re-open the **3di**
* ***or***: if the **3di** has crashed but the computer is still running, close the **3di**
* if you can’t close the **3di**, and you are not familiar with closing an application via opening the Windows **Task Manager** using **\**, simply save any other work you were doing (in Word, for example), and hold down the machine’s power button until it closes down; then restart the computer and re-open the **3di**
* revisit the interview
* revisit the question you were on when the problem arose: it alone may not have been updated – complete the question if necessary
# Routes
## Routes through the interview
A **route** is a named set of questions drawn from the complete interview which it might be helpful to ask or review sequentially. At any stage of an interview, a different route may be installed as current from the **Route Explorer**.
The Route Explorer
The **Route Explorer** behaves exactly like the **Interview Explorer**, except that it displays only the questions which lie on the currently selected route.
The **3di** provides a number of pre-defined Routes, most of which select the questions which contribute to the making of one or another diagnosis – for example, the **ASD\_brief** Route selects the questions which constitute the **3di’s** rapid assessment for ASD.
The provided Routes are referred to as **System** Routes. Read more about the [four built-in ASD routes](/clinical-background/the-four-asd-assessments). You can also create your own [Custom Routes](/using-the-software/routes#creating-custom-routes-with-the-route-editor).
A **red** subsection or section icon in the Route Explorer tells you that there is at least one unanswered question on the route; conversely, when all the route questions are answered or disabled, every icon will be **green** regardless of the status of any questions not on the route.
#### **Opening the Route Explorer**
* click the button on the ribbon:
* *or* press **\** (think of **R**-oute)
#### **Installing a route**
Choose a route from the **Choose route** dropdown. You will be taken directly to the first unanswered question on the route, or to the first question if all questions are answered.
You can install a different route as often as you like during the course of a single interview.
Closing the **Route Explorer** removes the current Route and the associated highlighting of questions.
#### **Moving along a route**
To move to the next question on the route, click the button on the ribbon
*or* press **\** (think of forwar-**D**).
To move to the prior question on the route, click the button on the ribbon
*or* press **\** (think of **B**-ack).
Completing a question with **\** or **\** will as usual take you to the next question in the interview, rather than to the next question on the route.
## System Routes
The several System Routes built in to the 3di are described in [The four ASD assessments](/clinical-background/the-four-asd-assessments). The questions on these routes are the basis of the ASD scoring tables which appear in [Reports](/using-the-software/reports). In typical usage of the 3di, you will choose one of the ASD routes, answer only those questions, and focus on the corresponding report components.
For users of pre-2025 versions of the 3di, there is a separate reference on [Renaming of old routes](/setup/renaming-of-old-routes).
## Custom Routes and the Route Editor
Custom Routes behave exactly like the provided System Routes. They appear in all the dropdowns from which Routes can be chosen, and so can be used from the **Case Manager** to create **Route Reports** and **PreEntry** forms, as well as being chosen in the **Route Explorer** form when an interview is open.
Custom Routes can be used for everything from creating a version of a System Route (such as **ASD\_brief**) which adds off‑route questions you routinely like to complete, through to a Route with a handful of questions whose responses you like to copy and paste into a final Report from a Route Report.
To create or modify a Custom Route open the **Route Editor** from **Main Menu 🡪 Utilities 🡪 Create and edit Routes**.
You specify your Route by ticking or unticking questions in the **Selected** column. By choosing from the dropdown at the top of the form you can start with:
* no questions selected – choose **No route**
* the questions of a System Route selected – choose any of the Routes listed as **system** in the third column of the dropdown
* the questions of a Custom Route selected – choose any of the Routes listed as **custom** in the third column of the dropdown
Find questions you want to add to (or remove from) your Route, and review your current selection, by using the buttons at the head of the first and last columns.
Toggling the **Qid** button sorts the questions by their question ID, rather than their interview order. Toggling the **Selected** button sorts the questions by whether or not they are included on the route.
Both edited Custom Routes and edited System Routes can be saved as new Custom Routes.
If you started from a Custom Route, the **Save changes to Route** button will replace it with your edited version.
System Routes cannot be modified – but edits can be saved as a new Custom Route by clicking the **Save as new Route** button.
## The Route Manager
The **Route Manager** enables you to delete custom Routes, rename them and edit their brief descriptions. Open the Route Manager from **Main Menu 🡪 Utilities 🡪 Manage Routes**.
Select a Route by clicking in the left margin of the corresponding row in the table. Its name and description are copied to the editable fields in the bottom section of the Route Manager. You can then edit those details and use the buttons to **Save** or **Abandon** your changes, or use the **Delete** button to remove the Route.
Note that whenever you save a new Route from the Route Editor you are taken automatically to a simplified version of the Route Manager which limits you to editing the temporary name and description assigned by the **3di**.
# Reports
Word Reports are generated for the currently displayed patient from the buttons in the sage-coloured reporting section of the [Case Manager](/using-the-software/starting-an-interview#open-the-case-manager):
You cannot generate a Report while the interview is open, nor for a patient who has never been interviewed.
## Report principles
From a single interview, the 3di can generate several kinds of reports as Word documents. Most of the time you will use the Full report.
The structure of each kind of report is fixed, and is filled in as completely as possible given the questions you have answered. This may leave parts of the report empty or incomplete. These parts can be deleted or simply ignored.
In normal clinical use, picking the appropriate route in the [Route Explorer](/using-the-software/routes#opening-the-route-explorer) will allow you to complete just the necessary questions for that single assessment, thus populating the corresponding report components. See [The four ASD assessments](/clinical-background/the-four-asd-assessments) for details of the routes relating to autism.
If you generate a report without answering any questions, the result will be structurally complete but clinically uninformative — containing only placeholder notes explaining why scores could not be calculated. For clinical validity, you should complete all questions on the route relevant to your chosen assessment.
## Repeating a report
* If you use a report button to repeat the generation of the corresponding report, the new material will be *appended* to the existing document, so that you can see the effects of any interview responses you may have added or changed without the risk of overwriting any editing you might have done of the original document. This can be confusing! By selective deletion, or copying and pasting elsewhere, you can quickly reduce the doubled-up report to preserve what you need from each part.
* The most recent content in a report will always be at the end — so go straight there if you’re looking for the effects of adding or changing interview responses.
* If you delete or rename an existing report file, then a new document with the standard name is created when you repeat the generation of the report. If you want to discard the old report completely and create a new one from scratch, the quickest way is to delete the existing report file, then hit the button to create a new one.
## Finding reports
To find a patient’s reports (and to see other **3di** outputs relating to the patient, including the **Notes** file), use the **Find** dropdown in the [Case Manager](/using-the-software/starting-an-interview#open-the-case-manager) to move to the patient’s record, then click the **Go to documents folder** button.
Remember that the buttons which generate reports do exactly that: they’re not the way to find existing reports!
## Notes in reports
If you took any [notes](/using-the-software/conducting-an-interview#taking-notes) during the interview, these will be included in the report underneath the relevant section. For example if you made notes on questions in the [DSM-5 ASD extended route](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-3.-dsm-5-extended), they will appear underneath the DSM-5 Extended Assessment table.
Any notes also remain in the separate notes document, which you may edit and print separately if desired.
## Editing Word Reports
Once a Report has been generated it has no further dependency on the **3di** – you can edit it freely, rename, copy, move or delete it.
The **3di** reports can be navigated, pruned and reordered using the tree of headings in the documents. In Word, open the **Navigation Pane**: find this under the **View** ribbon, in the **Show** group. Click on **Headings** in the Navigation Pane. You can then:
* go to any heading by clicking on the heading
* see or hide the sub-headings of a heading by clicking on the triangular icon at the heading’s left
* see or hide all sub-headings by right-clicking over any text in the navigation tree and choosing **Expand All** or **Collapse All**
* delete a heading and all the document content belonging to that heading by right-clicking on the heading and choosing **Delete**
* move a heading and all the document content belonging to that heading by dragging the heading to a new position in the navigation tree.
In Reports you may want to remove from tables the columns listing omitted questions or similar material. You can use the **Edit report preferences** button in the **Case Manager** to ensure that such columns simply do not appear when the Full Report and Brief Report are generated. However, you might want to remove the columns selectively from just some tables. Columns are easily eliminated like this:
* while editing the document in Word, move the mouse pointer to the head of the unwanted column until the pointer assumes the appearance of a bold black stubby downward pointing arrow
* right-click to open a context menu
* choose **Delete Columns.**
## The Full report
The full report is the principal and usual report that you will generate after running [an ASD assessment in the 3di](/clinical-background/the-four-asd-assessments).
A Word document is generated and saved in the child’s documents folder. The file name is based on the child's case ID — a child with case ID 000031 will have a report named Report\_000031.
The Word document should open within a few seconds, but sometimes instead you will see a flashing Word icon in the taskbar at the bottom of your screen which you will need to click to make visible. Note that it takes some time for the report to be written, during which you may see the report content being actively composed. It is important not to interfere with Word until the report generation is completed.
Some of the report content depends on your 3di version. The 3di version number is shown in the title bar of the software while running, and also appears in the bottom left of every page in any report you generate. The first two digits of the version number denote the year, so for example *251219a* is the version from 19 December 2025.
## The Brief report
The brief report is a short document containing only the scoring tables from the brief assessment(s) for ASD (see [The four ASD assessments](/clinical-background/the-four-asd-assessments)). All information about other disorders, and any qualitative information you captured concerning the child's developmental history and so on, are excluded.
A Word document is generated and saved in the child’s documents folder. The file name is based on the child's case ID — a child with case ID 000031 will have a report named Report\_000031.
The Word document should open within a few seconds, but sometimes you will see a flashing Word icon in the taskbar at the bottom of your screen which you will need to click to make visible. Note that it takes some time for the report to be written, during which you may see the report content being actively composed. It is important not to interfere with Word until the report generation is completed.
Some of the report content depends on your 3di version. The 3di version number is shown in the title bar of the software while running, and also appears in the bottom left of every page in any report you generate. The first two digits of the version number denote the year, so for example *251219a* is the version from 19 December 2025.
## Comorbidities summary
A Word document is generated and saved in the child’s documents folder. The file name is based on the child's case ID — a child with case ID 000031 will have a report named Comorbidities\_000031.
The Word document should open within a few seconds, but sometimes you will see a flashing Word icon in the taskbar at the bottom of your screen which you will need to click to make visible. Note that it takes some time for the report to be written, during which you may see the report content being actively composed. It is important not to interfere with Word until the report generation is completed.
The document covers whatever comorbidities you specify in the [Comorbidities dialog](/using-the-software/comorbidities#generating-comorbidity-outcomes).
## Including ICD-10 scores
Since 2022, the ICD-10 elements of ASD reporting only appear in the report if you have first selected the option [*Case Manager*](/using-the-software/starting-an-interview#open-the-case-manager) *→ Edit report preferences → ICD-10 ASD***.**
# Report structure
This page describes the elements which are present in the 3di's Full and Brief reports.
{% hint style="info" %}
The 3di report components have evolved over time. This page describes the reports as found in the latest version of the software. For older versions, consult the user guide provided at the time of your training.
{% endhint %}
## Full report structure
The Full report includes the following components. In Word, you can see the report structure in the Navigation pane (*Ctrl-F*, or in the ribbon, click *View → Show → Navigation pane*). Below we use an example child named Sam.
#### 3di assessment for Sam
Basic details of the child, referral, interviewer and interviewed, and the family’s account of presenting problems.
#### The family
Basic demographic details of the family and household members.
#### Sam's medical history
The child’s medical history. Medication and hospital visits.
#### Sam’s educational history
The child’s educational history. Schools attended, academic difficulties, and special abilities.
#### Sam's developmental history
Pregnancy and birth, motor skills, hearing, eating, bladder and bowel, sleeping behaviour.
#### Autism spectrum disorder
This section contains language milestones and the scored Children's Communication Checklist (CCC) table.
#### DSM-5: ASD extended assessment
This pair of tables give scores out of 100 based on the DSM-5 extended route for each of the symptomatic elements within Criteria A and B for ASD. See [/pages/mHywH6FL0C6JT2331w4F#id-3.-dsm-5-extended](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-3.-dsm-5-extended "mention").
#### DSM-5: ASD brief assessment
Two tables *DSM-5: ASD brief assessment, Criterion A/B* give percentage scores based on the DSM-5 brief route for the seven sub-criteria within Criteria A and B for ASD. See [/pages/mHywH6FL0C6JT2331w4F#id-4.-dsm-5-brief](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-4.-dsm-5-brief "mention").
#### ICD-10 ASD
From 2022 onwards this section is by default excluded from the report, but is retained as an option for those users who still administer this older version of the assessment. Enable this section from the Preferences window. See [Reports](/using-the-software/reports#including-icd-10-scores).
The *Autism Spectrum Disorder subscales* table records ASD outcomes according to ICD-10 and DSM-4 and derived from scores in the triad of behavioural domains (social reciprocity, communication, repetitive behaviours and interests) based on the questions in [/pages/mHywH6FL0C6JT2331w4F#id-1.-icd-10-extended](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-1.-icd-10-extended "mention").
