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Wallis KE, Usher R. Applying autism screening research to real-world scenarios: a commentary on Sheldrick et al. (2023). J Child Psychol Psychiatry 2024; 65:720-722. [PMID: 38009449 DOI: 10.1111/jcpp.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 11/28/2023]
Abstract
Early identification of autism spectrum disorder (ASD) continues to be a challenge despite universal screening efforts. One explanation is that screening tools have lower sensitivity and specificity than initial studies report when accounting for incomplete follow-up for all children screened. Sheldrick and colleagues used statistical modeling to demonstrate the impact on sensitivity and specificity when assumptions about the diagnostic outcome of children who do not pursue diagnostic evaluation are altered. Crucially, the work of Sheldrick et al. serves as a reminder that autism screening in primary care is just one component of the clinical assessment and should not be conflated with a diagnostic evaluation. Thus, lack of follow-up after a positive screen is a feature, not only a bug when using a screen in a clinical setting. Engaging families in shared decision-making around screening may help encourage follow-up, and thus, screening tool psychometric performance.
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Affiliation(s)
- Kate E Wallis
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rosalind Usher
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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2
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Sheldrick RC, Hooker JL, Carter AS, Feinberg E, Croen LA, Kuhn J, Slate E, Wetherby AM. The influence of loss to follow-up in autism screening research: Taking stock and moving forward. J Child Psychol Psychiatry 2024; 65:656-667. [PMID: 37469104 PMCID: PMC10801774 DOI: 10.1111/jcpp.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND How best to improve the early detection of autism spectrum disorder (ASD) is the subject of significant controversy. Some argue that universal ASD screeners are highly accurate, whereas others argue that evidence for this claim is insufficient. Relatedly, there is no clear consensus as to the optimal role of screening for making referral decisions for evaluation and treatment. Published screening research can meaningfully inform these questions-but only through careful consideration of children who do not complete diagnostic follow-up. METHODS We developed two simulation models that re-analyze the results of a large-scale validation study of the M-CHAT-R/F by Robins et al. (2014, Pediatrics, 133, 37). Model #1 re-analyzes screener accuracy across six scenarios, each reflecting different assumptions regarding loss to follow-up. Model #2 builds on this by closely examining differential attrition at each point of the multi-step detection process. RESULTS Estimates of sensitivity ranged from 40% to 94% across scenarios, demonstrating that estimates of accuracy depend on assumptions regarding the diagnostic status of children who were lost to follow-up. Across a range of plausible assumptions, data also suggest that children with undiagnosed ASD may be more likely to complete follow-up than children without ASD, highlighting the role of clinicians and caregivers in the detection process. CONCLUSIONS Using simulation modeling as a quantitative method to examine potential bias in screening studies, analyses suggest that ASD screening tools may be less accurate than is often reported. Models also demonstrate the critical importance of every step in a detection process-including steps that determine whether children should complete an additional evaluation. We conclude that parent and clinician decision-making regarding follow-up may contribute more to detection than is widely assumed.
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Affiliation(s)
| | | | - Alice S. Carter
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Emily Feinberg
- School of Public Health, Brown University, Providence, MA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jocelyn Kuhn
- School of Public Health, Brown University, Providence, MA
| | - Elizabeth Slate
- Department of Statistics, Florida State University, Tallahassee, FL
| | - Amy M. Wetherby
- College of Medicine, Florida State University, Tallahassee, FL
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3
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Sobieski M, Grata-Borkowska U, Bujnowska-Fedak MM. Implementing an Early Detection Program for Autism Spectrum Disorders in the Polish Primary Healthcare Setting-Possible Obstacles and Experiences from Online ASD Screening. Brain Sci 2024; 14:388. [PMID: 38672037 PMCID: PMC11047999 DOI: 10.3390/brainsci14040388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
A screening questionnaire for autism symptoms is not yet available in Poland, and there are no recommendations regarding screening for developmental disorders in Polish primary healthcare. The aim of this study was to assess the opinions of parents and physicians on the legitimacy and necessity of screening for autism spectrum disorders, potential barriers to the implementation of the screening program, and the evaluation and presentation of the process of online ASD screening, which was part of the validation program for the Polish version of one of the screening tools. This study involved 418 parents whose children were screened online and 95 primary care physicians who expressed their opinions in prepared surveys. The results indicate that both parents and doctors perceive the need to screen children for ASD in the general population without a clear preference as to the screening method (online or in person). Moreover, online screening is considered by respondents as a satisfactory diagnostic method. Therefore, online screening may prove to be at least a partial method of solving numerous obstacles indicated by participants' systemic difficulties including time constraints, the lack of experienced specialists in the field of developmental disorders and organizational difficulties of healthcare systems.
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Affiliation(s)
- Mateusz Sobieski
- Department of Family Medicine, Wroclaw Medical University, Syrokomli 1, 51-141 Wroclaw, Poland; (U.G.-B.); (M.M.B.-F.)
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Ben-Sasson A, Guedalia J, Nativ L, Ilan K, Shaham M, Gabis LV. A Prediction Model of Autism Spectrum Diagnosis from Well-Baby Electronic Data Using Machine Learning. CHILDREN (BASEL, SWITZERLAND) 2024; 11:429. [PMID: 38671647 PMCID: PMC11049145 DOI: 10.3390/children11040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
Early detection of autism spectrum disorder (ASD) is crucial for timely intervention, yet diagnosis typically occurs after age three. This study aimed to develop a machine learning model to predict ASD diagnosis using infants' electronic health records obtained through a national screening program and evaluate its accuracy. A retrospective cohort study analyzed health records of 780,610 children, including 1163 with ASD diagnoses. Data encompassed birth parameters, growth metrics, developmental milestones, and familial and post-natal variables from routine wellness visits within the first two years. Using a gradient boosting model with 3-fold cross-validation, 100 parameters predicted ASD diagnosis with an average area under the ROC curve of 0.86 (SD < 0.002). Feature importance was quantified using the Shapley Additive explanation tool. The model identified a high-risk group with a 4.3-fold higher ASD incidence (0.006) compared to the cohort (0.001). Key predictors included failing six milestones in language, social, and fine motor domains during the second year, male gender, parental developmental concerns, non-nursing, older maternal age, lower gestational age, and atypical growth percentiles. Machine learning algorithms capitalizing on preventative care electronic health records can facilitate ASD screening considering complex relations between familial and birth factors, post-natal growth, developmental parameters, and parent concern.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel (L.N.)
| | - Joshua Guedalia
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel (L.N.)
| | - Liat Nativ
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel (L.N.)
| | - Keren Ilan
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel (L.N.)
| | - Meirav Shaham
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel (L.N.)
| | - Lidia V. Gabis
- Maccabi Healthcare Services, Tel-Aviv 6812509, Israel;
- Pediatrics, Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Keshet Autism Center Maccabi Wolfson, Holon 5822007, Israel
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5
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Zamstein O, Sheiner E, Binyamin Y, Pariente G, Wainstock T. Examining the relationship between autism spectrum disorder in children whose mother had labour epidural analgesia for their birth: A retrospective cohort study. Eur J Anaesthesiol 2024; 41:282-287. [PMID: 38084085 DOI: 10.1097/eja.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Controversy exists regarding the association between autism spectrum disorder (ASD) in children whose mother had labour epidural analgesia for their birth, as the few existing investigations have reported mixed findings. OBJECTIVE This study aims to evaluate the possibility of an association in our heterogeneous population. DESIGN A retrospective population-based cohort study. SETTING Vaginal deliveries that took place between the years 2005 and 2017 at Soroka University Medical Center, a tertiary referral hospital in Israel, and a follow-up on the incidence of ASD in the children. PATIENTS A hundred and thirty-nine thousand, nine hundred and eighty-one labouring patients and their offspring. MAIN OUTCOME MEASURES The incidence of children diagnosed with ASD (both hospital and community-based diagnoses) was compared based on whether their mothers had received labour epidural analgesia during their labour. A Kaplan-Meier survival curve compared cumulative incidence of ASD. A Cox proportional hazards model was used to control for relevant confounders. RESULTS Labour epidural analgesia was administered to 33 315 women. Epidural analgesia was more common among high-risk pregnancy groups (including pregnancies complicated with diabetes mellitus, hypertensive disorders, intrauterine growth restriction, and oligohydramnios; P < 0.001). In a Cox proportional hazards model, the association between epidural analgesia during labour and ASD in the children lost statistical significance following adjustment for confounders such as maternal age, gestational age, hypertensive disorders, diabetes mellitus, and ethnicity [adjusted hazard ratio = 1.13, 95% confidence interval (CI), 0.96 to 1.34, P = 0.152]. CONCLUSION In our population, after adjusting for confounders, epidural analgesia is not independently associated with autism spectrum disorder in the children. These findings enhance our knowledge regarding the safety of epidural analgesia and enable patients to make informed decisions about their pain relief techniques during labour.