The *Developmental normality* table records motor and language milestones, and age at onset of ASD symptomatology.
The tables are followed by an indicative *Autism Spectrum Disorder diagnosis (ICD-10)* according to the rules laid out in the flowchart provided in the Reference folder of your 3di installation, and formerly taught on 3di training courses.
#### Syndromes associated with autistic features
Only present if you answered the relevant questions. Records your responses to the questions about Rett, Fragile-X, and Tuberous sclerosis.
#### Regression
Only present if you answered the relevant questions. Records any noted regressions in language, motor, play or toileting skills.
#### Comorbidities
Consists of a scoring table for *Attention Deficit Hyperactivity Disorder (ADHD)*, any *Conduct disorders* (table is absent if none recorded), and any recorded *Tic disorders*.
## Brief report structure
The brief report includes the following components. In Word, you can see the report structure in the Navigation pane (*Ctrl-F*, or in the ribbon, click *View → Show → Navigation pane*). Below we use an example child named Sam.
#### DSM-5: ASD brief assessment
This same section appears in the full report.
Two tables *DSM-5: ASD brief assessment, Criterion A/B* give percentage scores based on the DSM-5 brief route for the seven sub-criteria within Criteria A and B for ASD. See [/pages/mHywH6FL0C6JT2331w4F#id-4.-dsm-5-brief](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-4.-dsm-5-brief "mention"). These tables are an alternative view to the section above. From 2022-2024, both interpretations of the same responses are presented, once in each format.
#### ICD-10 ASD
From 2022 onwards this section is by default excluded from the report, but is retained as an option for those users who still administer this older version of the assessment. Enable this section from the Preferences window. See [Reports](/using-the-software/reports#including-icd-10-scores).
The *Autism Spectrum Disorder subscales* table records ASD outcomes according to ICD-10 and DSM-4 and derived from scores in the triad of behavioural domains (social reciprocity, communication, repetitive behaviours and interests) based on the smaller number of questions in [/pages/mHywH6FL0C6JT2331w4F#id-2.-icd-10-brief](https://docs.ixdx.org/using-the-software/pages/mHywH6FL0C6JT2331w4F#id-2.-icd-10-brief "mention").
{% hint style="warning" %}
Despite having the same title and format as the corresponding table in the full report, the *ICD-10 ASD* table in the brief report is based on the reduced question set of the ICD-10 brief assessment. For a comparison, see [The four ASD assessments](/clinical-background/the-four-asd-assessments).
{% endhint %}
The *Developmental normality* table records motor and language milestones, and age at onset of ASD symptomatology.
The tables are followed by an indicative *Autism Spectrum Disorder diagnosis (ICD-10)* according to the rules laid out in the flowchart provided in the Reference folder of your 3di installation, and formerly taught on 3di training courses.
# Pre-entry forms
Pre-entry forms are questionnaires used to gather data from parents and school which can be entered into the **3di** prior to running the interview with the parents.
To make it easy to transcribe to the **3di** from a pre-entry form, the Route Explorer provides a [Route](/using-the-software/routes) corresponding to each form: the Route will present the **3di** questions in precisely the order in which they appear on the pre-entry form.
## The three sources of pre-entry forms
1. Provided pre-entry forms: some forms are provided in the **PreEntry** folder within your **3di** [installation folder](/setup/installation#the-installation-folder).
2. Pre-entry forms generated from the [System Routes](/using-the-software/routes) which come with the **3di**.
3. Pre-entry forms generated from any [Custom Routes](/using-the-software/routes#creating-custom-routes-with-the-route-editor) you have created within the **3di**.
## Creating a pre-entry form from any Route
All the Route dropdowns in the **3di** list both the system Routes and your custom Routes, and for any of the Routes you can generate a pre-entry form tailored to any particular child. Here’s the procedure:
1. Go to the **Case Manager**.
2. Select the child from the **Find** dropdown.
3. Make your choice from the system and custom Routes offered by the **Question by question** dropdown in the lower‑right section of the **Case Manager**.
4. Click the **Pre-entry Form** button. You will be prompted to say whether or not you want to include guidance notes for the parents – see below.
5. When the form opens (it can take a noticeable time), use the radio buttons at the top-right to choose the format of the final document:\
`rtf = Word format`\
`pdf = Acrobat format`\
`xls = Excel format`\
The different formats lend themselves to different particular purposes: you may need to experiment.
6. Click the **Export Form** button. The form will be saved to the child’s document folder, and also displayed on the screen in the chosen format.
### Improving a pre-entry form
Although an automatically generated pre-entry form can be used as it stands, there are several things you may sometimes want to do, including the following:
* Add a preamble to the form, briefing the parents on what to do.
* Add a header and/or footer – with page numbers, for example.
* Condense or otherwise adjust the layout.
* For at least some Repeating Answer questions:
* Create more room for responses by inserting new lines.
* Copy and paste the answer framework so that several sets of responses can be recorded without the parents needing to use the reverse of the sheet or extra sheets.
* Edit the content for a “special case” child - anything from adding notes to removing or rewording some items.
### Making a generic pre-entry form
The previous steps describe how to make a pre-entry form for a particular child, and will include text tailored to the child's name. You may want to make a “generic” form that can be used for any child.
* If you plan to create several different forms, it’s a good idea to create a Backend for that and other adventurous purposes; you might call it WorkBench.
* In the **Case Manager** create a child with a **Forenow** (the familiar version of the forename) which is unlikely to appear as a word or part-word anywhere else in the interview text – actually, 'Forenow' might be a good choice! Later, when you open your generic form in Word, you can do a find and replace to substitute the name of any actual child: your generic form can be tailored in seconds.
* To do a find and replace in Word, use the shortcut: **\**
* You’ll realise that if you aim for a generic form which can be tailored to any given child, you will actually need **two forms** – one where you make the child a boy in the **Case Manager**, the other where you change the child to a girl and repeat the exercise; that way one form will have male pronouns, the other female pronouns.
* Open an interview with your “generic” child, and for any question on the Route for which you would like any kind of explanatory or other text to appear on the interview form as part of that question, use the 3di's **Notes** system to enter that text. It will be reproduced at the bottom of the answer space for the question in the generated pre-entry form.
## Transcribing from a pre-entry form
Having opened the child’s interview in the **3di**, open the **Route Explorer** (click the road-map icon on the **3di** toolbar), and select the required route from the **Choose route** dropdown. You will be taken to the first unanswered question on the route.
Use the [keyboard shortcuts](/using-the-software/conducting-an-interview#keyboard-shortcuts) to move along the route efficiently and speed up your data entry.
## Provided pre-entry forms
The provided pre-entry forms are named to reflect their Routes.
#### *ADHD\_behaviour\_school\_nameless\_unisex\_yymmdd*
Completed by the parents or carers.
#### *CCC\_named\_boy\_yymmdd* and *CCC\_named\_girl\_yymmdd*
Children’s Communication Checklist\
(Dorothy Bishop, 1998, Journal of Child Psychology and Psychiatry)
Completed by the parents or carers and also by the school.
Choose the form for the child’s gender and do a find and replace to substitute your child’s forename for the boy Ziggy or the girl Capucine.
The CCC is described in the second reference Tab of your training course manual, and also in the **CCC table interpretation** document in the **Reference** folder within your **3di** installation folder.
Although given to both parents and school, the **3di** accommodates only one set of CCC responses: the parents’ responses should be used unless there is reason to believe that their responses are heavily biased.
Scoring the school responses to the CCC can be achieved in either of two ways:
1. You can create a second “dummy” interview with the child and complete in that interview *just the CCC questions as rated by the school*. You then generate a full Report from that interview, and pay heed only to the CCC table within it. If the child is called Sam Bloggs, you might call the child created in the **Case Manager** for the dummy interview Sam Bloggs\_CCC\_School. This naming strategy makes it easier to find the dummy interview when you are choosing Sam Bloggs from the **Find:** dropdown at the top of the **Case Manager** (because Bloggs\_CCC\_School will appear immediately below Bloggs) – and you get a reminder that there *is* such an interview!
2. Dorothy Bishop's Excel scoring spreadsheet for the Children's Communication Checklist, which can be found online. Probably the spreadsheet is useful only if you have many CCC forms to process as a batch: the responses for each child occupy a single row (with the columns captioned by abbreviated questions), and you must enter numerical codes for the outcomes. Moreover, the spreadsheet declines to give scores for any CCC subscale (there are nine in all) for which under 80% of the items have been answered, whereas the **3di** pro-rates subscale scores from the answered questions, reports the number of unanswered questions, and leaves you to decide what validity should be attached to the results.
## Converting multi-line option sets to a more compact format
To make your pre-entry forms more compact you can convert multi-line option sets to continuous text. Try this out by creating a pre-entry form for the Route **ASD\_brief** and then using Word’s **Find and Replace** dialog in Word (shortcut **\**) with the three pairs of text below: copy the first in a pair to the **Find** box and the second to the **Replace** box. Make sure you end each copy immediately after the last visible character.
{% hint style="info" %}
The below templates make use of the fact that `^p` signifies 'paragraph break' in Word.
{% endhint %}
{% hint style="info" %}
If the text you have selected appears to include a “space” (actually a newline character) at the end, holding down **\** and tapping **<🡨>** will drop that “space” – assuming you made your original selection by dragging from left to right.
{% endhint %}
Find:
`[.....] often^p^p[.....] rarely^p^p[.....] never`
Replace:
`^poften / rarely / never`
Find:
`[.....] no, does not apply^p^p[.....] applies somewhat^p^p[.....] definitely applies^p^p[.....] unable to judge (not applicable)`
Replace:
`^pno, does not apply / applies somewhat / definitely applies / unable to judge (not applicable)`
Find:
`[.....] definitely^p^p[.....] possibly^p^p[.....] no`
Replace:
`^pdefinitely / possibly / no`
Once you’ve tried the process for converting multi-line options sets to continuous text you’ll be able to follow this brief account of how you could do the same thing for any option set:
To create the **Find** string:
1. Copy and paste the multi-line version from any automatically generated PreEntry form which uses that option set.
2. Modify the pasted copy by replacing each newline character (it’s the last on each line) with **^p^p**. Your several lines will progressively collapse into a single “paragraph”. It helps to tick **Show all formatting marks** via **File → Options → Display** – that way you’ll see exactly what you’re working with, including newline characters (`¶`) and spaces (`·`).
To build the **Replace** string:
1. Add a blank line after your edited **Find** string and then begin with the characters **^p** (look at the provided **Replace** strings if you’re unsure how this should look).
2. Then copy from the **Find** string the text of each response option in turn and paste it onto the end of the **Replace** string you are building, adding after each (except the last) something like “ / ” (that’s two spaces, a forward slash, and two more spaces).
# Route reports
A route report is the counterpart to a [pre-entry form](/using-the-software/pre-entry-forms): while the pre-entry form shows an empty template of a set of questions ready to be filled in, the route report provides a transcript of questions after they have been completed, including whatever responses were entered.
With the *Responses recorded* button you can generate a complete listing of the questions and recorded responses for any [Route](/using-the-software/routes) you choose from the dropdown. We call this a Route report. The Route report optionally contains any notes you made during the interview. You could print the Route report directly, or copy and paste from it to add narrative and detail to any final report you are preparing.
The beginning of a Route report
After clicking the *Responses recorded* button, the Route report opens inside the **3di**. You will see the document as a readonly preview. In the top-right you have the option to Export Report.
* rtf format will open in Word as an editable document.
* xls format creates an Excel spreadsheet (see [tips](#editing-excel-route-reports) below).
* pdf format creates a readonly document which looks identical to what you see.
In every case, the document is saved to the child's documents folder.
## Editing Excel route reports
**Route Reports** may be exported in **Excel format**, in which case they are more easily read and manipulated if you do the following:
* reduce the widths of the first three columns
* change the font colour to black for any column where you find the text is not distinct (right-click the column letter, eg **F**, and choose the font colour through the menus/icons offered)
* click into cell **C3** and then:
* set-up Autofilter dropdowns for every column by using the shortcut\
**\**
* on the **View** ribbon or toolbar choose **Freeze panes** (*not* **Freeze top row** *or* **Freeze first column**) so that the column headings in row **2** and the Section and Subsection labels in columns **A** and **B** remain visible when you scroll down or scroll right)
* move up by one row the contents of the **ResponseOrStatus** and **Note\_Content** columns so that they are in the same row as the text of the questions to which they relate – here’s how:
* select cells **F5** and **G5** (click over one and drag to the other; or click into **F5** and then **\** over **G5**)
* press **\** to pop-up the **Delete** dialog
* select **Shift cells up**
* click **OK**
* you may then like to remove the now empty row which follows each row containing a Qid in column **D**:
* **\** on the row number of each empty row to highlight all and only the empty rows, then right-click over any one of the highlighted rows and choose **Delete** from the context menu which opens – you can do this a few rows at a time if a more ambitious approach is leading to errors!