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Affiliation(s)
- Omri Zamstein
- From the Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (OZ, ES, GP), Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YB) and Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (TW)
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6
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Wallis KE, Guthrie W. Screening for Autism: A Review of the Current State, Ongoing Challenges, and Novel Approaches on the Horizon. Pediatr Clin North Am 2024; 71:127-155. [PMID: 38423713 DOI: 10.1016/j.pcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Screening for autism is recommended in pediatric primary care. However, the median age of autism spectrum disorder (ASD) diagnosis is substantially higher than the age at which autism can reliably be identified, suggesting room for improvements in autism recognition at young ages, especially for children from minoritized racial and ethnic groups, low-income families, and families who prefer a language other than English. Novel approaches are being developed to utilize new technologies in aiding in autism recognition. However, attention to equity is needed to minimize bias. Additional research on the benefits and potential harms of universal autism screening is needed. The authors provide suggestions for pediatricians who are considering implementing autism-screening programs.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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7
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Jonsdottir SL, Saemundsen E, Thorarinsdottir EA, Rafnsson V. Evaluating screening for autism spectrum disorder using cluster randomization. Sci Rep 2024; 14:6855. [PMID: 38514752 PMCID: PMC10957883 DOI: 10.1038/s41598-024-57656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/20/2024] [Indexed: 03/23/2024] Open
Abstract
We evaluated the rate of autism spectrum disorder (ASD) in a group invited to a screening program compared to the rates in two groups who received usual care. The population eligible for screening was all children in Iceland registered for their 30-month well-child visits at primary healthcare centers (PHCs) from March 1, 2016, to October 31, 2017 (N = 7173). The PHCs in the capital area of Reykjavik were the units of cluster randomization. Nine PHCs were selected for intervention (invited group), while eight PHCs received usual care (control group 1). PHCs outside the capital area were without randomization (control group 2). An interdisciplinary team, including a pediatrician contributing with physical and neurological examination, a psychologist evaluating autism symptoms using a diagnostic instrument, and a social worker interviewing the parents, reached a consensus on the clinical diagnosis of ASD according to the ICD-10 diagnostic system. Children in the population were followed up for at least two years and 119 cases were identified. The overall cumulative incidence of ASD was 1.66 (95% confidence interval (CI): 1.37, 1.99). In the invited group the incidence rate was 2.13 (95% CI: 1.60, 2.78); in control group 1, the rate was 1.83 (95% CI: 1.31, 2.50); and in control group 2, the rate was 1.02 (95% CI: 0.66, 1.50). Although the rate of ASD was higher in the invited group than in the control groups, the wide confidence intervals prevented us from concluding definitively that the screening detected ASD more readily than usual care.
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Affiliation(s)
- Sigridur Loa Jonsdottir
- State Diagnostic and Counseling Center, Dalshraun 1B, 220, Hafnarfjordur, Iceland.
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
| | - Evald Saemundsen
- State Diagnostic and Counseling Center, Dalshraun 1B, 220, Hafnarfjordur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Elin Astros Thorarinsdottir
- Department of Psychology, University of Iceland, Reykjavík, Iceland
- Center of Children's Mental Health, Reykjavík, Iceland
| | - Vilhjalmur Rafnsson
- Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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8
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Chang X, Zhang Y, Chen X, Li S, Mei H, Xiao H, Ma X, Liu Z, Li R. Gut microbiome and serum amino acid metabolome alterations in autism spectrum disorder. Sci Rep 2024; 14:4037. [PMID: 38369656 PMCID: PMC10874930 DOI: 10.1038/s41598-024-54717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/15/2024] [Indexed: 02/20/2024] Open
Abstract
Gut microbiota and their metabolic products might play important roles in regulating the pathogenesis of autism spectrum disorder (ASD). The purpose of this study was to characterize gut microbiota and serum amino acid metabolome profiles in children with ASD. A non-randomized controlled study was carried out to analyze the alterations in the intestinal microbiota and their metabolites in patients with ASD (n = 30) compared with neurotypical controls (NC) (n = 30) by metagenomic sequencing to define the gut microbiota community and liquid chromatography/mass spectrometry (LC/MS) analysis to characterize the metabolite profiles. Compared with children in the NC group, those in the ASD group showed lower richness, higher evenness, and an altered microbial community structure. At the class level, Deinococci and Holophagae were significantly lower in children with ASD compared with TD. At the phylum level, Deinococcus-Thermus was significantly lower in children with ASD compared with TD. In addition, the functional properties (such as galactose metabolism) displayed significant differences between the ASD and NC groups. Five dominant altered species were identified and analyzed (LDA score > 2.0, P < 0.05), including Subdoligranulum, Faecalibacterium_praushitzii, Faecalibacterium, Veillonellaceae, and Rumminococcaceae. The peptides/nickel transport system was the main metabolic pathway involved in the differential species in the ASD group. Decreased ornithine levels and elevated valine levels may increase the risk of ASD through a metabolic pathway known as the nickel transport system. The microbial metabolism in diverse environments was negatively correlated with phascolarctobacterium succinatutens. Our study provides novel insights into compositional and functional alterations in the gut microbiome and metabolite profiles in ASD and the underlying mechanisms between metabolite and ASD.
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Affiliation(s)
- Xuening Chang
- Department of Child Health Care, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Yuchen Zhang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Xue Chen
- School of Medicine, Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Shihan Li
- Department of Child Health Care, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Hong Mei
- Department of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Han Xiao
- Department of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Xinyu Ma
- Department of Radiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Zhisheng Liu
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Ruizhen Li
- Department of Child Health Care, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
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9
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Mangione CM, Ogedegbe G, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:329-334. [PMID: 38261037 DOI: 10.1001/jama.2023.26952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Importance Speech and language delays and disorders can pose significant problems for children and their families. Evidence suggests that school-aged children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening for speech and language delay and disorders in children 5 years or younger. Population Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. Evidence Assessment The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children who do not present with signs or symptoms or parent/caregiver concerns. Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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10
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Kim JI, Yoo HJ. Diagnosis and Assessment of Autism Spectrum Disorder in South Korea. Soa Chongsonyon Chongsin Uihak 2024; 35:15-21. [PMID: 38204740 PMCID: PMC10774553 DOI: 10.5765/jkacap.230009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 01/12/2024] Open
Abstract
Autism spectrum disorder (ASD) is diagnosed by the clinical decision of a trained professional based on the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition or International Classification of Diseases 11th Revision diagnostic criteria. To obtain information for diagnostic formulation, professionals should explore detailed developmental history, and can use structured or semi-structured assessment tools to observe interaction between the child and parents or strangers. Diagnostic assessment should include a profile of the strength and weaknesses of the individual and should be conducted using an optimal approach by a multidisciplinary team with appropriate techniques and experience. Assessment of language, cognitive, neuropsychological, and adaptive functioning should be conducted in ASD individuals prior to establishing an individualized treatment plan. Genetic testing, brain magnetic resonance imaging or electroencephalogram testing can be considered for identification of underlying causes.
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Affiliation(s)
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
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11
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Hwang JW, Lee JS. Korean Clinical Guideline for Autism Spectrum Disorder - Clinical Features, Course, Epidemiology, and Cause. Soa Chongsonyon Chongsin Uihak 2024; 35:8-14. [PMID: 38204746 PMCID: PMC10774551 DOI: 10.5765/jkacap.230040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous developmental disorder characterized by impairments in two core areas: 1) social communication and interaction and 2) restricted and repetitive patterns of behaviors and interests. In general, ASD is known to be a lifelong disorder. Follow-up studies from childhood to adulthood have reported that the severity of the key symptoms ASD decreases over time. However, chronic health problems including mental health occur in many patients with ASD. The prevalence of ASD has increased from around 0.04% in the 1970s to 2.8% at present. The average age of diagnosis in developed countries is 38-120 months of age. Recent evidence suggests that biological factors which include genetic, congenital, immunological, neuroanatomical, biochemical, and environmental ones are important in causing autism. Until now, early signs and various risk factors of ASD have been suggested.
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Affiliation(s)
- Jun-Won Hwang
- Department of Psychiatry, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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12
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Herkert D, Sullivan C, Zhu Y, Dawson G. Prevalence and nature of prior developmental and medical concerns in toddlers who screen positive for autism in primary care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2361-2371. [PMID: 37838915 PMCID: PMC10593482 DOI: 10.1177/13623613231162146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT The American Academy of Pediatrics recommends that all children be screened for autism at their 18- and 24-month well-child visit. For children who screen positive for autism, it is unknown whether this usually represents the first time a developmental concern has been raised or if other developmental concerns typically precede a positive autism screen. Such knowledge could help guide providers in how to appropriately convey feedback regarding autism screening. This study found that, for close to 80% of children with a positive autism screen, caregivers or providers had a prior autism, language, motor, or other developmental concern documented in the electronic health record. Many also had other prior concerns frequently linked to autism, such as sleep and gastrointestinal problems, and received physical or speech therapy. On average, prior to screening children who received a positive Modified-Checklist for Autism in Toddlers had two documented concerns by at 1 year of age and three concerns by 2 years of age. These findings imply that screening for autism as a part of routine pediatric care likely takes place in the context of larger conversations regarding existing developmental concerns, allowing for a less stigmatizing discussion of autism. Framing the presence of prior concerns in the setting of a positive screen in this context may create a reaffirming space for existing caregiver concerns and a lessened emotional burden on caregivers.
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Affiliation(s)
- Darby Herkert
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Connor Sullivan
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
| | - YiQin Zhu
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
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13
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Lord C, Wilson RB. Digital phenotyping could help detect autism. Nat Med 2023; 29:2412-2413. [PMID: 37798439 PMCID: PMC10799608 DOI: 10.1038/s41591-023-02557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Researchers have developed a screening tool for autism that uses computer vision and machine learning to analyze autism-related behaviors – but greater reliability and robust validation will be needed if such tools are to be used in primary care settings.
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Affiliation(s)
- Catherine Lord
- Department of Psychiatry, Division of Child Psychiatry, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Rujuta B Wilson
- Department of Psychiatry, Division of Child Psychiatry, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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14
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Szatmari P. Editorial: The Importance of Screening for Developmental Disorders and Demonstrating Improved Health Outcomes. J Am Acad Child Adolesc Psychiatry 2023; 62:1086-1088. [PMID: 36958406 DOI: 10.1016/j.jaac.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
Screening for emotional, behavioral, and developmental disorders is generally considered to be a valuable activity in the child and youth developmental and mental health service sectors. The premise is that screening allows for early identification, which in turn allows for early intervention, which in turn leads to better long-term outcomes. While the hypothesized causal chain from screening to outcomes may seem long, the evidence base to support this aspiration is growing. In this issue of the Journal, the article by Rah et al.1 provides an important piece of the puzzle to support screening for developmental disorders in early childhood in particular and has a number of important lessons for the field.
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Affiliation(s)
- Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto, Toronto Ontario, Canada.
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15
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Lee CM, Altschuler MR, Esler AN, Burrows CA, Hudock RL. Why are only some children with autism spectrum disorder misclassified by the social communication questionnaire? An empirical investigation of individual differences in sensitivity and specificity in a clinic-referred sample. J Neurodev Disord 2023; 15:28. [PMID: 37608249 PMCID: PMC10463287 DOI: 10.1186/s11689-023-09497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The Social Communication Questionnaire (SCQ) is a checklist for autism spectrum disorder (ASD) commonly used in research and clinical practice. While the original validation study suggested that the SCQ was an accurate ASD screener with satisfactory sensitivity and specificity, subsequent studies have yielded mixed results, with some revealing low sensitivity, low specificity, and low utility in some settings. METHOD The present study examined the psychometric properties of the SCQ as well as the individual difference characteristics of 187 individuals with and without autism spectrum disorder (ASD) who were misclassified or accurately classified by the SCQ in a clinic-referred sample. RESULTS The SCQ showed suboptimal sensitivity and specificity, regardless of age and sex. Compared to true positives, individuals classified as false positives displayed greater externalizing and internalizing problems, whereas individuals classified as false negatives displayed better social communication and adaptive skills. CONCLUSIONS The findings suggest that non-autistic developmental and behavioral individual difference characteristics may explain high rates of misclassification using the SCQ. Clinicians and researchers could consider using the SCQ in combination with other tools for young children with internalizing and externalizing symptoms and other more complex clinical presentations.
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Affiliation(s)
- Chimei M Lee
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN, 55414, USA.
| | | | - Amy N Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN, 55414, USA
| | - Catherine A Burrows
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN, 55414, USA
| | - Rebekah L Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN, 55414, USA
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16
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Guthrie W, Wetherby AM, Woods J, Schatschneider C, Holland RD, Morgan L, Lord CE. The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231159153. [PMID: 36922406 PMCID: PMC10502186 DOI: 10.1177/13623613231159153] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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Affiliation(s)
- Whitney Guthrie
- Children’s Hospital of Philadelphia, USA
- University of Pennsylvania, USA
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17
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Chang X, Sun L, Li R. Application of symbolic play test in identification of autism spectrum disorder without global developmental delay and developmental language disorder. BMC Psychiatry 2023; 23:138. [PMID: 36879230 PMCID: PMC9990336 DOI: 10.1186/s12888-023-04647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Children with autism spectrum disorders (ASD) usually experience difficulty regarding symbolic play. However, studies on whether symbolic play test (SPT) can differentiate between ASD and other developmental disorders are inconsistent, and evaluating the application value of the SPT in the identification of ASD without global developmental delay (GDD) and developmental language disorder (DLD) is necessary. METHODS A total of 200 children were selected as the research participants. There were 100 cases of ASD without GDD and 100 cases of DLD. All children were tested by SPT and Children Neuropsychological and Behavioral Scale-Revision (CNBS-R2016). Binomial logistic regression was used for multivariate analysis. The receiver operating characteristic (ROC) curve was used to evaluate the value of SPT in identifying ASD without GDD and DLD. RESULTS SPT equivalent age was lower than chronological age in the two groups, the difference between the ASD without GDD group was greater than that in the DLD group, and the proportion of SPT equivalent age retardation was higher than that in the DLD group; the differences were statistically significant. Logistic regression analysis showed that there was a difference in SPT equivalent age between DLD and ASD without GDD. When the cut-off value of the SPT was 8.5, the largest area under the ROC curve was 0.723, and the sensitivity and specificity for the diagnosis of ASD without GDD were 0.720 and 0.620 respectively. CONCLUSIONS Symbolic play ability in ASD children is worse than that of DLD children at comparable development levels. SPT may be helpful to distinguish ASD without GDD from children with DLD.
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Affiliation(s)
- Xuening Chang
- Department of Child Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Lingli Sun
- Department of Child Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Ruizhen Li
- Department of Child Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China.
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18
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Coscini N, Heyes P, Bedford H, Cohen E, D'Aprano A, Goldfeld S, Hargreaves D, Loveday S, Nejat S, Roberts G, Sarkadi A, Saunders NR, Woolfenden S, Milner K. Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians. Arch Dis Child 2023; 108:153-159. [PMID: 35764409 DOI: 10.1136/archdischild-2021-322799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
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Affiliation(s)
- Nadia Coscini
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Priya Heyes
- Department of Child Development Service, Government of Western Australia Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Helen Bedford
- Population, Policy and Practice Department, University College London Institute of Child Health, London, UK
| | - Eyal Cohen
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Anita D'Aprano
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Loveday
- Health Services Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sahar Nejat
- Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for euroasiatiska studier, Uppsala, Sweden
| | - Gehan Roberts
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Natasha Ruth Saunders
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Kate Milner
- Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurodisability and Rehabilitation Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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19
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Nurse KM, Janus M, Birken CS, Keown-Stoneman CDG, Omand JA, Maguire JL, Reid-Westoby C, Duku E, Mamdani M, Tremblay MS, Parkin PC, Borkhoff CM. Predictive Validity of the Infant Toddler Checklist in Primary Care at the 18-month Visit and School Readiness at 4 to 6 Years. Acad Pediatr 2023; 23:322-328. [PMID: 36122830 DOI: 10.1016/j.acap.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure. METHODS We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years. We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates. RESULTS Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n = 11, 3.8%), concern for other communication delay (n = 13, 4.4%), and concern for both (n = 6, 2.0%). At follow-up (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11% to 32%, specificity from 91% to 96%, false positive rates from 4% to 9%, PPV from 16% to 35%, NPV from 83% to 95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β = -1.08; 95% CI: -2.10, -0.17; β = -2.35; 95% CI: -3.63, -1.32) and EDI language and cognitive development (β = -0.62; 95% CI: -1.25, -0.18; β = -1.22; 95% CI: -2.11, -0.58). CONCLUSIONS The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening.
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Affiliation(s)
- Kimberly M Nurse
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University (M Janus, C Reid-Westoby, and E Duku), Hamilton, Ontario, Canada
| | - Catherine S Birken
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children (CS Birken, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto (CS Birken, JL Maguire, and PC Parkin), Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- The HUB Health Research Solutions, Li Ka Shing Knowledge Institute (CDG Keown-Stoneman), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto (CDG Keown-Stoneman and M Mamdani), Toronto, Ontario, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children (JA Omand), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto (CS Birken, JL Maguire, and PC Parkin), Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital (JL Maguire and M Mamdani), Toronto, Ontario, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University (M Janus, C Reid-Westoby, and E Duku), Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University (M Janus, C Reid-Westoby, and E Duku), Hamilton, Ontario, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto (CDG Keown-Stoneman and M Mamdani), Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital (JL Maguire and M Mamdani), Toronto, Ontario, Canada; Unity Health Toronto (M Mamdani), Toronto, Ontario, Canada; Temetry Faculty of Medicine, University of Toronto (M Mamdani), Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto (M Mamdani), Toronto, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research, CHEO Research Institute (MS Tremblay), Ottawa, Ontario, Canada
| | - Patricia C Parkin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children (CS Birken, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto (CS Birken, JL Maguire, and PC Parkin), Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada; Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children (CS Birken, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada.
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20
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Lipkin PH. Screening Success in the Age of Autism. JAMA Pediatr 2023; 177:331-332. [PMID: 36806882 DOI: 10.1001/jamapediatrics.2022.5972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Paul H Lipkin
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
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21
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Abstract
IMPORTANCE Autism spectrum disorder (ASD), characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, is a neurodevelopmental disorder affecting approximately 2.3% children aged 8 years in the US and approximately 2.2% of adults. This review summarizes evidence on the diagnosis and treatment of ASD. OBSERVATIONS The estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018, which is likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness. No biomarkers specific to the diagnosis of ASD have been identified. Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play. The criterion standard for the diagnosis of ASD is a comprehensive evaluation with a multidisciplinary team of clinicians and is based on semistructured direct observation of the child's behavior and semistructured caregiver interview focused on the individual's development and behaviors using standardized measures, such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview. These diagnostic measures have sensitivity of 91% and 80% and specificity of 76% and 72%, respectively. Compared with people without ASD, individuals with ASD have higher rates of depression (20% vs 7%), anxiety (11% vs 5%), sleep difficulties (13% vs 5%), and epilepsy (21% with co-occurring intellectual disability vs 0.8%). Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication (small to medium effect size based on standardized mean difference). Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder. Risperidone and aripiprazole can improve irritability and aggression (standardized mean difference of 1.1, consistent with a large effect size) compared with placebo. Psychostimulants are effective for attention-deficit/hyperactivity disorder (standardized mean difference of 0.6, consistent with a moderate effect size) compared with placebo. These medications are associated with adverse effects including, most commonly, changes in appetite, weight, and sleep. CONCLUSIONS AND RELEVANCE ASD affects approximately 2.3% of children aged 8 years and approximately 2.2% of adults in the US. First-line therapy consists of behavioral interventions, while co-occurring psychiatric conditions, such as anxiety or aggression, may be treated with specific behavioral therapy or medication.
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Affiliation(s)
- Tomoya Hirota
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Bryan H King
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco
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22
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Sobieski M, Sobieska A, Sekułowicz M, Bujnowska-Fedak MM. Tools for early screening of autism spectrum disorders in primary health care – a scoping review. BMC PRIMARY CARE 2022; 23:46. [PMID: 35291950 PMCID: PMC8925080 DOI: 10.1186/s12875-022-01645-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests itself in early childhood. Early diagnosis of these disorders allows for the initiation of early therapy, which is crucial for the child's further functioning in society.