* for the most condensed arrangement at the cost of losing the Section and Subsection labels you might like to delete columns **A** and **B** and then delete the now empty rows the labels used to occupy – for which you can use the **\** technique of the previous bullet
# Comorbidities
The Comorbidities Tool allows you to generate for any patient a report in relation to any of:
* just one disorder (eg Separation Anxiety of Childhood)
* a chosen family of disorders (eg the Anxiety disorders)
* all disorders in the system (*except* where “no” appears in the **In Comorbidities Report** column of the disorder dropdowns)
The Word report is opened – and saved automatically in the patient’s [Case](/using-the-software/frontend-and-backends#the-3di-and-the-disc-filing-system) folder, with a file name on the pattern *Comorbidities\_000134* in which *000134* is the patient’s system ID written as six digits.
Each time you generate a comorbidity report the results are appended to the existing document – so always go to the end of the document to find the latest material.
## Generating comorbidity outcomes
Open the **Comorbidities Tool** in one of two ways:
* click **Comorbidities summary** in the **Case Manager**
* *or* press **\** (think of **T**-ool)
1. Choose the patient for whom a report is required.
2. Click an option button to select reporting on a **Disorder group**, a **Disorder**, or **All disorders**.
3. Unless reporting **All disorders**, choose required **Disorder group** or **Disorder**.
4. Click the **Report** button.
## Interpreting a Comorbidities summary
The Comorbidities summary has from one to many rows, depending on the choices you make in the **Comorbidities Tool**. The following notes apply in all cases:
Disorder Group
Disorder
Criteria met?
Qs to do
Notes
Anxiety
Generalised anxiety disorder
yes
Anxiety
Agoraphobia
no
1 of 3
Anxiety
Social anxiety of childhood
no
. . . . . . . .
. . . . . . . .
. . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . .
. . . . . . . .
. . . . . . . .
ADHD
Attention deficit hyperactivity disorder
?
2 of 41
Met: 4
Might be met: 1
home: impulsivity
. . . . . . . .
. . . . . . . .
. . . . . . .
. . . . . . . .
. . . . . . . .
**Criteria met?** says whether diagnostic criteria are met or not. Definite outcomes, both positive and negative, are possible even where there are unanswered questions. A **?** means that the outcome could go either way, depending on how the **Qs to do** are completed – so it’s important to answer them.
To find and answer any omitted questions, revisit the interview and select the appropriate [Route](/using-the-software/routes) – you can then use the Route Explorer to jump to each red question mark.
# Question types
The interview is built from 11 question types which differ in either or both of two ways:
* the kind of information they capture
* how you enter your response.
The following notes cover in detail the characteristics of each question type.
{% hint style="info" %}
In the case of every question type which is completed by keying-in text or numbers (as opposed to choosing from a list, for example), you can *undo* a new entry you have started (or the changes to a previously completed entry which you are now editing) by tapping **\**.
{% endhint %}
## Text
* stores up to 255 arbitrary characters (i.e. any printable keyboard character is accepted); 255 characters correspond to about 3 lines of typing on an A4 page.
* the size of the text box on the interview form gives an indication of the scale of the response thought to be appropriate in a typical case; however, the text box will scroll to allow the editing and reading of a longer entry
* when you are typing into a text box you can open an editing window by keying **\** – this is especially helpful if the text box is not big enough to show all your text at once
* if the length of your text entry exceeds the allowed maximum, then you are prompted to deal with the situation as described at [handling of overlong text entries](/using-the-software/conducting-an-interview#handling-of-over-long-text-entries)
* deletion of the entire content of a text entry is intercepted by a request for confirmation; should deletion proceed, the question is reverted to the unanswered status
* the 'Don't know' attribute is available for Text questions – see [Don't know](#dont-know)
## Numeric
* stores numeric values (positive or negative, of more or less any magnitude)
* the minimum and maximum acceptable values are set for each question, and values outside those limits are rejected – but we have found that exceptional values do arise, so the limits are currently ‘generous’
* whether or not responses must be integral (whole number as opposed to decimal fractions such as 3.4) is set for each question
* deletion of a numeric entry is intercepted by a request for confirmation; should deletion proceed, the question is reverted to the unanswered status
* the 'Don't know' attribute is available for Numeric questions – see [Don't know](#dont-know)
## Date
* stores a date consisting of day, month and year
* the earliest and latest acceptable dates are set for each question, and values outside those limits are rejected – but we have found that exceptional values do arise, so the limits are currently ‘generous’
* deletion of a Date entry is intercepted by a request for confirmation; should deletion proceed, the question is reverted to the unanswered status
* the 'Don't know' attribute is available for Date questions – see [Don't know](#dont-know)
## Fuzzy Date
* fuzzy date questions distinguish themselves from standard questions requiring a date by having a yellow border around the answer control
* stores a date which may be incompletely known in dd/mm/yyyy format
* where a date is not fully known, a fuzzy date will accept as much of the date as is known, and will then ‘complete’ the date using question marks for missing information; this behaviour is best illustrated by a few examples:
| entry made | entry as expanded by the 3di |
| ---------- | ---------------------------- |
| ? | ??/??/???? |
| 2 | ??/??/2002 |
| 83 | ??/??/1983 |
| 1983 | ??/??/1983 |
| 11/2002 | ??/11/2002 |
| 3/5/1998 | 03/05/1998 |
* as these entries imply, the ‘finer detail’ of a date cannot be entered when the ‘grosser detail’ is not known – thus neither 18/??/1974 nor ??/25/???? would be acceptable; in practice, it is very rare for an uncertain date to be partially known other than in this hierarchical way – for example, parents do not recall the day of the month when they don’t know the month, or the month when they don’t know the year (with the exception of events associated with birthdays or other anniversaries; but even then recording the day or month is unlikely to be useful in the absence of the year)
* some Repeating Answer questions present records ordered by the entered fuzzy dates; whenever a fuzzy date is entered whose order is ambiguous relative to the dates in other records, the system will prompt for an instruction on where to ‘place’ the date – parents can almost always order events, even when they know not even their years
* the year of a fuzzy date must lie in the range 1949 to 10 years beyond the current year
* if you economise on effort by entering the year in the abbreviated ways illustrated then values from 0 to (10 + the tens part of the current year) are interpreted as in the 21st century; other values upwards from 49 are interpreted as years in the 20th century (see the examples above) – of course you can always enter “1983” rather than “83”, or “2002” rather than “2”, if you prefer
## Time (or duration) in hours and minutes
* stores a time or duration using the 24-hour notation
* the earliest and latest acceptable times of day (or the shortest and longest durations) are set for each question, and values outside those limits are rejected – but we have found that exceptional values do arise, so the limits are currently ‘generous’
* deletion of a Time entry is intercepted by a request for confirmation; should deletion proceed, the question is reverted to the unanswered status
* the 'Don't know' attribute is available for Time questions – see [Don't know](#dont-know)
## Age (or duration) in years and months
* stores an age or duration in the form of years and months, each value chosen from a drop-down list
* the youngest and oldest acceptable ages (or the shortest and longest durations) are set for each question, and values outside those limits are rejected – but the limits are currently ‘generous’
* where an Age question has dependants, you will be asked after each change you make to *either* the year *or* the month whether the entry is complete: the system cannot know whether you have also a change to make to the other part of the age, and so cannot go ahead and deal with dependants or otherwise without your confirmation
* the 'Don't know' attribute is available for Age questions – see [Don't know](#dont-know)
## Don't know
* not a free-standing question type, but a question attribute which has been applied to some instances of the foregoing question types (Text, Numeric, Date, Time and Age); it provides for the possibility that no answer is known
* where 'Don't know' is a specified question attribute, the question appears exactly as it would have done otherwise, but is preceded by a **?** 'Don't know' button whose selection disables the question. For example:
* selecting a question’s ‘Don’t know’ button qualifies the question as answered
* if a question has already been answered when 'Don't know' is selected, you are asked whether the intention really is to override the earlier response (confirmation leading to the loss of that response)
* it’s possible to unset a ‘Don’t know’ button by clicking it a second time: the question’s standard answer control is then re-enabled and the question marked as unanswered
* note that question types OptionGroup, Combo and ListMulti (see below) include 'Don't know' as a selectable response where it has seemed necessary – and so never appear with a separate 'Don't know' button
## OptionGroup (radio buttons)
* presents a selection of options from which only one may be chosen
* displays each option above a 'radio button', the buttons being arranged in a single row on the screen
* where 'Don't know' is an allowable response to the question, it is included as one of the selectable options
* making a selection causes the question to be marked as answered; it cannot then revert to unanswered, because any other selection also constitutes an answer – except through the use of [The shortcut menu](/using-the-software/conducting-an-interview#the-question-number-context-menu)
## Combo
* presents a selection of options from which only one may be chosen
* displays the options in a drop-down list
* where 'Don't know' is an allowable response to the question, it is included as one of the selectable options
* making a selection causes the question to be marked as answered; it cannot then revert to unanswered, because any other selection also constitutes an answer – except through the use of [The shortcut menu](/using-the-software/conducting-an-interview#the-question-number-context-menu)
## ListMulti
* presents a selection of options from which any number may be chosen
* displays the options in a permanently visible list (as opposed to a dropdown list)
* the option 'none applies' is automatically appended to the option set of a ListMulti question, and the option is given special handling: whereas any combination of other options may be chosen, selection of 'none applies' automatically clears any other selection; and if 'none applies' is already selected when another option is selected, 'none applies' is itself cleared
* if 'Don't know' is your interviewee’s response to the question, the 'none applies' option should be used
* note that because it can be difficult for a ListMulti to be exhaustive without also offering an unwieldy number of options, the last ListMulti option is often something like 'other - see below'; there is then a follow-up Text question in which you can enter further details; you can also use that text box to elaborate on other selections you have made from the list – for that reason, the **3di** generally does not disable the follow-up question even though you have not included the ‘other – see below’ item in your selection
* making a selection causes the question to be marked as answered; it cannot then revert to unanswered, because any other selection also constitutes an answer – except through [The shortcut menu](/using-the-software/conducting-an-interview#the-question-number-context-menu)
## Repeating Answer
* **Repeating Answer** questions allow for the fact that some questions need to be repeated for each of a variable number of 'entities' (for example, for each of the children in a family) and may well comprise a series of items (thus for each child: surname, forename, date of birth, gender, and so on)
* the system includes a question with Repeating Answers just once in the interview, but provides for the sets of answers a table to which ***records*** may be added, and in which each record captures answers to all the items about an entity (for example, a child); in most cases, a record corresponds to one row in the table; but there are instances of records with at least two rows
* some items in a Repeating Answer record may be obligatory: if one of these is left blank when you attempt to move to another record, or to another interview question, or when you try to delete the record, an error message will tell you that something is missing – and you will have to enter the information before you can continue ***or*** abandon the editing of the record by tapping **\** once or twice so that the pencil icon in the record’s left margin disappears
* similarly, some items in a Repeating Answer record may be unable to accept certain entries (for example, a date citing month 13 or having a two-digit year when four digits are expected): if one of these is incorrectly completed when you attempt to move to another record, or to another interview question, or when you try to delete the record, an error message will tell you that something is faulty – and you will have to correct your entry before you can continue, or else abandon the editing of the record by tapping **\** once or twice
* to start a new record in a Repeating Answer question:
* click into the empty record which appears below those you have completed
* or click on the new record button (the asterisk) among the navigation buttons at the foot of the subform
* or use the **\** key as described below in the last bullet relating to Repeating Answer questions
* to **abandon** a record you have begun to complete in a Repeating Answer question, just tap **\** once or twice so that the pencil icon in the record’s left margin disappears
* to **delete** a record from a Repeating Answer table, select the record by clicking over the margin at its left (the record’s margin will become highlighted) and tap **\**
* a Repeating Answer question may not be overridden by 'Don't know'
* because there may be no entities corresponding to a Repeating Answer question (e.g. no additional children in the family), such questions cannot be positively marked as not answered just because they have no entry; nor can they be reliably marked as done just because they have some entries (e.g. there might be further children); Repeating Answer questions are therefore provided with a **Mark as done** / **Mark as to do** button which toggles question status (and its own caption, of course)
* it’s important to realise that clicking **Mark as done** for a Repeating Answer question in which you have made no entries *makes a clear statement to the* 3di – for example, that the child has “no OCD symptoms” or that “there are no other children in the family”
* whereas in the body of the interview the **\** key moves you forward to the next question (and **\** moves you to the prior question), when you are in a Repeating Answer record these key presses move you from item to item (for example, from the Surname to the Forename). Keying **\** when you are in the last item in a record takes you to the first item in the next record. When you are ready to move to another interview question, you must click on the question text or the place for your answer (or use the [Interview Explorer](/using-the-software/conducting-an-interview#the-interview-explorer) or [Route Explorer](/using-the-software/conducting-an-interview#routes-and-the-route-explorer) if you want to move to a question you cannot see)
# Exporting data to SPSS
{% hint style="warning" %}
This feature was removed in 2021. If you need export functionality (e.g. for research use), please contact us.
{% endhint %}
In older versions of the 3di, the contents of patient records in the currently linked backend can be exported to an SPSS file. Whichever backend is involved (even if it resides on a removable drive) the file is saved automatically in the **SPSS** folder which sits in the same folder as your **3di** frontend – the [3di installation folder](/using-the-software/frontend-and-backends). The file is not opened automatically for inspection; indeed, the file can be created on a machine which does not have the SPSS application installed.
The file is given a name on the pattern
> **3di\_abcdef\_031105\_085710**
in which:
**abcdef** is the name of the backend from which the data come\
**031105** is the date in the form **yymmdd**\
**085710** is the time in the form **hhmmss**
You are free to rename (and delete) SPSS export files.
## Open the Patient Selector
* click **Export data to SPSS** on the Main Menu
* *or* click  on the **toolbar**
* *or* press **\** (think of **S**-elector)
## Configuring the export
* select the patients whose data you wish to export by setting the check box in the right-hand column
* if you click a button at a column head (eg **DOB**) the patients will be sorted on that value
* a clicked button has a *pressed* appearance; a second click will *release* the button, so that patients return to their default order by name
* clicking another button will replace one sort order with another (and release the button previously pressed)
* if you click a button at a column foot, it will set or clear the check box for all the related records in the right-hand column (eg clicking **Set f** will ensure that all and only females are selected)
* click **Export selected to Spss** or **Export ASD subscales to Spss** – the latter is much faster, but exports only details from the **Case Manager** together with ASD scores (both summative eg B-scale, and contributory down to the lowest level eg B1a, B1b, and so on).
* remember that the exported file will not be opened and displayed
## SPSS variables
With the exception of Repeating Answer questions (which are not currently exported), every question in the interview is represented by one or more variables in the Spss datafile. All questions of a given type (Text, Numeric, Combo and so on) share a particular pattern of Spss variables.
Also exported are all the computed outcomes of the **3di** – for example, the Children’s Communication Checklist scores, the Autistic Spectrum Disorders scores, and the results of the [Comorbidities Tool](/using-the-software/comorbidities). See [below](/using-the-software/spss#export-of-computed-values).
Each exported *question* has an Spss variable, here termed the question’s **base variable**, whose name may be derived from the question’s ID within the **3di** system as follows:
* determine the question’s ID – one way is to hover the mouse pointer over a question’s interview number (eg 5.2.8) on the interview form;
* write the ID as a four-digit number by prefixing zeroes as necessary
* prefix the result with **q** (for **q**-uestion)
For example:
| 3di system ID (Qid) | Name of Spss variable |
| ------------------- | --------------------- |
| 6 | q0006 |
| 25 | q0025 |
| 564 | q0564 |
The further details of this variable, and of any further variables associated with a question, depend upon the question’s type, as follows:
## Text
The base variable:
| property of variable | property value/s | note |
| -------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| name |
qnnnn (eg q0178)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value |
if text has been entered
text of response
otherwise, whichever one of the following is appropriate:
-ToDo-
-NotApp-
-Dk-
|
Spss does not provide a missing values device for String variables; the export system provides a work-around by inserting special text values for null text boxes.
-Dk- can appear only where the question is provided with a ‘?’ option button as well as a text box
-NotApp- can appear only where the question may be disabled as the result of responses to other questions
|
| value labels | | Spss does not provide value labels for String variables |
| missing values | | Spss does not provide a missing values device for String variables; but see note above on the value property |
Questions of type Text have no additional Spss variables.
## Numeric
The base variable:
| property of variable | property value/s | note |
| -------------------- | ---------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| name |
qnnnn (eg q0019)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| value | the numeric value entered | |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value labels |
ToDo
NotApp
Dk
|
values are mapped to labels as follows:
Note that Dk is included only where the question is provided with a ‘?’ option button as well as a box for numeric input
|
| missing values |
-1
-2
-3 (but see note on value labels)
| ie ToDo, NotApp and Dk are treated as missing values |
Questions of type Numeric have no additional Spss variables.
## Age
The base variable:
| property of variable | property value/s | note |
| -------------------- | ---------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| name |
qnnnn (eg q0113)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| value | the age entered in the separate dropdowns for years and months converted into an age in months | for example, an age entered as 3 years 5 months would be exported to Spss as the value 41 (ie 3 x 12 plus 5) |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value labels |
ToDo
NotApp
Dk
|
values are mapped to labels as follows:
Note that Dk is included only where the question is provided with a ‘?’ option button as well as dropdowns for years and months
|
| missing values |
-1
-2
-3 (but see note on value labels)
| ie ToDo, NotApp and Dk are treated as missing values |
Questions of type Age have no additional Spss variables.
## Date
The base variable:
| property of variable | property value/s | note |
| -------------------- | ---------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------ |
| name |
qnnnn (eg q0615)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value |
if a date has been entered: date entered, in the format dd-MMM-yy otherwise no value is exported
| eg 04-JUN-97 |
| value labels | | No practical use can be made of value labels for dates |
| missing values | | Spss does not provide a missing values device for Date variables |
Questions of type Date have no additional Spss variables.
## Time
The base variable:
| property of variable | property value/s | note |
| -------------------- | -------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------ |
| name |
qnnnn (eg q0024)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value |
if a time has been entered time entered, in the format hh:mm:ss otherwise no value is exported
| eg 21:30:00 |
| value labels | | No practical use can be made of value labels for times |
| missing values | | Spss does not provide a missing values device for Time variables |
Questions of type Time have no additional Spss variables.
## Combo and OptionGroup
The base variable:
| property of variable | property value/s | note |
| -------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------ |
| name |
qnnnn (eg q0248)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| value | the **3di**’s numeric encoding for the selected item | |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value labels |
the precise text of the items from which a single selection is made (combo box dropdown text items or option button labels)
option\_1
option\_2
…
option\_n
and
ToDo
NotApp
|
for example:
and
|
| missing values |
-1
-2
| ie ToDo and NotApp are treated as missing values |
Questions of type Combo or OptionGroup have no additional Spss variables.
## ListMulti
The base variable:
| property of variable | property value/s | note |
| -------------------- | ------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------ |
| name |
qnnnn (eg q0853)
| see [Spss base variable](#the-values-exported-and-the-spss-variables-which-receive-them) on the naming of a question’s base variable |
| value | the count of items selected from the list box *except that if ‘none applies’ has been selected, then a count of 0 is exported* | thus any value greater than 0 means a ‘positive’ response to the question; and the larger the value the ‘stronger’ the response |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value labels |
ToDo
NotApp
| v3eASWBhtVni |
| missing values |
-1
-2
| ie ToDo and NotApp are treated as missing values |
Questions of the type ListMulti have additional Spss variables. In addition to the base variable for the ListMulti question, one variable for each item in the list box is present, built on the following pattern:
| property of variable | property value/s | note |
| -------------------- | ------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| name |
qnnnn#NN (eg q0853#01)
| **NN** runs from ‘01’ to the number of items in the list box; the variable **qnnnn#01** always corresponds to the ‘**none applies**’ item which appears first in every list box |
| value |
if item #NN has not been selected
0
otherwise
1
| |
| label | text of question | tokens (such as *%name* for the patient’s name) remain unsubstituted |
| value labels |
two labels, as follows:
- (ie the dash character)
text of item #NN in list box
| *for example*: |
| missing values | none assigned | ToDo and NotApp are conveyed by the base variable for the question; where either of these applies, nothing is exported to the ‘item’ variables (which therefore appear as ‘system missing’) |
## Export of computed values
As well as the responses to individual questions, many *computed* outcomes of the **3di** are exported to SPSS. These include the Children’s Communication Checklist scores, the Autistic Spectrum Disorders scores, and some results from the [Comorbidities Tool](/using-the-software/comorbidities).
The SPSS variables which receive the exported outcomes are fully described by their SPSS labels: hover the pointer over the variable name at the head of a column in the SPSS data file to see the label (or switch to variable view in SPSS).
# Clinical background
# The four ASD assessments
## Background
Within the 3di's autism provision, there are four different assessments:
1. ICD-10 ASD extended
2. ICD-10 ASD brief
3. DSM-5 ASD extended
4. DSM-5 ASD brief
In total the 3di has a bank of nearly 900 questions, all of which are listed in the [Interview Explorer](/using-the-software/conducting-an-interview#the-interview-explorer). However, in typical usage you will answer only a much smaller set of questions drawn from this bank, known as a [route](/using-the-software/routes). Each ASD assessment has its own route, scoring algorithm, and scoring tables in the [Word reports](/using-the-software/reports).
The four assessments were added to the software over 25 years of research and use. In contemporary training, we only teach the newer DSM-5 assessments. However, the older ICD-10 assessments are still present in the latest 3di software for use by those who trained in them.
The ASD routes contain only those questions which contribute to the scoring tables in the report. They do not contain the qualitative questions about the child's family, medical and educational history. For a richer report, you can complete these in advance using [pre-entry](/using-the-software/pre-entry-forms), or during the interview via the [Interview Explorer](/using-the-software/conducting-an-interview#the-interview-explorer).
## The ASD assessments today
### 1. ICD-10 extended
This was the first ASD algorithm implemented in the 3di, around 2004. Its scoring is based on 134 questions. The corresponding route is *ASD\_extended (ICD-10)*.
This original 3di assessment was published in [The developmental, dimensional and diagnostic interview (3di): a novel computerized assessment for autism spectrum disorders](https://doi.org/10.1097/00004583-200405000-00008) and is the most widely translated and validated version in languages other than English.
In current 3di versions, if you want to run this assessment, you will have to choose to include its scoring tables in the report via the [Preferences form](/using-the-software/reports#including-icd-10-scores). The output of this algorithm appears only in the extended report, under the heading *ICD-10 ASD*. It does not appear in the brief report.
Previously, the ICD-10 extended was known simply as *ASD\_extended*.
### 2. ICD-10 brief
This was the second ASD algorithm implemented in the 3di, around 2009. Its scoring is based on 61 questions. The corresponding route is *ASD\_brief (ICD-10)*.
The derivation and validation of this assessment was published in [The construction and validation of a short form of the developmental, diagnostic and dimensional interview](https://doi.org/10.1007/s00787-009-0004-0). It also sees widespread use especially in non-English translations of the 3di.
In current 3di versions, if you want to run this assessment, you will have to choose to include its scoring tables in the report via the [Preferences form](/using-the-software/reports#including-icd-10-scores). The output of this algorithm appears only in the brief report, under the heading *ICD-10 ASD*. It does not appear in the extended report.
Previously, the ICD-10 brief was known simply as *ASD\_brief* or sometimes *3di-sv* for '3di short version'.
### 3. DSM-5 extended
This was the third ASD algorithm implemented in the 3di, around 2013. Its scoring is based on 177 questions. The corresponding route is *ASD\_extended (DSM-5 Crit A+B)*.
This output of this algorithm appears only in the extended report, and not in the brief report, under the heading *DSM-5: ASD extended assessment*.
### 4. DSM-5 brief
This was the fourth ASD algorithm implemented in the 3di, in 2022. Its scoring is based on 66 questions. The corresponding route for this algorithm is named *ASD\_brief (DSM-5 Crit A+B)*.
This output of this algorithm appears in both the brief and extended reports, under the heading *DSM-5: ASD brief assessment*.
## Scoring details
Your [3di installation folder](/using-the-software/frontend-and-backends#the-3di-and-the-disc-filing-system) contains a Reference subfolder with details of how the four algorithms work.
* For algorithms 1 and 2, *ASD\_three-domain\_scales\_defined* and *ASD\_diagnosis\_flowcharts\_3\_domain* describe the algorithm for computing scores, and the rules for determining if diagnostic criteria have been met. *ASD\_scales\_Ref* details which individual questions contribute to each subscale.
* For algorithms 3 and 4, *DSM-5\_ASD\_scoring* describes the algorithm, while *ASD\_scales\_Ref* details which individual questions contribute to each subscale.
## 3di-adult
You may have heard about this assessment. The 3di-adult is a standalone pen-and-paper tool developed as part of a research project, which drew on the 3di question bank. The 3di-adult has not been implemented in the 3di software, and presently there are no plans to do so. You can read about the 3di-adult [here](https://link.springer.com/article/10.1007/s10803-017-3321-z).
The 3di software is currently not suitable for the assessment of adults.
# A brief history
The 3di was initially developed as a research tool starting around 1998 at the Great Ormond Street Institute of Child Health under the direction of Professor David Skuse. The World Health Organisation's *International Statistical Classification of Diseases and Related Health Problems, 10th revision*, or ICD-10, came into effect in 1993. Meanwhile the American Psychiatric Association's *Diagnostic and Statistical Manual of Mental Disorders, fourth edition*, or DSM-IV, was published in 1994. The 3di treated the two systems as broadly equivalent, and the 3di's first ASD assessment was built around an amalgamation of ICD-10 and DSM-IV criteria.
The first autism assessment in the 3di, now known as the *ICD-10 extended*, contained 134 questions, and was designed for research use where there was sufficient time for such a thorough assessment.