Objectives
This review aims to gather and present the existing ASD screening tools that can be used in primary care and adapted to different countries conditions linguistically and culturally.
Eligibility criteria
We searched for English-language publications on ASD screening tools for children aged 0–3 years suitable for use in primary care (i.e. free, requiring no additional training or qualifications).
Sources of evidence
Four databases were explored to find English studies on ASD screening tools intended for the rapid assessment of children aged 0–3.
Charting methods
The information sought (specific features of the questionnaires relevant to primary health care workers, psychometric and diagnostic values of a given cultural adaptation of screening tools, and the linguistic and cultural changes made) were extracted and collected to create profiles of these tools.
Results
We found 81 studies which met inclusion criteria and underwent full data extraction. Three additional data sources were included. These allowed to create 75 profiles of adaptations for 26 different screening tools and collect data on their psychometric values and characteristic features.
Conclusions
The results of our study indicate the availability of several diagnostic tools for early ASD screening in primary care setting concordant culturally and linguistically with a given population. They could be an effective method of accelerating the diagnostic process and starting personalized therapy faster. However, most tools have significant limitations – some are only available for research purposes, while others do not have scientific evidence to prove their effectiveness.
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23
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Cibralic S, Hawker P, Khan F, Mendoza Diaz A, Woolfenden S, Murphy E, Deering A, Schnelle C, Townsend S, Doyle K, Eapen V. Developmental Screening Tools Used with First Nations Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15627. [PMID: 36497697 PMCID: PMC9739511 DOI: 10.3390/ijerph192315627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Developmental surveillance and screening is recommended for all children under five years of age, especially for those from at-risk populations such as First Nations children. No review to date has, however, evaluated the use of developmental screening tools with First Nations children. This review aimed to examine and synthesise the literature on developmental screening tools developed for, or used with, First Nations populations children aged five years or younger. A PRISMA-compliant systematic review was performed in the PsychInfo, PubMed, and Embase databases. Additional searches were also undertaken. In total 444 articles were identified and 13 were included in the final review. Findings indicated that several developmental screening tools have been administered with First Nations children. Most tools, however, have only been evaluated in one study. Results also found that no studies evaluated actions taken following positive screening results. More research evaluating the accuracy, acceptability, and feasibility of using developmental screeners with First Nations children is required before widespread implementation of developmental screening in clinical settings with First Nations children is recommended.
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Affiliation(s)
| | - Patrick Hawker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Feroza Khan
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Susan Woolfenden
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Local Health District, Sydney Institute Women, Children and Their Families, Camperdown, NSW 2050, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, St Leonards, NSW 2065, Australia
| | - April Deering
- New South Wales Ministry of Health, St Leonards, NSW 2065, Australia
| | - Clare Schnelle
- New South Wales Ministry of Health, St Leonards, NSW 2065, Australia
| | - Sharnee Townsend
- New South Wales Ministry of Health, St Leonards, NSW 2065, Australia
| | - Kerrie Doyle
- Indigenous Health, School of Medicine, Campbelltown Campus, Western Sydney University, Sydney, NSW 2560, Australia
| | - Valsamma Eapen
- Ingham Institute, Liverpool, NSW 2170, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia
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Azzano A, Vause T, Ward R, Feldman MA. Telehealth parent training for a young child at risk for autism spectrum disorder. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Song C, Wu L, Hong Y, Chen X, Zhu Z. Factors affecting knowledge of autism spectrum disorder among pediatric residents in eastern China: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:699. [PMID: 36192723 PMCID: PMC9528050 DOI: 10.1186/s12909-022-03770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a global increase in the prevalence of autism spectrum disorder (ASD). Early identification of ASD in children and intervention are key aspects in the management of ASD. However, early identification is partly dependent on knowledge on ASD among pediatricians. This study analyzed the extent of ASD knowledge and its underlying factors among pediatric residents in eastern China, to provide a reference for medical education reforms. METHODS The study employed the Knowledge about Childhood Autism among Health Workers questionnaire. A total of 138 pediatric residents participated in the survey. Descriptive statistics were used to describe demographic characteristics and the four domains of the questionnaire. Univariate analysis was employed to assess impacts of the demographic characteristics on the questionnaire scores. On the other hand, multivariate regression analysis was used to analyze the correlation between the participants' demographic characteristics and the questionnaire scores. RESULTS The average ASD cognitive score of 138 respondents was 13.38 ± 4.48. The ASD cognitive scores in female pediatric residents were higher compared to that in males (p < 0.05). Residents who had obtained professional doctor qualification certificate were more than those without professional doctor qualification certificate (p < 0.05). The ASD knowledge in the group which did not have rotation in both departments was lower than in the group which had rotation in both departments (p < 0.05) as well as the group that had rotation in developmental and behavioral pediatrics department only (p < 0.05). Our multivariate linear regression model demonstrated significant statistical differences (p < 0.05), and showed that gender and systematic exposure to ASD knowledge had significant effects on cognitive scores (p < 0.05). CONCLUSION Most participants had relatively low levels of awareness and knowledge about ASD, especially on ASD comorbidities and age of onset. Women, systematic learning of ASD knowledge in medical school, successful passing of the physician examination, and rotation in the developmental and behavioral pediatrics (DBP) department significantly influence the levels of ASD awareness and knowledge. It is, therefore, important to strengthen ASD education in medical students at the university level and make rotation in the DBP department a requisite for pediatric trainees.
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Affiliation(s)
- Chao Song
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Lingling Wu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Yunxia Hong
- Education Office, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Xiaoyang Chen
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Zhiwei Zhu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
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Ma BX, Kong YM, Zhang XY, Zhang YT, He Q. Analysis of misdiagnosis of children with autism spectrum disorders in China. Clin Child Psychol Psychiatry 2022; 27:1065-1068. [PMID: 35973072 DOI: 10.1177/13591045221119936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bing-Xiang Ma
- 232830The First Affiliated Hospital of Henan University of traditional Chinese Medicine, Zhengzhou, China
| | - Ya-Min Kong
- 232830The First Affiliated Hospital of Henan University of traditional Chinese Medicine, Zhengzhou, China
| | - Xue-Yuan Zhang
- 232830The First Affiliated Hospital of Henan University of traditional Chinese Medicine, Zhengzhou, China
| | - Yong-Ting Zhang
- 232830The First Affiliated Hospital of Henan University of traditional Chinese Medicine, Zhengzhou, China
| | - Qing He
- 232830The First Affiliated Hospital of Henan University of traditional Chinese Medicine, Zhengzhou, China
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27
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Chen YH, Chen Q, Kong L, Liu G. Early detection of autism spectrum disorder in young children with machine learning using medical claims data. BMJ Health Care Inform 2022. [PMCID: PMC9462117 DOI: 10.1136/bmjhci-2022-100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives Early diagnosis and intervention are keys for improving long-term outcomes of children with autism spectrum disorder (ASD). However, existing screening tools have shown insufficient accuracy. Our objective is to predict the risk of ASD in young children between 18 months and 30 months based on their medical histories using real-world health claims data. Methods Using the MarketScan Health Claims Database 2005–2016, we identified 12 743 children with ASD and a random sample of 25 833 children without ASD as our study cohort. We developed logistic regression (LR) with least absolute shrinkage and selection operator and random forest (RF) models for predicting ASD diagnosis at ages of 18–30 months, using demographics, medical diagnoses and healthcare service procedures extracted from individual’s medical claims during early years postbirth as predictor variables. Results For predicting ASD diagnosis at age of 24 months, the LR and RF models achieved the area under the receiver operating characteristic curve (AUROC) of 0.758 and 0.775, respectively. Prediction accuracy further increased with age. With predictor variables separated by outpatient and inpatient visits, the RF model for prediction at age of 24 months achieved an AUROC of 0.834, with 96.4% specificity and 20.5% positive predictive value at 40% sensitivity, representing a promising improvement over the existing screening tool in practice. Conclusions Our study demonstrates the feasibility of using machine learning models and health claims data to identify children with ASD at a very young age. It is deemed a promising approach for monitoring ASD risk in the general children population and early detection of high-risk children for targeted screening.
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Affiliation(s)
- Yu-Hsin Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- The Center for Applied Studies in Health Economics (CASHE), The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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28
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Raditha C, Handryastuti S, Pusponegoro HD, Mangunatmadja I. Positive behavioral effect of sensory integration intervention in young children with autism spectrum disorder. Pediatr Res 2022; 93:1667-1671. [PMID: 36030319 DOI: 10.1038/s41390-022-02277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/08/2021] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sensory integration occupational therapy (SI-OT) might be useful for autism spectrum disorders (ASD) in younger age, according to Pusponegoro. Previous studies were still limited, especially in younger age. This study evaluated the effect of SI-OT in improving positive behaviors of ASD children aged 2-5 years. METHODS Non-randomized controlled trial of SI-OT evaluation, assessed with Vineland Adaptive Behavior Scale-II. RESULTS A total of 72 subjects were studied. Following SI-OT, communication skills (expressive, receptive), socialization (coping skills), and daily living skills (personal, community) were improved significantly. CONCLUSIONS SI-OT with Ayres theory in 60 min, twice a week for 12 weeks improved positive behaviors. IMPACT To address the effectivity of sensory integration occupational therapy (SI-OT) in improving positive behaviors of autism spectrum disorders (ASD) children aged 2-5 years. The first study to evaluate evidence of SI-OT in ASD younger than 3 years. Non-randomized controlled trial of SI-OT evaluation of ASD in younger children aged 2-5 years with Vineland Adaptive Behavior Scale-II. SI-OT of Ayres theory in 60 min, twice a week for 12 weeks improves communication domain (expressive, receptive, written) aged 2-4 years, and socialization domain (interpersonal relationship, play, and leisure time) aged 2 years of ASD children.