Over the following years, demand grew for a quicker autism informant interview for use in CAMHS clinics where there was less time available. This led to the development of the *ICD-10 brief* assessment.
DSM-5 came into effect in 2013, followed by ICD-11 in 2022. The 3di was updated with a new *DSM-5 extended* assessment for autism in 2013. Finally in late 2022 the *DSM-5 brief* assessment was released.
Comparing DSM-5 and ICD-11, we consider that by design the two sets of criteria are so similar that ASD outcomes (and many others) can be reported as DSM-5 or as ICD-11. The 3di always references DSM-5 because the APA got there many years before the WHO; you can substitute one term for the other in your reports or perhaps reference neither.
# Setup
# The 3di licence
## Licence terms
On completion of the 3di training course, trainees are awarded a licence to use the 3di software on the following terms:
* This licence is without limit in time
* For use by the licensee, the software may be installed in more than one setting
* For example, in two clinics and on a machine used in private practice
* Clinical use of the software is limited to the licensee
* However, in exceptional circumstances such as the licensee’s illness, the licensee may authorise another licensed user of the 3di5 to use an existing installation
* For administrative purposes such as the entry of data gathered from carers and schools the software may be used by a colleague authorised and suitably instructed by the licensee
## Understanding the licence
The 3di is licenced per clinician, not per computer or by organisation. The clinician retains their licence even if they move between employers.
The licence is granted only as part of the training course. The skills to use the software depend on the training and the licence is not transferrable.
Receiving 3di training entitles you to install and use the 3di on more than one machine, for example a work desktop and a personal laptop. After training you may reinstall the 3di version you received on a different machine.
The licence pertains only to the version of the 3di software which you receive at the time of training. Newer versions of the software are released from time to time. Upgrades to new versions may be available on a chargeable basis.
# Installation
Most 3di users work in an institutional setting where an IT department manages their computer. Normally, you will need to ask your IT support to install the 3di for you.
**Users who manage their own computer directly:**
When you sign up for training, we will send you detailed download and installation instructions before the course. This page contains a copy of those instructions.
**IT support teams:**
The rest of this page including [#installing-the-3di-in-an-institutional-setting](#installing-the-3di-in-an-institutional-setting "mention") explains how to set up the 3di for your users.
{% hint style="info" %}
Please ensure you understand [The 3di licence](/setup/the-3di-licence) and [Looking after your data](/setup/looking-after) before installing the 3di software.
{% endhint %}
## Windows and Office
The 3di software requires:
* Microsoft Windows 10 or Windows 11.
* Microsoft Office 365, including both the Word and Access components.
Microsoft provide many subscription options for Office, which are constantly changing. All but the cheapest plans include Access. Check [here](https://www.microsoft.com/en-gb/microsoft-365/buy/compare-all-microsoft-365-products) for personal subscriptions, or [here](https://www.microsoft.com/en-gb/microsoft-365/business/microsoft-365-plans-and-pricing) for business plans. If in doubt, contact us.
## Obtain the installer
To get started, you will need a copy of the installer file.
The installer has a filename like `3di5_uk_230122_setup.exe`. This filename includes the version number **`23`****`01`****`22`** of the software in **yy****mm****dd** format, that is **year** **month** **day**. A suffix denotes a sub revision.
You will receive a copy of the installer file prior to your training course. To find the installer, open the Windows Start menu and type '3di5\_uk'. If the installer file is present on your machine, a file name ending in 'setup.exe' will appear in the list.
If you cannot find the installer, please [get in touch](mailto:contact@ixdx.org) for a new copy. There is typically a charge for this service and we may require you to upgrade to a more recent version, since we cannot offer technical support for very old 3di versions.
The instructions below cover the current 3di versions that we distribute. Steps to install very old 3di versions can be found [here](/setup/installation-old).
## Installation steps
1. Run the 3di installer.
1. You may be asked if you trust the installer file. Say Yes.
2. You will need to agree to the licence.
3. Choose the installation folder. The default is your desktop, which is fine for most users.
4. Click the Install button.
5. The 3di installer will run to completion and you can click the Close button.
2. Once the installer has completed, launch the 3di by double-clicking the 3di5\_run shortcut on your desktop.
3. The first time you run the 3di you will have to tell Access that you trust the software. These steps only need to be performed once.
1. Click OK when you see an error saying that active content is blocked.
2. When the following dialog appears, click on Stop all macros.
3. On the yellow bar near the top of the window, click Enable content.
4. If you have navigated the above warnings correctly, you should now see the Main menu window with 'no backend' loaded.
5. Continue to [Confirming the 3di is working](#confirming-the-3di-is-working).
## Confirming the 3di is working
1. Open the 3di and navigate to the purple Main menu.
2. Click *Select and open backend*.
3. Choose the backend named *Training5* from the list, then click *Open selected backend*.
4. Open the Case Manager by clicking the 🙂 button on the Add-ins ribbon.
5. Choose any child from the *Find:* dropdown at the top of the form.
6. Click the button *Generate full report*. Within a minute this should produce a Word document. The document may open in the background. If you can't see it, check the taskbar at the bottom of your screen.
7. Verify that the 3di interview forms open properly:
1. In the Case Manager, click on the button *Revisit interview* on the salmon-coloured central portion of the form.
2. Opening the interview can take 30 seconds or so on a slower machine, so ignore any early messages about "Access not responding". If an interview form doesn't appear in under two minutes, this may indicate a problem with your Access installation and you should contact us.
8. Close the 3di by clicking the 🗙 at the top-right of the application window.
## Installing in an institutional setting
These instructions apply if your computer is managed by someone other than the clinician who will be using the software.
You may find that your computer has administrative policies applied which mean you, the clinician, do not have permission to install the 3di or other software. If this is the case for your computer, please show these instructions to your IT department.
The rest of this section assumes that you are an IT administrator with the necessary powers to install software on the target machine.
### Dependencies
The target machine will need Windows and Office installed, as described [above](#windows-and-office). Microsoft Access must be installed, and your institutional policy may exclude this by default.
### **Simple installations**
If the clinician's machine is a regular Windows installation with their software and documents stored locally on the hard disk (not on a network share), then installation is straightforward.
The contents of the 3di installation folder must be readable and writeable by whichever Windows account the clinician uses to run the software and administer assessments. By default, the 3di installs to the user's Desktop folder, which usually meets this condition. Elsewhere in their user folder is fine too. Installing under Program Files will *not* work since unprivileged users do not have write permissions for this folder.
Since 2025, the 3di installer does not automatically run as Administrator. Since it only copies files into a folder which must be user-writeable, typically the user's Desktop, elevated privileges are not needed or helpful. If you run the installer as Administrator and install to a folder which the regular user cannot write to, you will be left with an unusable installation.
Typically then, you can just follow the instructions [above](#id-210110-or-newer) aimed at regular users.
In the rare event that Microsoft Access Runtime is present from a prior 3di installation (pre 2021), this should be uninstalled to ensure that Access database files are associated with the most recent installed version of Office, and not the Runtime.
To test your install was successful, follow the steps in [Confirming the 3di is working](#confirming-the-3di-is-working).
### **Networked installations**
The 3di is written in Microsoft Access. As with many Access applications, the 3di is split between two .mdb files, the so-called frontend and backend. The frontend is the part the user double-clicks to load in Access, and contains all of the code. The backend stores patient records. One frontend can switch between multiple backends. During the training course, trainees use the *Training5* backend which contains sample data. After that they will create their own backend, and likely never think about backends again, since a backend can store any number of patient records. The usual reason to switch backends is to transfer data between machines or allow collaboration in a research setting.
While it is possible to store the frontend or backend on a network share, **our experience is that on slow or laggy wifi with the backend stored remotely, the 3di software can become unusable.** Due to the huge diversity of network technologies, in the event of a problem we will usually be unable to help and can only direct you to the Microsoft Access documentation, or your network/remote software vendor's support options.
### The installation folder
After a fresh install, the 3di installation folder looks like this:
```
📁 3di5_uk_251219a ─ Root folder, normally located on user's Desktop
│
├───📁 Backends ─ The Backends folder has one subfolder per backend
│ │
│ ├── 📁 Training5 ─ A special backend with sample data for training
│ └── 📁 MyBackend ─ A user-created backend, normally there is only one
│ │
│ └──📁 Cases ─ User-generated Word reports are output here
│
├── 📁 PreEntry ┐
├── 📁 Reference ├ Must remain in same folder as the frontend
├── 📁 Resources ┘
│
└── ⚒️ 3di5_uk_251219a.mdb ─ The frontend: the main 3di 'program'
```
The default 3di install location is the user's Desktop folder. This is usually the best choice although anywhere the user has write access is fine (so *not* in `C:\Program Files`). The user needs to be able to find the 3di5\_run shortcut which the installer places on the Desktop and in their Start Menu. This shortcut simply points to the frontend .mdb file and must be adjusted if you move the frontend after installation.
It is most simple and reliable to keep the whole folder intact. However it is also possible to keep the Backends folder on a drive separate from everything else. This might be desirable when patient data must live on a designated drive distinct from where programs are installed. To achieve this, move the Backends folder to the other drive, then from the 3di Main menu click *Select and open backend* and navigate to the new Backends location.
It is essential that all the other subfolders of the root installation folder (Resources etc.) are kept together in the same location relative to the frontend .mdb file, or the software will not work.
The installation folder is under 100 MB when new. Each new case created by the user typically adds under 1 MB to the Backends folder, including generated reports.
We recommend against placing the 3di folder on a cloud-synchronised storage service such as OneDrive, Dropbox, or Google Drive. Microsoft Word and cloud-sync tools do not always treat files with the same name and location as distinct documents, even if one has been deleted and recreated. In some circumstances, previously deleted content can reappear when a report is regenerated. For reliable behaviour, install the 3di in a local (non-cloud-synced) folder.
When running from a network share:
1. A slow or erratic connection to the share will result in a poor user experience.
2. You will need to tell Access that the frontend file can be trusted via the Access *Trust Center*. You must tick an additional checkbox to allow network locations to be trusted.
3. Backends must not be accessed by multiple copies of the 3di running concurrently. This will cause errors and probable data loss. Therefore in a networked setup you must make sure this is impossible.
4. If you configure the 3di to store its backend on a network drive but that drive isn't available (for example if it depends on a VPN service that hasn't started), the 3di will prompt the user to create a new backend on a local drive. Users may not understand what is going on, and end up being unable to find patient records.
### **Other notes**
* After installation, you should go through the steps in [Confirming the 3di is working](#confirming-the-3di-is-working) to ensure the clinician has a smooth experience when they first launch the 3di. Hitting a problem in the first clinical session is bad news!
* You can perform an additional step to make the 3di easier to use:
1. With the 3di open, click *File → Options → Customize ribbon*.
2. In the right-hand pane, deselect every Office tab apart from *Add-ins*. This ensures that only the 3di toolbar is displayed, and hides toolbars that are irrelevant.
3. Click OK to exit.
* The installer can be run silently (for example as part of a script for use with SCCM or other software deployment tools) and with the installation path set from the command line using the `/S` and `/D` switches respectively. The installer is built using NSIS, therefore the standard NSIS flags are available as documented in section 3.2.1 [here](https://nsis.sourceforge.io/Docs/Chapter3.html#installerusage).
## Running the 3di on a Mac
The 3di software is designed for Windows and we cannot officially support running it on Apple Mac computers.
Some users do run the 3di on a Mac using software such as *Parallels*, which allows Windows applications to run within macOS. For technically confident users, setting this up is usually straightforward. However, we cannot provide technical support for this configuration, and you will have to proceed 'at your own risk'. If the 3di doesn't work on your Mac, we likely will not be able to help.
There are additional costs to this route. The typical steps are to purchase a Parallels licence, purchase a Windows licence and install Windows inside Parallels, then finally install the 3di software inside the Windows virtual machine according to our usual installation instructions.
# Looking after your data
It is vital that the patient data you record by running **3di** interviews, and the reports the **3di** generates from those data, are both secure (protected from unauthorised access) and backed up (protected from damage or loss). If you are working in an institutional environment such as the NHS or other healthcare provider where your computer is managed centrally, these requirements are usually met by your employer, who will describe and enforce the related practices you must follow.
If you are working as an individual and using your own personal laptop, then you become responsible for the management of patient data. You need to consider steps such as:
* encrypting your device, e.g. with the help of BitLocker in Windows
* controlling access to your computer with the use of strong passwords or biometrics
* backing up your data, e.g. by synchronising files to secure cloud storage such as Microsoft OneDrive.
We cannot make definitive recommendations – not least because the technologies and their vulnerabilities are constantly changing.
The 3di software is implemented in Microsoft Office, specifically the Access and Word components. The 3di is a completely 'offline' program and does not access the web. All your patient data and the program itself are stored in files on disk, and are therefore subject to the same considerations as other Office documents.
However you ensure the protection of your data it will help to recall how the 3di organises its files – refer to [**The 3di and the disc filing system**](/using-the-software/frontend-and-backends#the-3di-and-the-disc-filing-system). Inside a **Backends** folder you will find a folder for each of your backends. Within the backend folder **Clinic** you would find the backend data file **3di2\_Clinic\_be** — that’s the file which records everything you have entered on the **3di** interview forms and so must be treated as sensitive patient data. You would find also a folder called **Cases**, and within that folder a collection of folders with six-digit names such as **000004** or **000127**: in each of these folders are all the Reports and other documents relating to the child whose **Case\_ID** appears in the cyan box at the top-right of the **Case Manager**. Accordingly, copying or synchronising an entire backend folder (in this example, the folder called **Clinic**) backs up all recorded data and all **3di** clinical reports.
Should just the backend file **3di2\_Clinic\_be** become damaged or lost, you would replace it with the synchronised or copied version. Should the damage also affect your Reports, you would replace the complete **Clinic** backend folder with the synchronised or copied backup.
# Upgrading
## Installing different versions in parallel
When you [install the 3di](/setup/installation), by default an installation folder is created on your desktop containing the 3di program (frontend) and also the Backends folder which stores your interview data and reports. This is explained in [Frontend and backends](/using-the-software/frontend-and-backends).
The name of the installation folder contains the 3di version number. Therefore it is possible and completely reasonable to install two 3di versions in parallel. By default, each will use its own local Backends folder, so your cases will not be shared between the versions. Our recommended approach is to [create a new backend](/using-the-software/the-main-menu#create-and-open-backend) in the Backends folder of the new version and use that for new cases, while retaining the old 3di installation for when you want to revisit past cases.
## Using backends from an earlier version
Due to changes in interview content and scoring, we do not recommend that you load a backend from an older version into a newer version of the 3di frontend. Normally this is not necessary because you can simply load older cases in the previous frontend version if you need to revisit them. However, if you do need to do this, such as when dealing with historic research datasets, please contact us ().
# Renaming of old routes
{% hint style="info" %}
This page is only relevant to users of previous versions of the 3di released before 2025, and can be ignored by new 3di users.
{% endhint %}
The system routes built in to the 3di have been renamed over the years. This page serves as a reference for users of previous versions of the 3di.
### 2022-2024 versions
Route name
Description
# questions
ASD_brief (DSM-5 Crit A+B)
Brief assessment for Autism Spectrum Disorder using DSM-5 criteria
66
ASD_extended (DSM-5 Crit A+B)
Extended assessment for Autism Spectrum Disorder using DSM-5 criteria
177
ASD_brief (ICD-10)
Brief assessment for Autism Spectrum Disorder using ICD-10 criteria (obsolete)
61
ASD_extended (ICD-10)
Extended assessment for Autism Spectrum Disorder using ICD-10 criteria (obsolete)
134
Starting with 3di versions in 2023, the ASD\_brief and ASD\_extended routes come in two variants, one for each of the diagnostic criteria ICD-10 and DSM-5.
The new *ASD\_brief (DSM-5 Crit A+B)* route corresponds to the **DSM-5: ASD brief assessment** table in Word reports. The new *ASD\_extended (DSM-5 Crit A+B)* route corresponds to the **DSM-5: ASD extended assessment** table in Word reports.
The questions, routes and reporting tables for the ICD-10 criteria are present and unchanged from previous 3di versions, although the routes have been renamed to make the scoring criteria explicit: *ASD\_brief (ICD-10)* is the old *ASD\_brief*, and *ASD\_extended (ICD-10)* is the old *ASD\_extended*. The old reporting tables can still be generated, but you will have to [opt-in](/using-the-software/reports#including-dsm-4-scores) to include them in your reports. Note that according to UK guidelines the ICD-10 criteria are now considered to be superseded by DSM-5/ICD-11, and the the older routes are marked as obsolete.
The routes *ASD\_brief+DSM-5* and *ASD\_extended+DSM-5* have no equivalent in versions of the 3di from 2023 and later. Those routes combined questions from ICD-10 and DSM-5, which are now treated separately.
### 2021 version and before
Route name
Description
# questions
ASD_brief
Brief assessment for Autism Spectrum Disorder using ICD-10 criteria
61
ASD_extended
Extended assessment for Autism Spectrum Disorder using ICD-10 criteria
134
ASD_brief+DSM-5
All questions from ASD_brief, plus all questions from the extended DSM-5 ASD assessment
184
ASD_extended+DSM-5
All questions from ASD_extended, plus all questions from the extended DSM-5 ASD assessment
193
The *ASD\_brief* and *ASD\_extended* routes are the basis of the table in Word reports named **Autism Spectrum Disorder subscales**, which applies ICD-10 scoring criteria.
* In the brief report – when you click the button *Report ASD\_brief* – the table draws on the 61 questions of the *ASD\_brief* route.
* In the full report – when you click the button *Report (with ASD\_extended)* – the table draws on the 134 questions of the *ASD\_extended* route.
There are also two longer route variants *+DSM-5* containing additional questions which enable the **DSM-5 scales for ASD** tables to be populated in the reports. Those tables apply the DSM-5 scoring criteria.
# Release notes
Summary of changes to the software by version
## Note on version numbers
The 3di installer has a filename like `3di5_uk_230122_setup.exe`. This filename includes the version number **`23`****`01`****`22`** of the software in **yy****mm****dd** format, that is **year** **month** **day**, so in our example 22 January 2023. Sometimes you will see a suffix **x** which denotes a sub revision.
Version numbers of this form are also used in the documents provided in the **PreEntry** and **Reference** subfolders of your 3di installation. Sometimes the version numbers of these documents are much older than your 3di software — it doesn't mean the document is out of date, just that it hasn't needed any changes in a while.
## Changes
This section lists all changes introduced to the 3di, organised by version in reverse chronological order (newest first).
If you are upgrading from an earlier version, read the entries below starting with the first version *after* the one you have been using, and continue upwards.
Changes introduced in 251219a
### Summary
This release fixes a single minor scoring issue.
#### #133 DSM-5 extended question 713 reversed scoring
Fixes inverted scoring of question 713 (8.10.2) in the DSM-5 ASD extended assessment.
This question reads:
*And now I'd like us to look briefly at Sam's relationships with others. Would you say that: - she has at least one or two good friends*
* A response of "definitely applies" was incorrectly treated as the more symptomatic option, inflating the *A3d Developing and maintaining relationships - Making friends* score by 9%.
* A response of "no, does not apply" was incorrectly treated as the less symptomatic option, producing no increase in the subscale score when it should raise it by 9%.
This fix reverses the scoring of those two options to produce corrected subscale percentages.
Note that in the DSM-5 ASD extended assessment, we recommend you always complete every question on the route before generating the report. If you do not, the above errors could be amplified, since questions you did not answer are scored by averaging the answers from those you did.
Changes introduced in 251219
### Summary
Changes have been made which correct and improve the scoring of the DSM-5 ASD brief assessment. This is accompanied by revised guidance on interpretation of report scores, communicated to users separately. This includes a tightening of eligibility criteria and the requirement that every question in the assessment must be assigned a scorable response in order to compute percentage scores.
Minor corrections have also been made to the scoring of the DSM-5 ASD extended assessment.
Small changes have been made to clarify the user interface and address usability bugs.
### Clinically relevant changes
These changes relate to the clinical content of the 3di software and alter the interview content, scoring or reporting in some way.
#### #78 DSM-5 brief question 317 reversed scoring
Fixes an issue in the DSM-5 ASD brief assessment where inverted scoring was applied for question 317 (12.2.4) "*Does Sam vary her behaviour appropriately according to whom she is with or where she is?*". The "never" response was scored as asymptomatic with 0 points, while the "often" response was scored as symptomatic with 2 points. The scoring is now corrected.
For a full description, see *alg4 errata November 2025*.
#### #79 DSM-5 brief "with social impact" questions are scored too low
Fixes an issue in the DSM-5 ASD brief assessment where the "with social impact" response for six questions in Criterion B incorrectly led to no increase in the subscale percentage scores.
For a full description, see *alg4 errata November 2025*.
#### #81 Notes may be missing from report
Fixes an issue in the feature which allows you to record written notes on individual questions while conducting the interview. Not all notes relevant to an assessment appeared underneath the relevant scoring tables in the report. Some notes would appear twice. Now, any notes taken on a question in one of the four ASD assessments appear exactly once underneath the scoring table for that assessment.
#### #93 Assign distinct score to "with social impact" responses
Fixes an issue where several questions that had a "with social impact" response were not scored optimally. This change is in addition to #79 above.
In the DSM-5 ASD brief assessment, each scorable question contributes equally to its subscale. Responses are mapped linearly to values between 0 and 1, averaged, and expressed as a percentage.
Seventeen questions under Criterion B offer four response levels, the highest being "with social impact". Previously, the top two response levels were both mapped to the maximum score, while the second level ("minimal or transient") was mapped to half of that, and the lowest level to zero. Therefore although four response options were available to the clinician, only three distinct scoring outcomes existed.
To restore consistency with the rest of the instrument, all four levels now receive distinct scores, evenly spaced across the 0-1 range (0, ⅓, ⅔, 1). According to our research as communicated in *alg4 errata November 2025*, this produces a small but measurable improvement to the sensitivity and specificity of the instrument to predict autism diagnoses.
#### #94 DSM-5 brief should report applicability warnings
The applicability criteria for the DSM-5 ASD brief assessment have been formalised:
1. The child must be at least 5 years old at time of interview.
2. The child must have at least fluent speech, as recorded in question 8.1.1.
3. All of the 63 scorable questions of the route *ASD\_brief (DSM-5 Crit A+B)* must have been completed with scorable responses in order to generate the scoring table in the report.
A warning now appears underneath the scoring tables if either of condition 1 or 2 is not met.
If condition 3 is not met, the scoring tables do not appear at all. Since the DSM-5 ASD brief assessment is already of reduced length, we consider it essential to answer every question with a scorable response.
#### #95 DSM-5 extended question 729 reversed scoring
Fixes inverted scoring of question 729 (8.9.11) in the DSM-5 ASD extended assessment.
This question reads:
*I'd like to ask a few questions about the way in which Sam relates to others in conversation. Would you say that: - she makes good use of gestures to get her meaning across?*
* A response of "definitely applies" was incorrectly treated as the more symptomatic option, inflating the *A2e Non-verbal social communication - Body language* score by 7%.
* A response of "no, does not apply" was incorrectly treated as the less symptomatic option, producing no increase in the subscale score when it should raise it by 7%.
This fix reverses the scoring of those two options to produce corrected subscale percentages.
Note that in the DSM-5 ASD extended assessment, we recommend you always complete every question on the route before generating the report. If you do not, the above errors could be amplified, since questions you did not answer are scored by averaging the answers from those you did.
#### #96 DSM-5 extended B1a scores are confined to range 0-73%
Fixes the scoring of the "unable to judge" response to 12 questions in *B1 Stereotyped behaviours - Stereotyped and repetitive speech* in the DSM-5 ASD extended assessment.
In the DSM-5 ASD extended assessment, every scorable question takes responses from among 2, 3 or 4 levels of symptom severity or frequency. The subscale percentage score is computed by mapping each response to a number between 0 to 1, taking the average of these, then expressing the result as a percentage.
The "unable to judge" option is intended to be unscorable: if selected, the question should be excluded and its contribution replaced by the mean of the remaining scorable items.
Previously, "unable to judge" was incorrectly treated as a fourth, maximum level of severity. "definitely applies" should have been the maximum level, but a child with every "definitely applies" response selected would achieve a score of only 73% in *Stereotyped and repetitive speech*.
The fix restores the correct behaviour:
* "unable to judge" is treated as an unscorable response and excluded from the calculation.
* The remaining three levels are scored on the usual 0–½–1 mapping.
A maximally symptomatic child with all scorable responses will now correctly receive 100% for this subsubscale.
#### #99 Update wording of q99
Alters the wording of question 11.8.9 in interview subsection *11.8: Negative sensory reactions*. This reflects that hand dryers are nowadays a more common source of loud noise than vacuum cleaners.
#### #100 Reword four CCC questions
Four questions in interview section 8: Language and non-verbal communication have minor changes to their wording to bring them up to date. Specifically, the wording of the following has been updated: question 698 (8.8.2), question 701 (8.8.5), question 711 (8.9.14), question 723 (8.11.3).
#### #102 DSM-5 extended question 1227 reversed scoring
Fixes inverted scoring of question 1227 (10.3.7) in the DSM-5 ASD extended assessment.
This question reads:
*Does Sam interrupt other people (more than you would expect for her age), or intrude into their conversations, or into other children’s games?*
* A response of "never" was incorrectly treated as the more symptomatic option, inflating the *A.3 Developing and maintaining relationships - Adjusting behaviour to suit social contexts* score by 11%.
* A response of "often" was incorrectly treated as the less symptomatic option, producing no increase in the subscale score when it should raise it by 11%.
This fix reverses the scoring of those two options to produce corrected subscale percentages.