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Affiliation(s)
- Citra Raditha
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia. .,Division of Neurology, Department of Child Health, Harapan Kita National Women and Children Health Center, Letjend. S Parman Street No. 87, 11420, Jakarta, Indonesia.
| | - Setyo Handryastuti
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
| | - Hardiono D Pusponegoro
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
| | - Irawan Mangunatmadja
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
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29
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Matos MB, Bara TS, Cordeiro ML. Autism Spectrum Disorder Diagnoses: A Comparison of Countries with Different Income Levels. Clin Epidemiol 2022; 14:959-969. [PMID: 35992506 PMCID: PMC9386174 DOI: 10.2147/clep.s373186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to assess whether high-income countries have a lower mean age at the time of diagnosis of autism spectrum disorder (ASD) than low- and middle-income countries. Method We reviewed studies related to ASD diagnoses and the time of first concerns in low-, middle-, and high-income countries, published in PubMed, SciELO, Lilacs, and ScienceDirect. Thirty articles were included: 13 from low- and middle-income countries and 17 from high-income countries. Results The average delay between initial concerns and diagnosis was 32.33 months, with initial concerns averaging 23.64 months and diagnosis at 55.97 months. No statistical differences were found between countries with low-, middle-, and high-income. Conclusions This review found a considerable delay in ASD diagnosis despite an early presence of recognized signs and symptoms. It highlights the urgent need for standardized tools for early ASD diagnosis.
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Affiliation(s)
- Marilia B Matos
- Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Tiago S Bara
- Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Mara L Cordeiro
- Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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30
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Do Autism-Specific and General Developmental Screens Have Complementary Clinical Value? J Autism Dev Disord 2022:10.1007/s10803-022-05541-y. [PMID: 35579791 PMCID: PMC10214166 DOI: 10.1007/s10803-022-05541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18 months, reinforcing the need for recurrent screening as autism emerges in early development.
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31
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Denis F, Maurier L, Carillo K, Ologeanu-Taddei R, Septans AL, Gepner A, Le Goff F, Desbois M, Demurger B, Silber D, Zeitoun JD, Assuied GP, Bonnot O. Early Detection of Neurodevelopmental Disorders of Toddlers and Postnatal Depression by Mobile Health App: Observational Cross-sectional Study. JMIR Mhealth Uhealth 2022; 10:e38181. [PMID: 35576565 PMCID: PMC9152715 DOI: 10.2196/38181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023] Open
Abstract
Background
Delays in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) in mothers are major public health issues. In both cases, early intervention is crucial.
Objective
We aimed to assess if a mobile app named Malo can reduce delay in the recognition of NDD and PND.
Methods
We performed an observational, cross-sectional, data-based study in a population of young parents with a minimum of 1 child under 3 years of age at the time of inclusion and using Malo on a regular basis. We included the first 4000 users matching the criteria and agreeing to participate between November 11, 2021, and January 14, 2022. Parents received monthly questionnaires via the app, assessing skills on sociability, hearing, vision, motricity, language of their infants, and possible autism spectrum disorder. Mothers were also requested to answer regular questionnaires regarding PND, from 4-28 weeks after childbirth. When any patient-reported outcomes matched predefined criteria, an in-app notification was sent to the user, recommending the booking of an appointment with their family physician or pediatrician.
The main outcomes were the median age of the infant at the time of notification for possible NDD and the median time of PND notifications after childbirth. One secondary outcome was the relevance of the NDD notification for a consultation as assessed by the physicians.
Results
Among 4242 children assessed by 5309 questionnaires, 613 (14.5%) had at least 1 disorder requiring a consultation. The median age of notification for possible autism spectrum, vision, audition, socialization, language, or motor disorders was 11, 9, 17, 12, 22, and 4 months, respectively. The sensitivity of the alert notifications of suspected NDDs as assessed by the physicians was 100%, and the specificity was 73.5%. Among 907 mothers who completed a PND questionnaire, highly probable PND was detected in 151 (16.6%) mothers, and the median time of detection was 8-12 weeks.
Conclusions
The algorithm-based alert suggesting NDD was highly sensitive with good specificity as assessed by real-life practitioners. The app was also efficient in the early detection of PND. Our results suggest that the regular use of this multidomain familial smartphone app would permit the early detection of NDD and PND.
Trial Registration
ClinicalTrials.gov NCT04958174; https://clinicaltrials.gov/ct2/show/NCT04958174
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Affiliation(s)
- Fabrice Denis
- Institut Inter-Regional Jean Bernard, ELSAN, Le Mans, France
| | - Laura Maurier
- Institut Inter-Regional Jean Bernard, ELSAN, Le Mans, France
| | | | | | | | | | | | | | | | - Denise Silber
- Basil Strategies, Paris, France
- VRforHealth, Paris, France
| | - Jean-David Zeitoun
- Centre d'Epidémiologie Clinique, Hôtel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Olivier Bonnot
- Service de Pédopsychiatrie, Centre Hospitalier Universitaire de Nantes, Nantes, France
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32
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Bakare MO, Frazier TW, Karpur A, Abubakar A, Nyongesa MK, Mwangi PM, Dixon P, Khaliq I, Gase NK, Sandstrom J, Okidegbe N, Rosanoff M, Munir KM, Shih A. Brief report: Validity and reliability of the Nigerian Autism Screening Questionnaire. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1581-1590. [PMID: 35261274 PMCID: PMC7613535 DOI: 10.1177/13623613221080250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Informant-report measures for screening symptoms of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs) are needed for low-resource settings if early identification is to be prioritized because early developmental concerns are likely to be expressed by parents and other caregivers. This paper describes the initial psychometric evaluation of the Nigeria Autism Screening Questionnaire (NASQ). Parents and other caregivers completed the NASQ on 12,311 children ages 1 to 18 in a Nigerian population sample as part of the World Bank National General Household Survey conducted in the country in 2016. Factor analyses indicated a parsimonious three-factor structure with social communication/interaction, repetitive sensory motor, and insistence on sameness dimensions. Measurement invariance was excellent across age and sex. Reliability of the subscales and total scale was good, and item response theory analyses indicated good measurement precision in the range from below average to high scores, crucial for screening, and tracking ASD symptoms. Studies with gold standard ASD diagnostic instruments and clinical confirmation are needed to evaluate screening and diagnostic accuracy. The NASQ appears to be a reliable instrument with a clear factor structure and potential for use in screening and tracking ASD symptoms in future Nigerian samples.
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Affiliation(s)
- Muideen O Bakare
- Federal Neuro Psychiatric Hospital, Nigeria.,Childhood Neuropsychiatric Disorders Initiatives (CNDI), Nigeria.,Ike Foundation for Autism (IFA), Nigeria.,World Psychiatric Association (WPA), Switzerland
| | | | | | - Amina Abubakar
- Aga Khan University, Kenya.,KEMRI-Wellcome Trust Research Programme, Kenya
| | | | | | | | | | | | | | | | | | - Kerim M Munir
- World Psychiatric Association (WPA), Switzerland.,Harvard Medical School, USA
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33
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Barbaro J, Sadka N, Gilbert M, Beattie E, Li X, Ridgway L, Lawson LP, Dissanayake C. Diagnostic Accuracy of the Social Attention and Communication Surveillance-Revised With Preschool Tool for Early Autism Detection in Very Young Children. JAMA Netw Open 2022; 5:e2146415. [PMID: 35275169 PMCID: PMC8917423 DOI: 10.1001/jamanetworkopen.2021.46415] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Early identification of children on the autism spectrum is crucial to facilitate access to early supports and services for children and families. The need for improved early autism identification tools is highlighted by the lack of sufficient diagnostic accuracy in current tools. OBJECTIVES To examine the diagnostic accuracy of the Social Attention and Communication Surveillance-Revised (SACS-R) and SACS-Preschool (SACS-PR) tools when used with a large, community-based, convenience sample and identify the prevalence of autism in this sample. DESIGN, SETTING, AND PARTICIPANTS This diagnostic accuracy study was conducted in Melbourne, Australia, training maternal and child health nurses who monitored 13 511 children aged 11 to 42 months using the SACS-R and SACS-PR during their routine consultations (June 1, 2013, to July 31, 2018). Children identified as being at high likelihood for autism (12-24 months of age: n = 327; 42 months of age: n = 168) and at low likelihood for autism plus concerns (42 months of age: n = 28) were referred by their maternal and child health nurse for diagnostic assessment by the study team. Data analysis was performed from April 13, 2020, to November 29, 2021. EXPOSURES Children were monitored with SACS-R and SACS-PR at 12, 18, 24, and 42 months of age. MAIN OUTCOMES AND MEASURES Diagnostic accuracy of the SACS-R and SACS-PR was determined by comparing children's likelihood for autism with their diagnostic outcome using clinical judgment based on standard autism assessments (Autism Diagnostic Observation Schedule-Second Edition and Autism Diagnostic Interview-Revised). RESULTS A total of 13 511 children (female: 6494 [48.1%]; male: 7017 [51.9%]) were monitored at least once with the SACS-R at their 12-, 18-, and 24-month-old routine maternal and child health consultations (mean [SD] age, 12.3 [0.59] months at 12 months; 18.3 [0.74] months at 18 months; 24.6 [1.12] months at 24 months) and followed up at their 42-month maternal and child health consultation (mean [SD] age, 44.0 [2.74] months) with SACS-PR (8419 [62.3%]). At 12 to 24 months, SACS-R showed high diagnostic accuracy, with 83% positive predictive value (95% CI, 0.77-0.87) and 99% estimated negative predictive value (95% CI, 0.01-0.02). Specificity (99.6% [95% CI, 0.99-1.00]) was high, with modest sensitivity (62% [95% CI, 0.57-0.66]). When the SACS-PR 42-month assessment was added, estimated sensitivity increased to 96% (95% CI, 0.94-0.98). Autism prevalence was 2.0% (1 in 50) between 11 and 30 months of age and 3.3% (1 in 31) between 11 and 42 months of age. CONCLUSIONS AND RELEVANCE The SACS-R with SACS-PR (SACS-R+PR) had high diagnostic accuracy for the identification of autism in a community-based sample of infants, toddlers, and preschoolers, indicating the utility of early autism developmental surveillance from infancy to the preschool period rather than 1-time screening. Its greater accuracy compared with psychometrics of commonly used autism screening tools when used in community-based samples suggests that the SACS-R+PR can be used universally for the early identification of autism.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Erin Beattie
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Lael Ridgway
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Lauren P. Lawson
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
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Sheldrick RC, Carter AS, Eisenhower A, Mackie TI, Cole MB, Hoch N, Brunt S, Pedraza FM. Effectiveness of Screening in Early Intervention Settings to Improve Diagnosis of Autism and Reduce Health Disparities. JAMA Pediatr 2022; 176:262-269. [PMID: 34982099 PMCID: PMC8728657 DOI: 10.1001/jamapediatrics.2021.5380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE The American Academy of Pediatrics recommends referring children at elevated risk of autism spectrum disorder (ASD) for Part C early intervention (EI) services, but notes that EI services often fail to provide ASD screening. OBJECTIVE To evaluate the hypothesis that a multistage screening protocol for ASD implemented in 3 EI settings will increase autism detection, especially among Spanish-speaking families. DESIGN, SETTING, AND PARTICIPANTS Difference-in-differences analyses with propensity score weighting of a quasi-experimental design using administrative data on 3 implementation EI agencies and 9 comparison EI agencies from 2012 to 2018 provided by the Massachusetts Department of Public Health. Eligible children were aged 14 to 36 months, enrolled in EI, had no prior ASD diagnosis or medical condition precluding participation, and had parents who spoke English or Spanish. The final analytic sample included 33 326 unique patients assessed across 150 200 person-quarters. EXPOSURES Multistage ASD assessment protocol including ASD screening questionnaires, observational screener, and diagnostic evaluation. MAIN OUTCOMES AND MEASURES Increased incidence of ASD diagnoses as documented in Department of Public Health records and reductions in language-associated health care disparities. RESULTS Implementation of screening at 3 EI sites was associated with a significant increase in the rate of ASD diagnoses (incidence rate ratios [IRR], 1.6; 95% CI, 1.3-2.1; P < .001), representing an additional 8.1 diagnoses per 1000 children per quarter. Among Spanish-speaking families, screening was also associated with a significant increase in the rate of ASD diagnoses (IRR, 2.6; 95% CI, 1.6-4.3; P < .001), representing 15.4 additional diagnoses per 1000 children per quarter-a larger increase than for non-Spanish-speaking families (interaction IRR, 1.8; 95% CI, 1.0-3.1; P = .005). Exploratory analyses revealed that screening was associated with a larger increase in the rate of ASD diagnoses among boys (IRR, 1.8; 95% CI, 1.4-2.3; P < .001) than among girls (IRR, 1.1; 95% CI, 0.6-1.7; P = .84). CONCLUSIONS AND RELEVANCE In this study, associations between increased rates of ASD diagnoses and reductions in disparities for Spanish-speaking households support the effectiveness of multistage screening in EI. This study provides a comprehensive evaluation of ASD screening in EI settings as well as a rigorous evaluation of ASD screening in any setting with a no-screening comparison condition. Given that the intervention included multiple components, mechanisms of action warrant further research, as do disparities by child sex.
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Affiliation(s)
| | | | | | - Thomas I. Mackie
- State University of New York Downstate Health Sciences University, Brooklyn
| | | | - Noah Hoch
- University of Massachusetts Boston, Boston,Clark University, Worcester, Massachusetts
| | - Sophie Brunt
- University of Massachusetts Boston, Boston,University of Virginia, Charlottesville
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35
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Eilenberg JS, Kizildag D, Blakey A, Cardona ND, Oberoi A, Broder-Fingert S, Feinberg E, Long KA. Implications of Universal Autism Screening: Perspectives From Culturally Diverse Families With False-Positive Screens. Acad Pediatr 2022; 22:279-288. [PMID: 34963655 PMCID: PMC8939055 DOI: 10.1016/j.acap.2021.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) recommends that pediatricians screen all young children for autism spectrum disorder (ASD). However, the US Preventive Services Task Force stated that there is insufficient evidence about the potential harms and benefits of universal ASD screening. To address this gap, we conducted qualitative interviews with caregivers of children who received a false-positive ASD screen to learn about families' perceptions of the harms and benefits of universal ASD screening. METHODS Culturally diverse caregivers (N = 26) of children with false-positive ASD screens completed qualitative interviews focused on parents' experiences with and recommendations to improve the ASD screening and evaluation process. Interviews were transcribed verbatim, coded, and analyzed using applied thematic analysis. RESULTS Parents explained that the ASD screening and evaluation process increased their knowledge about child development and substantiated existing concerns. The ASD screening and evaluation process resulted in connecting their child to services, which parents felt led to improvements in their child's delays. Parents endorsed anxiety during wait times for the formal developmental assessment. However, all parents expressed that, if given the option, they would repeat the screening and evaluation process again. Caregivers recommended universal screening for ASD and suggested that screening extend beyond the pediatrician to other settings. CONCLUSIONS From parents' perspectives, the connection to developmental services and increased knowledge of child development that resulted from the false-positive ASD screen outweighed the time-limited emotional distress triggered by a positive ASD screen. Overall, parents' preferences for universal ASD screening align with the AAP's recommendations.
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Affiliation(s)
- Jenna Sandler Eilenberg
- Department of Psychological and Brain Sciences, Boston University (JS Eilenberg, D Kizildag, AO Blakey, ND Cardona, A Oberoi, and KA Long), Boston, Mass.
| | - Deniz Kizildag
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Ariel Blakey
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Nicole D. Cardona
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Anjali Oberoi
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Sarabeth Broder-Fingert
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA,Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Kristin A. Long
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
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36
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Factor RS, Arriaga RI, Morrier MJ, Mathys JB, Dirienzo M, Miller CA, Southerland AM, Abowd GD, Ousley OY. Development of an interactive tool of early social responsiveness to track autism risk in infants and toddlers. Dev Med Child Neurol 2022; 64:323-330. [PMID: 34427344 DOI: 10.1111/dmcn.15035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/01/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the psychometric properties of a 4-minute assessment designed to identify early autism spectrum disorder (ASD) status through evaluation of early social responsiveness (ESR). METHOD This retrospective, preliminary study included children between 13 and 24 months (78 males, 79 females mean age 19.4mo, SD 3.1) from two independent data sets (an experimental/training sample [n=120] and a validation/test sample [n=37]). The ESR assessment examined social behaviors (e.g. eye contact, smiling, ease-of-social-engagement) across five common play activities (e.g. rolling a ball, looking at a book). Data analyses examined reliability and accuracy of the assessment in identifying ESR abilities and in discriminating children with and without ASD. RESULTS Results indicated adequate internal consistency and test-retest reliability of the ESR assessment. Receiver operator curve analysis identified a cutoff score that discriminated infants with ASD-risk from peers in the training sample. This score yielded moderate sensitivity and high specificity for best-estimate ASD diagnosis in the validation sample. INTERPRETATION Preliminary findings indicated that brief, systematic observation of ESR may assist in discriminating infants with and without ASD, providing concrete evidence to validate or supplement parents', pediatricians', or clinicians' concerns. Future studies could examine the utility of ESR 'growth curves'.
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Affiliation(s)
- Reina S Factor
- Department of Psychology, Virginia Polytechnic Institute & State University, Blacksburg, VA, USA.,Virginia Tech Center for Autism Research, Blacksburg, VA, USA
| | - Rosa I Arriaga
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Michael J Morrier
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Emory Autism Center, Atlanta, GA, USA
| | - Jennifer B Mathys
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Charlotte, NC, USA
| | | | - Chanel A Miller
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Audrey M Southerland
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gregory D Abowd
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Opal Y Ousley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Emory Autism Center, Atlanta, GA, USA
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37
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Abstract
The rural areas have been at the receiving end amidst mental health disparity across the USA. There is a serious and concerning divide among ones with autism spectrum disorders (ASDs) living in underserved areas as compared to urban residents. With the higher than ever prevalence of ASD as per the recent reports of the Centers for Disease Control and Prevention; there is a need for a closer look at the prevailing issues. The trends are reflecting marked underdiagnosis, late diagnosis, lack of evidence-based diagnostic measures and interventions. These factors interplay in worsening the mental health crisis and there is an urgent need for corrective measures to address these highly modifiable problems.
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Schjølberg S, Shic F, Volkmar FR, Nordahl-Hansen A, Stenberg N, Torske T, Larsen K, Riley K, Sukhodolsky DG, Leckman JF, Chawarska K, Øien RA. What are we optimizing for in autism screening? Examination of algorithmic changes in the M-CHAT. Autism Res 2022; 15:296-304. [PMID: 34837355 PMCID: PMC8821132 DOI: 10.1002/aur.2643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
The present study objectives were to examine the performance of the new M-CHAT-R algorithm to the original M-CHAT algorithm. The main purpose was to examine if the algorithmic changes increase identification of children later diagnosed with ASD, and to examine if there is a trade-off when changing algorithms. We included 54,463 screened cases from the Norwegian Mother and Child Cohort Study. Children were screened using the 23 items of the M-CHAT at 18 months. Further, the performance of the M-CHAT-R algorithm was compared to the M-CHAT algorithm on the 23-items. In total, 337 individuals were later diagnosed with ASD. Using M-CHAT-R algorithm decreased the number of correctly identified ASD children by 12 compared to M-CHAT, with no children with ASD screening negative on the M-CHAT criteria subsequently screening positive utilizing the M-CHAT-R algorithm. A nonparametric McNemar's test determined a statistically significant difference in identifying ASD utilizing the M-CHAT-R algorithm. The present study examined the application of 20-item MCHAT-R scoring criterion to the 23-item MCHAT. We found that this resulted in decreased sensitivity and increased specificity for identifying children with ASD, which is a trade-off that needs further investigation in terms of cost-effectiveness. However, further research is needed to optimize screening for ASD in the early developmental period to increase identification of false negatives.