Note that in the DSM-5 ASD extended assessment, we recommend you always complete every question on the route before generating the report. If you do not, the above errors could be amplified, since questions you did not answer are scored by averaging the answers from those you did.
#### #115 Count of questions to do is inconsistent
Fixes an inaccurate question count in the "Qs to do" column of the ASD report tables.
In the report, this column describes how many questions were left unanswered on the relevant interview route. Three questions were not correctly counted in this column: q226 (8.8.8), q625 (8.9.7), and q757 (11.6.4). The "Qs to do" count is now accurate.
#### #122 Remove colour highlighting of ASD table rows
In the Word reports, the tables which report ASD scores in terms of percentages no longer feature yellow highlighting according to built-in thresholds. Instead, users will separately be issued with guidance on how to interpret these scores.
### Non-clinical changes
These changes affect the user experience of the 3di software, but not in a way which changes the interview content, scoring or reporting.
#### #12 Selecting no backend causes unrecoverable error
Fixes an issue where double-clicking the list of backends under *Select and open backend* caused the application to become unusable until restart.
#### #75 Use better names for report buttons
To better reflect their purpose, the two buttons which generate Word reports have been re-labelled:
Report (with ASD\_extended) → Generate full report
Report ASD\_brief → Generate brief report
#### #77 Update route descriptions
The system route descriptions have been modified slightly for clarity. Following the previous release, there are only seven system routes.
#### #90 Cannot create report when default Word format has been changed
Fixes an issue where creating a report failed when the Word default file format was set to something other than the standard Word format, .docx.
#### #103 Remove ResearchPapers from installation folder
The ResearchPapers folder is no longer distributed as part of the 3di installation folder. Find a more up-to-date reading list on our website at .
#### #104 Remove Tools from installation folder
The Tools folder is no longer distributed as part of the 3di installation folder.
#### #105 Remove binaries from 3di Resources subfolder
The 3di is now compatible only with 32-bit or 64-bit Office 365 and not previous Office versions. Several program files no longer need to be distributed with the software.
#### #107 3di installer no longer runs as Administrator
The 3di installer no longer makes any changes at the system level, and no longer prompts to run as Administrator. The default 3di install location remains the user's Desktop folder. For more details, see the installation chapter of the online user guide.
Changes introduced in 250215
### Summary
Some non-ASD Word report elements have been removed. The detailed DSM-5 ASD brief scoring table has also been removed.
Short explanatory text and colour highlighting have been added to the Word report for clarity.
Numerous disused built-in Routes have been removed.
### Detail
1. (#54) Remove table 'DSM-5 scales for SCD, Criteria A and B' from full and brief reports.
2. (#55) Remove the section 'Restricted or Repetitive Behaviours and Interests' which appears in the full report.
3. (#56) There are two tables under 'DSM-5: ASD extended assessment' and two tables under 'DSM-5: ASD brief assessment' which have a column heading including the text 'bigger = poorer'. This text is replaced by '% maximum severity'.
4. (#60) Add colour highlighting to the table under 'Children's communication checklist'.
1. Rows where the score meets the criterion under column 'Severe deficit if score:' are highlighted in colour.
2. Scale X receives colour highlighting if the child's score is less than or equal to 130.
3. Display the <= 130 threshold for Scale X where currently we just have '-'.
5. (#61) Add colour highlighting to the table under 'Attention Deficit Hyperactivity Disorder (ADHD)'. Rows which have a tick in the 'Criterion met' column are highlighted in colour.
6. (#62) The table 'Attention Deficit Hyperactivity Disorder (ADHD)' and the ASD scoring tables currently show unanswered scorable questions in the 'Qs to do' column. This doesn't help the user understand how to fix the problem. Worse, the 'Qs to do' column can optionally be hidden from the Report Preferences dialog, meaning a report can be generated from partial data without any visible indication. If there were any unanswered scorable questions, add a note beneath the table saying 'Insufficient questions were answered to complete this table. Go back and complete the ADHD\_brief route' using the appropriate route for each table.
7. (#63) Under 'Tic disorders', the two headings 'Motor tics' and 'Vocal tics' correspond to questions 17.1.2 and 17.1.3 in the interview. Currently the text under these headings says 'None' both when the interviewer recorded that there were no tics present, but also when the interviewer simply didn't fill in the two relevant questions. For each of these two questions:
1. When the interviewer completes the relevant question and records that no tics were present, the text now says 'None'.
2. When the interviewer didn't complete the relevant question, the text instead says 'Question \[q number] not answered' as appropriate.
8. (#57) Remove most of the routes from the 3di. Only the below are kept: ADHD\_brief (DSM-5), ASD\_brief (DSM-5 Crit A+B), ASD\_brief (ICD-10), ASD\_extended (DSM-5 Crit A+B), ASD\_extended (ICD-10), CCC.
9. (#58) Under 'DSM-5: ASD brief assessment', remove the pair of tables which give detailed scores in the range 0-6 per behaviour (e.g. Abnormal social approach), leaving just the shorter pair of tables which give scores summarised as percentages per sub-criterion (e.g. A.1 Social-emotional reciprocity).
10. (#59) In all four of the remaining tables under 'DSM-5 ASD', add colour highlighting to all rows with scores strictly over 50%.
Changes introduced in 230122
1. DSM-5 (ICD-11) scoring is promoted, while scoring according to ICD-10 (DSM-4) criteria is available but described as superseded. If you do require ICD-10 scores you can select their inclusion from the **Edit report preferences** button in the **Case Manager**. The related interview Routes are available in the Choose route dropdowns.
2. The new *DSM-5 brief* ASD assessment has been added. See [The four ASD assessments](/clinical-background/the-four-asd-assessments).
3. In the *DSM-5 extended* ASD assessment, the behaviour *Sharing of interests* formerly contained only the single question 9.2.2 (qid 303). In this release, that question was remapped into behaviour *Sharing emotions and responding to emotions*. The behaviour *Sharing of interests*, which would now contain no questions, has been removed from the report.
4. In the *DSM-5 extended* ASD assessment, question 8.9.8 (qid 626) has been added to the behaviour *Reading facial expressions*.
Changes introduced in 210110
1. SPSS export functionality is completely removed.
2. Support added for 64-bit Office. Compatibility with 32-bit Office retained.
3. No longer includes a bundled Microsoft Access Runtime. This means users are required to have Access preinstalled, or else download the Access Runtime themselves.
4. An early version of the DSM-5\_brief subscales (T and U) and routes are present but undocumented. Do not use this feature.
5. The Route Explorer now contains 'jump to question' functionality.
Changes introduced in 190109
Compared to a baseline of version `170107`.
1. Bug fix: in certain cases, for example when entering the child's date of birth, dates beyond 2020 had been rejected. Now any date can be entered.
2. Bug fix: in Word reports, a pair of 'Qs to do' cells had been incorrectly swapped in the *ASD Outcomes: Developmental normality* table. This has been rectified.
3. Bug fix: in Word reports, Chinese characters no longer appear in patient ages in the 3di English edition.
4. Bug fix: previously only the most recently created user route could be selected. Now, any user route can be selected.
5. Bug fix: in Word reports, scores in *DSM-5 SCD Criterion B: S1a Functional impairment* were incorrectly calculated in certain cases. This has been rectified.
# Troubleshooting
Failure of the 3di to load or run as expected is almost always due to one of two things:
* A change to the installed version of Microsoft Office or Windows.
* Moving or deleting the 3di installation folder or some of its contents.
For most users, the 3di is installed on a computer managed by their Trust or organisation's IT support team. Therefore if the 3di completely stops working, the quickest route to getting it running again is normally to contact your IT team and direct them to this page, and the [installation](/setup/installation) page which will remind them of the steps they took to install the 3di in the first place.
The remainder of this page describes the error messages we have seen before, and can be followed by an IT team or any technically confident 3di user managing their own computer.
Error message: "The text you entered isn't an item in the list"
This occurs when you are completing the interview, and instead of choosing an option from a multiple-choice dropdown, you type in some other text which is not a valid option from the list. In the example below, 'fake value' has been typed in, which will produce the above message.
If you see the error message, tap the Escape (Esc) key twice to clear what you entered, then select one of the valid options.
Error message: "The active content in this file is blocked"
This message appears the first time you run the 3di after installing and does not indicate a problem. Complete the instructions under [Installation](/setup/installation) to dismiss this error.
Error message: "The expression On Click... Automation error"
This error indicates a problem with the way Microsoft Access was installed on your machine.
Specifically, you may have the *Microsoft Access Runtime* installed alongside a more recent version of the full program, usually *Microsoft Access 365*. Try this: run Access from the Start menu, click `File->Open` and navigate to the 3di frontend file to load it directly. If the 3di loads and runs without the error, you can uninstall the Access Runtime from your machine to permanently address the issue.
Error message: "Run-time error '6': Overflow"
This occurs if you attempt to generate a report for a child with an implausibly large age — for example, 1000 years. This can happen if you accidentally mistype the child's date of birth, for example typing the year '1015' instead of '2015'. Correct the child's date of birth and date of interview, then try generating the report again.
Error message: "Compile error..."
This message can appear when you run a very old version of the 3di on a new computer. Specifically, the older 3di version is only compatible with 32-bit Microsoft Office, but your computer has the modern 64-bit Microsoft Office installed. You should contact your IT support team, who may be able to install 32-bit Office for you. Our advice is to upgrade to a more modern version of the 3di.
Error message: "There was an error executing the command"
This error occurs when you open newer versions of the 3di in the *Microsoft Access Runtime* instead of *Access for Microsoft 365*.
Workaround:
1. Run Access from your Start menu. To do this, press the ⊞ Windows key and type 'access' then press Enter.
2. Access should open with the File menu visible, allowing you to pick which Access file to open.
3. The 3di5\_uk\_230122a.mdb frontend file may already be in the list, in which case select it to open.
4. Otherwise you will need to navigate to your 3di installation folder, which is normally found on your desktop and named on the pattern 3di5\_uk\_230122a. Within that folder, select the 3di5\_uk\_230122a.mdb frontend file.
You will need to perform the above steps each time you launch the 3di.
A lasting fix is to uninstall the Microsoft Access Runtime which may be on your computer from an old 3di installation, and make sure Office 365 (including Access and Word) are both installed. If an IT department manages your computer for you, ask them to do this. Full installation instructions are [here](/setup/installation).
Error message: “System resource exceeded”
This is a shortcoming in Access. The solution is to shut down the **3di** (or the whole computer if nothing responds to your clicks) and restart – it’s a matter of just a minute or two, no more than the last response you entered will ever be lost, and you may well be able to continue your conversation with the parents so that they are never aware of the glitch!
Error message: “the template file ... is missing”
This can occur if you have partially moved or copied your 3di installation folder around on disk. This might happen inadvertently due to the use of OneDrive or other cloud sync systems. You may need to reinstall the 3di software. The [installation](/setup/installation) page describes the 3di installation folder structure, and how to install the software.
I generated a Word report a second time but it looks the same or is very long
Remember that if you repeat a report, the new version will be *appended* to the existing report document – so scroll to the end of the document to find what you need.
Error message: “You must first select a backend”
If you see this message and yet the **Main Menu** is displaying the name of a backend (rather than displaying **no backend**), just close the **3di** and restart.
Carer deletion and tailored text (Qid 25)
If you delete a carer whose details are reflected in the tailored text of the interview, that text will not be updated on the fly. For example, if Mrs Bloggs is recorded as present at the interview and you then delete her record during the interview, questions will continue to read “Did you, Mrs Bloggs, …” and the like. However, if you use the **Case Manager** to **Close interview** and then **Revisit interview** the text of the affected questions will be updated.
Multiple biological parents
The system will not prevent you from entering more than one biological mother or father; the first entered will be used for tailoring text, in Report generation, and so on. Of course you should go back and correct your error!
Child deletion (Q 3.2.1 to 3.2.3, Qids 6, 1070, 1071)
If you delete from question **3.2.1** a child who is recorded as a sibling or half-sibling, then any records related to that child in **Qs 3.2.2** and **3.2.3** will remain in place, but ‘lose’ the child’s name. Probably you should manually delete those ‘orphaned’ records (see [Repeating Answer Deletion](/using-the-software/question-types#repeating_answer)) – though no positive harm will result from their remaining in place.
# Installation (pre 2021)
{% hint style="warning" %}
These instructions apply to old versions of the 3di from January 2021 and earlier, and are included only for reference. For current 3di versions, please see [Installation](/setup/installation).
{% endhint %}
{% hint style="info" %}
Please ensure you understand [The 3di licence](/setup/the-3di-licence) and [Looking after your data](/setup/looking-after) before installing the 3di software.
{% endhint %}
## Obtain the installer
To get started, you will need a copy of the installer.
The installer has a filename like `3di5_uk_230122_setup.exe`. This filename includes the version number **`23`****`01`****`22`** of the software in **yy****mm****dd** format, that is **year** **month** **day**. Sometimes you will see a single-letter suffix which denotes a sub revision.