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Affiliation(s)
- Synnve Schjølberg
- a: Norwegian Institute of Public Health, University of Washington School of Medicine
| | - Frederick Shic
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | - Fred R. Volkmar
- c: Yale Child Study Center, The Arctic University of Norway,d: Southern Connecticut University, The Arctic University of Norway
| | | | - Nina Stenberg
- f: Oslo University Hospital, The Arctic University of Norway
| | - Tonje Torske
- g: Vestre Viken Hospital:, The Arctic University of Norway
| | | | - Katherine Riley
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | | | | | | | - Roald A. Øien
- c: Yale Child Study Center, The Arctic University of Norway,h: UiT – The Arctic University of Norway,Corresponding author tel: +4793099994, PB 6070, 9037 Tromsoe, Norway
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39
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Petruccelli M, Ramella L, Schaefer AJ, Sheldrick RC, Carter AS, Eisenhower A, Broder-Fingert S, Mackie TI. A Taxonomy of Reported Harms in Pediatric Autism Spectrum Disorder Screening: Provider and Parent Perspectives. J Autism Dev Disord 2022; 52:647-673. [PMID: 33751375 PMCID: PMC8455720 DOI: 10.1007/s10803-021-04964-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The U.S. Preventive Services Task Force (USPSTF) report on screening for Autism Spectrum Disorder (ASD) highlighted the need for research that examines the harms potentially associated with screening so as to assess the overall net benefit of universal screening. In response, this study engages qualitative, semi-structured interviews to generate a taxonomy outlining potential harms reported by parents and providers (pediatricians and Early Intervention providers) with experience in screening young children for ASD. Potential harms emerged including: physical, psychological, social, logistical/financial, opportunity cost, attrition, and exacerbation of non-targeted disparities. Respondents reported harms being experienced by the toddlers, parents, and providers. The harms reported highlight opportunities for providers to offer resources that mitigate the potential for these unintended consequences.
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Affiliation(s)
- Marisa Petruccelli
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | - Leah Ramella
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA 02215, USA
| | - Ana J. Schaefer
- 683 Hoes Lane West, Rutgers School of Public Health, Piscataway, NJ, USA
| | - R. Christopher Sheldrick
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA 02215, USA
| | - Alice S. Carter
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | - Abbey Eisenhower
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | | | - Thomas I. Mackie
- 683 Hoes Lane West, Rutgers School of Public Health, Piscataway, NJ, USA,112 Paterson Ave, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA 08901
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40
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Hudock RL, Esler AN. Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children. Clin Neuropsychol 2022; 36:921-942. [DOI: 10.1080/13854046.2022.2025907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebekah L. Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Amy N. Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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41
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 121.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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42
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Sturner R, Howard B, Bergmann P, Attar S, Stewart-Artz L, Bet K, Allison C, Baron-Cohen S. Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners. Mol Autism 2022; 13:2. [PMID: 34980240 PMCID: PMC8722322 DOI: 10.1186/s13229-021-00480-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.
Methods This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.
Results While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Limitations Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Conclusions Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00480-4.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA. .,Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Paul Bergmann
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,Foresight Logic, Inc., St. Paul, MN, USA
| | - Shana Attar
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,University of Washington, Seattle, WA, USA
| | - Lydia Stewart-Artz
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA
| | - Kerry Bet
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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43
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Zhang Y, Zhou Z, Xu Q, Li H, Lv Y, Zhu G, Dong P, Li D, Wang Y, Tang X, Xu X. Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits. Front Psychiatry 2022; 13:879625. [PMID: 35573353 PMCID: PMC9097214 DOI: 10.3389/fpsyt.2022.879625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/31/2022] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Early screening contributes to the early detection of children with autism spectrum disorder (ASD). We conducted a longitudinal ASD screening study in a large community setting. The study was designed to investigate the diagnostic rate of ASD screening and determine the effectiveness of ASD screening model in a community-based sample. METHODS We enrolled children who attended 18- and 24-month well-child care visits in Shanghai Xuhui District. Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Binomial Observation Test (BOT) were selected as screening instruments. Screen-positive children were referred to a tertiary diagnostic center for comprehensive ASD diagnostic evaluation. Screen-negative children received well-child checkups and follow-up every 3-6 months until age three and were referred if they were suspected of having ASD. RESULTS A total of 11,190 toddlers were screened, and 36 screen-positive toddlers were diagnosed with ASD. The mean age at diagnosis for these children was 23.1 ± 4.55 months, diagnosed 20 months earlier than ASD children not screened. The diagnostic rate of ASD was 0.32% (95% CI: 0.23-0.45%) in this community-based sample. In addition, 12 screen-negative children were diagnosed with ASD during subsequent well-child visit and follow-up. The average diagnostic rate of ASD rose to 0.43% (95% CI: 0.32-0.57%) when toddlers were followed up to 3 years old. The positive predictive values (PPVs) of M-CHAT-R/F, M-CHAT-R high risk, and BOT for ASD were 0.31, 0.43, and 0.38 respectively. CONCLUSION Our findings provide reliable data for estimating the rate of ASD detection and identifying the validity of community-based screening model. M-CHAT-R/F combined with BOT can be an effective tool for early detection of ASD. This community-based screening model is worth replicating.
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Affiliation(s)
- Ying Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Zhaoe Zhou
- Department of Child Healthcare, Xuhui Maternal and Child Healthcare Hospital, Shanghai, China
| | - Qiong Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Huiping Li
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Yujing Lv
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Guowei Zhu
- Department of Child Healthcare, Xuhui Maternal and Child Healthcare Hospital, Shanghai, China
| | - Ping Dong
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Dongyun Li
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Xinrui Tang
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
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44
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TRAN AMANDAT, DEL ROSARIO MITHI, NOSCO ERIN, LI YIHAO, SENTURK DAMLA, MCDONALD NICOLEM, WILSON RUJUTAB, DAPRETTO MIRELLA, JESTE SHAFALIS. Early concerns in parents of infants at risk for autism. Dev Med Child Neurol 2021; 63:1410-1416. [PMID: 34109620 PMCID: PMC8666093 DOI: 10.1111/dmcn.14925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine parental concerns about children at increased familial risk (i.e. high risk) of developing autism spectrum disorder (ASD) in early infancy. METHOD ASD-related and general parental concerns were prospectively collected for 76 infants at ages 1.5, 3, 6, 9, 12, and 18 months. Outcome classification was determined at 36 months. Analyses included generalized linear mixed models and qualitative evaluation of parental concerns in relation to risk status (high vs low risk) and outcome classification within the high-risk group (atypically developing vs typically developing) over time. RESULTS Most parents had no concerns at 1.5 (high risk 71%, low risk 87%) and 3 months (high risk 77%, low risk 86%). Beginning at 6 months, parents of high-risk infants reported more ASD-related (p<0.001) and general concerns (p=0.003) than parents of low-risk infants. Beginning at 12 months, parents of high-risk atypically developing infants reported more ASD-related concerns than parents of high-risk typically developing infants (p=0.013). INTERPRETATION Clinicians should elicit parental concerns and provide support, as parents are worried about their high-risk infants by age 6 months. Additionally, parents' abilities to identify concerns that are suggestive of ASD by age 12 months may aid in earlier screening and intervention. What this paper adds Most parents did not report concerns during early infancy. By 6 months, parents of high-risk infants reported autism spectrum disorder (ASD)-related and general concerns. By 12 months, parents of high-risk atypically developing infants identified ASD-related concerns.
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Affiliation(s)
- AMANDA T TRAN
- David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - MITHI DEL ROSARIO
- David Geffen School of Medicine at the University of California, Los Angeles, CA,Department of Medicine, University of California, San Francisco, CA
| | - ERIN NOSCO
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - YIHAO LI
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - DAMLA SENTURK
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - NICOLE M MCDONALD
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - RUJUTA B WILSON
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - MIRELLA DAPRETTO
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - SHAFALI S JESTE
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
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45
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Gabbay-Dizdar N, Ilan M, Meiri G, Faroy M, Michaelovski A, Flusser H, Menashe I, Koller J, Zachor DA, Dinstein I. Early diagnosis of autism in the community is associated with marked improvement in social symptoms within 1-2 years. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1353-1363. [PMID: 34623179 PMCID: PMC9340129 DOI: 10.1177/13623613211049011] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT It is widely believed that early diagnosis and treatment of autism spectrum disorder is essential for better outcome. This is demonstrated by the American Academy of Pediatrics recommendation to screen all 1.5-2.5-year-old toddlers for autism spectrum disorder. However, multiple longitudinal studies of children diagnosed with autism spectrum disorder at 1.5-6 years of age and treated in community settings have not reported any associations between earlier diagnosis and improved outcome in core autism spectrum disorder symptoms. In this study, we measured changes in core autism spectrum disorder symptoms over a 1-2-year period in 131 children diagnosed with autism spectrum disorder at 1.2-5 years of age, and treated in the community. The results revealed that children who were diagnosed before 2.5 years of age were three times more likely to exhibit considerable improvements in social autism spectrum disorder symptoms in comparison to children diagnosed at later ages. These results highlight the importance of early diagnosis and treatment of autism spectrum disorder even in community settings with heterogeneous services. In addition, these results motivate further prioritization of universal screening for autism spectrum disorder before 2.5 years of age.
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Affiliation(s)
| | - Michal Ilan
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Gal Meiri
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Michal Faroy
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Analya Michaelovski
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Hagit Flusser
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
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46
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Lo YH, Cheng HC, Hsiung CN, Yang SL, Wang HY, Peng CW, Chen CY, Lin KP, Kang ML, Chen CH, Chu HW, Lin CF, Lee MH, Liu Q, Satta Y, Lin CJ, Lin M, Chaw SM, Loo JH, Shen CY, Ko WY. Detecting Genetic Ancestry and Adaptation in the Taiwanese Han People. Mol Biol Evol 2021; 38:4149-4165. [PMID: 33170928 PMCID: PMC8476137 DOI: 10.1093/molbev/msaa276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Taiwanese people are composed of diverse indigenous populations and the Taiwanese Han. About 95% of the Taiwanese identify themselves as Taiwanese Han, but this may not be a homogeneous population because they migrated to the island from various regions of continental East Asia over a period of 400 years. Little is known about the underlying patterns of genetic ancestry, population admixture, and evolutionary adaptation in the Taiwanese Han people. Here, we analyzed the whole-genome single-nucleotide polymorphism genotyping data from 14,401 individuals of Taiwanese Han collected by the Taiwan Biobank and the whole-genome sequencing data for a subset of 772 people. We detected four major genetic ancestries with distinct geographic distributions (i.e., Northern, Southeastern, Japonic, and Island Southeast Asian ancestries) and signatures of population mixture contributing to the genomes of Taiwanese Han. We further scanned for signatures of positive natural selection that caused unusually long-range haplotypes and elevations of hitchhiked variants. As a result, we identified 16 candidate loci in which selection signals can be unambiguously localized at five single genes: CTNNA2, LRP1B, CSNK1G3, ASTN2, and NEO1. Statistical associations were examined in 16 metabolic-related traits to further elucidate the functional effects of each candidate gene. All five genes appear to have pleiotropic connections to various types of disease susceptibility and significant associations with at least one metabolic-related trait. Together, our results provide critical insights for understanding the evolutionary history and adaption of the Taiwanese Han population.
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Affiliation(s)
- Yun-Hua Lo
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Hsueh-Chien Cheng
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Show-Ling Yang
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Han-Yu Wang
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Wei Peng
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Chen
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kung-Ping Lin
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Ling Kang
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Hou-Wei Chu
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | | | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Quintin Liu
- Department of Evolutionary Studies of Biosystems, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| | - Yoko Satta
- Department of Evolutionary Studies of Biosystems, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| | - Cheng-Jui Lin
- Molecular Anthropology and Transfusion Medicine Research Laboratory, Mackay Memorial Hospital, Taipei, Taiwan
| | - Marie Lin
- Molecular Anthropology and Transfusion Medicine Research Laboratory, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Miaw Chaw
- Biodiversity Research Center, Academia Sinica, Taipei City, Taiwan
| | - Jun-Hun Loo
- Molecular Anthropology and Transfusion Medicine Research Laboratory, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yang Shen
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Wen-Ya Ko
- Faculty of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
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47
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Abstract
We looked at existing recommendations and supporting evidence on the effectiveness of screening young children for autistic spectrum disorder (ASD) for improving short- and long-term outcomes.We conducted a literature search up to the 8th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.There are discrepancies among the recommendations given by different institutions on universal screening for ASD in children. Some recommend that all children should be screened with an ASD-specific instrument during well-child visits at ages 18 and 24 months in conjunction with ongoing developmental surveillance and broadband developmental screening; some conclude that the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician; and others recommend against universal screening, but for a screening among children with high risks.There is adequate evidence that ASD screening tools applied to children between 12 and 36 months accurately identify those with ASD. There is some evidence showing benefit of early interventions applied to children with ASD, from children identified with developmental concern by their family, teacher or clinicians. We found no evidence on the effectiveness of interventions applied to children with ASD detected through screening.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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48
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Kuhn J, Levinson J, Udhnani MD, Wallis K, Hickey E, Bennett A, Fenick AM, Feinberg E, Broder-Fingert S. What Happens After a Positive Primary Care Autism Screen Among Historically Underserved Families? Predictors of Evaluation and Autism Diagnosis. J Dev Behav Pediatr 2021; 42:515-523. [PMID: 33631787 PMCID: PMC8380258 DOI: 10.1097/dbp.0000000000000928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Families, pediatric providers, and service systems would benefit from expanded knowledge regarding (1) who is most likely to receive a recommended diagnostic evaluation after a positive primary care-administered autism screen and (2) of those who screen positive, who is most likely to be diagnosed with autism? METHOD Participants included 309 predominantly low-income, racial/ethnic minority parents and their child, aged 15 to 27 months, who screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Generalized estimating equations were used to fit models of predictors for each binary outcome: receiving a diagnostic evaluation and receiving an autism diagnosis on evaluation. RESULTS Significant predictors of diagnostic evaluation receipt included the parent being older or non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis on evaluation included male child, lower child communication functioning, screening directly in the parent's preferred language, White/non-Hispanic parent, and no parent history of mood disorder. CONCLUSION Children with younger parents, Hispanic ethnicity, relatively higher communication skills, public insurance, and no Early Intervention services were less likely to receive recommended diagnostic care. Reduced likelihood of autism diagnosis after a positive screen in non-White/non-Hispanic subgroups supports previous research indicating issues with M-CHAT-R/F positive predictive power for racial/ethnic minorities. The use of telephonic interpreters to administer screens, as opposed to directly screening in families' preferred languages, may lead to identification of fewer true autism cases. Thus, multilingual clinical staff capacity may improve positive predictive power of autism screening.
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Affiliation(s)
| | | | | | - Kate Wallis
- Children’s Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania
| | | | | | | | - Emily Feinberg
- Boston University School of Public Health
- Boston University School of Medicine
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Pierce K, Gazestani V, Bacon E, Courchesne E, Cheng A, Barnes CC, Nalabolu S, Cha D, Arias S, Lopez L, Pham C, Gaines K, Gyurjyan G, Cook-Clark T, Karins K. Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis. J Pediatr 2021; 236:179-188. [PMID: 33915154 DOI: 10.1016/j.jpeds.2021.04.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the impact of a new approach, Get SET Early, on the rates of early autism spectrum disorder (ASD) detection and factors that influence the screen-evaluate-treat chain. STUDY DESIGN After attending Get SET Early training, 203 pediatricians administered 57 603 total screens using the Communication and Symbolic Behavior Scales Infant-Toddler Checklist at 12-, 18-, and 24-month well-baby examinations, and parents designated presence or absence of concern. For screen-positive toddlers, pediatricians specified if the child was being referred for evaluation, and if not, why not. RESULTS Collapsed across ages, toddlers were evaluated and referred for treatment at a median age of 19 months, and those screened at 12 months (59.4% of sample) by 15 months. Pediatricians referred one-third of screen-positive toddlers for evaluation, citing lack of confidence in the accuracy of screen-positive results as the primary reason for nonreferral. If a parent expressed concerns, referral probability doubled, and the rate of an ASD diagnosis increased by 37%. Of 897 toddlers evaluated, almost one-half were diagnosed as ASD, translating into an ASD prevalence of 1%. CONCLUSIONS The Get SET Early model was effective at detecting ASD and initiating very early treatment. Results also underscored the need for change in early identification approaches to formally operationalize and incorporate pediatrician judgment and level of parent concern into the process.
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Affiliation(s)
- Karen Pierce
- Department of Neurosciences, University of California, San Diego, La Jolla, CA.
| | - Vahid Gazestani
- Department of Neurosciences, University of California, San Diego, La Jolla, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Elizabeth Bacon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Eric Courchesne
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Amanda Cheng
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | | | - Srinivasa Nalabolu
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Debra Cha
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Steven Arias
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Linda Lopez
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Christie Pham
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Kim Gaines
- San Diego Regional Center, San Diego, CA
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Pileggi ML, Brane N, Bradshaw J, Delehanty A, Day T, McCracken C, Stapel-Wax J, Wetherby AM. Early Observation of Red Flags in 12-Month-Old Infant Siblings Later Diagnosed With Autism Spectrum Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1846-1855. [PMID: 33989505 PMCID: PMC8702865 DOI: 10.1044/2020_ajslp-20-00165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Purpose Valid and reliable screening tools are needed to improve early detection and optimize developmental outcomes for toddlers at risk for autism spectrum disorder (ASD). The current study aimed to evaluate the utility of the Systematic Observation of Red Flags (SORF) for ASD at 12 months of age in a sample of high-risk infant siblings of children with ASD. Method As part of a prospective, longitudinal study, we examined the sensitivity and specificity of the SORF at 12 months for predicting a diagnosis of ASD at 24 months in a sample of 122 infants, 31 of whom were diagnosed with ASD. Results The optimal SORF Composite cutoff score of 18 correctly identified 24 of the 31 twelve-month-olds who were diagnosed with ASD, yielding a sensitivity of .77 and a specificity of .76. The optimal SORF Red Flags cutoff score of 7 correctly identified 20 of the 31 infants, yielding a sensitivity of .65 and a specificity of .75. Conclusion This preliminary study demonstrates the potential of the SORF as an effective observational screening measure for 12-month-olds at risk for ASD with good discrimination, sensitivity, and specificity.
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Affiliation(s)
| | - Natalie Brane
- Marcus Autism Center, Children's Healthcare of Atlanta, GA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia
| | - Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Taylor Day
- Department of Psychology, Florida State University, Tallahassee
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Amy M. Wetherby
- Department of Clinical Sciences, Florida State University, Tallahassee
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