You will receive a copy of the installer prior to your training course. To find the installer, open the Windows Start menu and type '3di5\_uk'. If the installer file is present on your machine, a file name ending in 'setup.exe' will appear in the list. If you cannot find the installer, please get in touch for a new copy.
The installation steps depend on which version of the 3di you are trying to install. Please consult the version number of the installer you are trying to run, then choose the relevant instructions:
* [**19****01****09****e** to **21****01****09**](#id-190109e-to-210109)
* [**19****01****09****d** and older](#id-190109d-and-older)
If you are in an institutional setting where an IT department manages your computer, your IT support team should read the [additional instructions](#installing-the-3di-in-an-institutional-setting) below.
## Installing version **19****01****09**e - **21****01****09**
These 3di versions require the *32-bit* version of Microsoft Office to be installed – the other option being the *64-bit* version. If you have purchased Microsoft Office, you will be entitled to install the version in either 'bitness'. Microsoft will normally provide you the 64-bit version unless you choose otherwise. In normal usage there is no visible difference between the two versions. However it does affect compatibility with certain software such as the 3di.
To be precise, these 3di versions require only the Word and Access components of Office to be installed. The latest 32-bit Office 365 (now rebranded Microsoft 365) is compatible with the 3di and installs both Word and Access by default. The following 32-bit Office versions are also compatible: 2016, 2019, 2021.
With Office 365 you can determine whether you have the 32-bit or 64-bit version currently installed according to the instructions [here](https://support.microsoft.com/en-gb/office/about-office-what-version-of-office-am-i-using-932788b8-a3ce-44bf-bb09-e334518b8b19).
If you have the 64-bit version of Office installed, you will need to uninstall it and replace it with the 32-bit version. This is best performed by IT support if you have access to such assistance. The general steps are as follows:
1. In the case of Microsoft 365 (the latest version of Office), log in to [office.com](https://office.com/).
2. Navigate to your Microsoft account page.
3. Click the Install button.
4. This should offer you a choice of versions. Choose the 32-bit option and download the installer.
5. Open *Start menu → Add or remove programs*, choose *Microsoft 365* and *Uninstall*.
6. Run the new Microsoft 365 installer you just downloaded.
Before you proceed, verify that Microsoft Access is installed. You can do this by opening the Start menu and typing 'Access'. If Access is installed it will appear at the top of the list:
If Access is not installed, you will have to install it before you proceed, or the 3di will not work. The freely-available Microsoft Access Runtime will also serve. Contact your technical support before proceeding.
With the correct Word and Access version installed, you are ready to begin.
1. Run the 3di installer.
1. You will be asked if you trust the installer file. Say Yes.
2. You will need to agree to the licence.
3. Choose the installation folder. The default is your desktop, which is fine for most users.
4. Click the Install button.
5. The 3di installer will run to completion and you can click the Close button.
2. Once the installer has completed, launch the 3di by double-clicking the 3di5\_run shortcut on your desktop.
3. The first time you run the 3di you will have to tell Access that you trust the software. These steps only need to be performed once.
1. Click OK if you see an error saying that active content is blocked.
2. If the following dialog appears, click on Stop all macros.
3. On the yellow bar near the top of the window, click Enable content.
4. If you have navigated the above warnings correctly, you should now see the Main menu window with 'no backend' loaded.
5. Continue to [Confirming the 3di is working](#confirming-the-3di-is-working).
## Installing version **19****01****09**d and older
These versions of the 3di require the *32-bit* version of Microsoft Office to be installed -- the other option being the *64-bit* version. If you have purchased Microsoft Office, you will be entitled to install the version in either 'bitness'. Microsoft will normally provide you the 64-bit version unless you choose otherwise. In normal usage there is no visible difference between the two versions. However it does affect compatibility with certain software such as the 3di.
To be precise, these 3di versions require only the Word component of Office to be installed. Preferably you would have the Access component of Office installed too, but if you don't, 3di setup will install the Access Runtime which is freely provided by Microsoft to run Access applications. The latest 32-bit Office 365 (now rebranded Microsoft 365) is compatible with the 3di and installs both Word and Access by default. The following 32-bit Office versions are also compatible: 2016, 2019, 2021.
With Office 365 you can determine whether you have the 32-bit or 64-bit version currently installed according to the instructions [here](https://support.microsoft.com/en-gb/office/about-office-what-version-of-office-am-i-using-932788b8-a3ce-44bf-bb09-e334518b8b19).
If you have the 64-bit version of Office installed, you will need to uninstall it and replace it with the 32-bit version. This is best performed by IT support if you have access to such assistance. The general steps are as follows:
1. In the case of Microsoft 365 (the latest version of Office), log in to [office.com](https://office.com/).
2. Navigate to your Microsoft account page.
3. Click the Install button.
4. This should offer you a choice of versions. Choose the 32-bit option and download the installer.
5. Open *Start menu → Add or remove programs*, choose *Microsoft 365* and *Uninstall*.
6. Run the new Microsoft 365 installer you just downloaded.
With the correct Office version installed, you are ready to begin.
1. Take note of whether Microsoft Access is already installed. You can do this by opening the Start menu and typing 'Access'. If Access is installed it will appear at the top of the list:
2. Run the 3di installer.
1. You will be asked if you trust the installer file. Say Yes.
2. You will need to agree to the licence.
3. Choose the installation folder. The default is your desktop, which is fine for most users.
4. Click the Install button.
5. A new window will appear, asking if you want to install the Microsoft Access Runtime. The Access Runtime is a package freely provided by Microsoft so that applications written in Access (a less famous component of the Office suite) can still be run on machines which don't have the full paid version of Access. Recall from the prior instructions whether Access is installed on your machine:
* If Access is already installed, click Cancel and exit from this Access Runtime installer window.
* If Access is not already installed, continue to install the Access Runtime. This will allow you to run the 3di even though you do not have a full copy of Access installed. When the Runtime installer is complete, the window will close and you will return to the 3di installer.
6. The 3di installer will run to completion and you can click the Close button.
3. Once the installer has completed, launch the 3di by double-clicking the 3di5\_run shortcut on your desktop.
4. The first time you run the 3di you will have to tell Access that you trust the software. These steps only need to be performed once.
1. Click OK if you see an error saying that active content is blocked.
2. If the following dialog appears, click on Stop all macros.
3. On the yellow bar near the top of the window, click Enable content.
5. If you have navigated the above warnings correctly, you should now see the Main menu window with 'no backend' loaded.
6. Continue to [Confirming the 3di is working](#confirming-the-3di-is-working).
## Confirming the 3di is working
1. Open the 3di and navigate to the purple Main menu.
2. Click *Select and open backend*.
3. Choose *Training5* with a double-click.
4. Open the Case Manager by clicking the 🙂 button on the Add-ins ribbon.
5. Choose any child from the *Find:* dropdown at the top of the form.
6. Click the button *Report ASD\_brief*. Within a minute this should produce a Word document. The document may open in the background. If you can't see it, check the taskbar at the bottom of your screen.
7. Verify that the 3di interview forms will open properly:
1. Choose Sally Pringle from the *Find:* dropdown at the top of the Case Manager.
2. Click on the button *Revisit interview* on the salmon-coloured central portion of the form.
3. Opening the interview can take 30 seconds or so on a slower machine, so ignore any early messages about "Access not responding". If an interview form doesn't appear in under two minutes, this may indicate a problem with your Access installation and you should contact support.
8. Close the 3di by clicking the ❌ at the top-right of the application window -- clicking *Close 3di5* on the purple Main Menu leaves you in Access, which is unhelpful!
## Installing in an institutional setting
These instructions apply if your computer is managed by someone other than the clinician who will be using the software.
You may find that your computer has administrative policies applied which mean you, the clinician, do not have permission to install the 3di or other software. If this is the case for your computer, please show these instructions to your IT department.
The rest of this section assumes that you are an IT administrator with the necessary powers to install software on the target machine.
### **Simple installations**
If the clinician's machine is a regular Windows installation with their software and documents stored locally on the hard disk (not on a network share), then installation should be very straightforward. Log in to the machine as an administrator, or elevate the session the clinician was running in, then follow the instructions in the appropriate section above according to your 3di installer version.
The frontend file and backends folder must both be writeable by whichever Windows account the clinician uses to run the software and administer assessments.
### **Networked installations**
The 3di is written in Microsoft Access. As with many Access applications, the 3di is split between two .mdb files, the so-called frontend and backend. The frontend is the part the user double-clicks to load in Access, and contains all of the code. The backend stores patient records. One frontend can switch between multiple backends. During the training course, trainees use the *Training5* backend which contains sample data. After that they will create their own backend, and likely never think about backends again, since a backend can store any number of patient records. The usual reason to switch backends is to transfer data between machines or allow collaboration in a research setting.
It is possible but often troublesome to store the frontend or backend on a network share. If the user has a slow network connection, the software can become unusable. Due to the huge number of network solutions, and potential problems, we will usually be unable to help with any issues and can only direct you to the Microsoft Access documentation, or your network/remote software vendor's support options to resolve any problems.
### The installation folder
After a fresh install, the 3di installation folder looks like this:
```
📁 3di5_uk_230122a ─ Root folder, normally located on user's Desktop
│
├───📁 Backends ─ The Backends folder has one subfolder per backend
│ │
│ ├── 📁 Training5 ─ A special backend with sample data for training
│ └── 📁 MyBackend ─ A user-created backend, normally there is only one
│ │
│ └──📁 Cases ─ User-generated Word reports are output here
│
├── 📁 PreEntry ┐
├── 📁 Reference │
├── 📁 ResearchPapers ├ Must remain in same folder as backend
├── 📁 Resources │
├── 📁 Tools ┘
│
└── ⚒️ 3di5_uk_230122a.mdb ─ The frontend: the main 3di 'program'
```
The default 3di install location is the user's Desktop folder. This is usually the best choice although anywhere the user has write access is fine (so *not* in `C:\Program Files`). The user needs to be able to find the 3di5\_run shortcut which the installer places on the Desktop. This shortcut simply points to the frontend .mdb file and must be adjusted if you move the frontend after installation.
It is most simple and reliable to keep the whole folder intact. However it is also possible to have the frontend on one drive and backends on another. This might be desirable when patient data must live on a designated drive separate from where programs are installed. To achieve this, move *everything except the frontend .mdb file* to the other drive, then from the 3di Main menu click *Select and open backend* and navigate to the new Backends location.
It is essential that all the subfolders of the root installation folder (Backends, Resources etc.) are kept together in the same location relative to one another, or the software will not work.
Placing the 3di folder on a cloud storage service such as OneDrive, Dropbox or Google Drive is untested and may cause intermittent problems.
The installation folder is under 100 MB when new. Each new case created by the user typically adds under 1 MB to the Backends folder, including generated reports.
When running from a network share:
1. A slow or erratic connection to the share will result in a poor user experience.
2. You will need to tell Access that the frontend file can be trusted via the Access *Trust Center*. You must tick an additional checkbox to allow network locations to be trusted.
3. Backends must not be accessed by multiple copies of the 3di running concurrently. This will cause errors and possible data loss. Therefore in a networked setup you must make sure this is impossible.
4. If you configure the 3di to store its backend on a network drive but that drive isn't available (for example if it depends on a VPN service that hasn't started), the 3di will prompt the user to create a new backend on a local drive. Users may not understand what is going on, and end up being unable to find patient records.
### **Other notes**
* After installation, you should go through the steps in [Confirming the 3di is working](#confirming-the-3di-is-working) to ensure the clinician has a smooth experience when they first launch the 3di. Hitting a problem in the first clinical session is bad news!
* If the machine has Access installed as part of Office, rather than the free Access Runtime, you can perform an additional step to make the 3di easier to use:
1. With the 3di open, click *File → Options → Customize ribbon*.
2. In the right-hand pane, deselect every Office tab apart from *Add-ins*. This ensures that only the 3di toolbar is displayed, and hides toolbars that are irrelevant.
3. Click OK to exit. Restarting is not necessary, despite the message which pops up.
* It is not possible simply to copy the 3di installation folder to another computer and expect it to work. This is because the 3di installer setup.exe installs dependencies at the system level.
* The installer can be run silently (for example as part of a script for use with SCCM or other software deployment tools) and with the installation path set from the command line using the `/S` and `/D` switches respectively. The installer is built using NSIS, therefore the standard NSIS flags are available as documented in section 3.2.1 [here](https://nsis.sourceforge.io/Docs/Chapter3.html#installerusage).
#### Compatibility with different Office versions:
* Oldest versions of the 3di require the 32-bit version of Word. 32-bit Access will be used if present, but the installer will unconditionally attempt to install the free 32-bit Access Runtime redistributable. This can be cancelled if not required, and the 3di setup will continue.
* 190109e is the first version of the 3di where the installer does not include the bundled Access Runtime installer. The Runtime can still be downloaded from Microsoft and installed separately. The user's machine requires 32-bit Word, and either 32-bit Access or the 32-bit free Access Runtime to be installed.
* 210110 and any newer version is compatible with both 32-bit and 64-bit variants of Office. The user's machine requires Word, and either Access or the free Access Runtime to be installed.