Reliability and validity of the translated Chinese version of Autism Spectrum Rating Scale (2-5 years)

Autism diagnosis in children and adolescents: A systematic review and meta-analysis of test accuracy

Accurate diagnosis of Autism Spectrum Disorder (ASD) is essential for appropriate care. This systematic review evaluated the accuracy of standardized structured tools in diagnosing ASD in children and adolescents. Searches were conducted on PubMed/MEDLINE, Embase, PsycINFO, Cochrane Library, and references. Certainty of evidence was evaluated according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Thirty-two studies were included. Pooled data indicated different degrees of sensitivity (Se) and specificity (Sp) for Autism Diagnostic Interview-Revised (Se:.60 and Sp:.84), Autism Diagnostic Observation Schedule (Se:.91 and Sp:.74), Autism Diagnostic Observation Schedule -Second Edition (Se:.90 and Sp:.69), Autism Spectrum Rating Scales (Se:.66 and Sp:.86), Childhood Autism Rating Scale (Se:.85 and Sp:.94), Checklist for Autism Spectrum Disorder (Se:.91 and Sp:.98), Developmental, Dimensional and Diagnostic Interview-11 (Se:.96 and Sp:.50), and Gilliam Autism Rating Scale (Se:.50 and Sp:.78). Overall, certainty of the evidence was low and very low except for ADOS-2 (moderate). The results indicate a discrepancy between clinical judgment and the assessment derived from a standardized test when applying their thresholds, suggesting that the tests may not always fully align with the clinician's evaluation. Clinicians should apply diagnostic tools while considering their limitations in terms of their sensitivity, specificity, and certainty of evidence. Diagnostic tools should be regarded as adjunctive aids rather than comprehensive substitutes for diagnosis.

Differential One-Carbon Metabolites among Children with Autism Spectrum Disorder: A Case-Control Study

BACKGROUND

Driven by the complex multifactorial etiopathogenesis of autism spectrum disorder (ASD), a growing interest surrounds the disturbance in folate-dependent one-carbon metabolism (OCM) in the pathology of ASD, whereas the evidence remained inconclusive.

OBJECTIVES

The study aims to investigate the association of OCM metabolism and ASD and characterize differential OCM metabolites among children with ASD.

METHODS

Plasma OCM metabolites were investigated in 59 children with ASD and 40 neurotypical children using ultra-performance liquid chromatography tandem mass spectrometry technology. Differences (significance level < 0.001) were tested in each OCM metabolite between cases and controls. Multivariable models were also performed after adjusting for covariates.

RESULTS

Ten out of 22 examined OCM metabolites were significantly different in children with ASD, compared with neurotypical controls. Specifically, S-adenosylmethionine (SAM), oxidized glutathione (GSSG), and glutathione (GSH) levels were increased, whereas S-adenosylhomocysteine (SAH), choline, glycine, L-serine, cystathionine, L-cysteine, and taurine levels were significantly decreased. Children with ASD showed significantly higher SAM/SAH ratio (3.87 ± 0.93 compared with 2.00 ± 0.76, P = 0.0001) and lower GSH/GSSG ratio [0.58 (0.46, 0.81) compared with 1.71 (0.93, 2.99)] compared with the neurotypical controls. Potential interactive effects between SAM/SAH ratio, taurine, L-serine, and gastrointestinal syndromes were further observed.

CONCLUSIONS

OCM disturbance was observed among children with ASD, particularly in methionine methylation and trans-sulfuration pathways. The findings add valuable insights into the mechanisms underlying ASD and the potential of ameliorating OCM as a promising therapeutic of ASD, which warrant further validation.

Screening for Autism: A Review of the Current State, Ongoing Challenges, and Novel Approaches on the Horizon

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.

Investigating and comparing the psychometric properties of the Chinese Mandarin version of social responsiveness scale-2 and its shortened version in preschool-age children with autism spectrum disorder

We aimed to investigate and compare the psychometric properties of the Chinese Mandarin Social Responsiveness Scale-2 (SRS-2) and its shortened version. The study assessed 670 children with autism spectrum disorder (ASD) aged 30-54 months and 138 typical developmental (TD) children of the same age in mainland China. Our item reliability test revealed that only 36 items of the 65 items in the Chinese Mandarin SRS-2 (Preschool) met the reliability criteria. Moreover, the shortened version of SRS-2 (Preschool) with four subscales and 30 items maintained strong correlations (r = 0.961) with the Chinese Mandarin SRS-2 (Preschool), and demonstrated improved psychometric performance on the 4-week test-retest reliability (intraclass correlations was 0.70), internal consistency (Cronbach's alpha 0.71-0.91), construct validity, and convergent validity with the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview-Revised, and Child Behavior Checklist. Receiver operating characteristics (ROC) analyses showed excellent and comparable discriminant validity of the shortened version with an area under the curve of 0.992. Our data suggested a cutoff ≥ 22.5 for the shortened version, with good accuracy in screening autism symptoms (sensitivity=96.9 %, specificity=94.2 %). Our findings demonstrated that the shortened version of SRS-2 (Preschool) was a reliable and valid instrument for identifying preschoolers with ASD in mainland China.

The validity and reliability of the simplified Chinese version of the Social Communication Questionnaire

This study aims to validate the simplified Chinese version of the Social Communication Questionnaire (SCQ) in children aged 2-12 years from both general and clinical populations. We recruited 819 Chinese children in this study, including 505 typically developing (TD) children, 202 children with autism spectrum disorder (ASD) and 112 children with non-ASD neurodevelopmental disorders. All the children's parents completed the simplified Chinese version of the SCQ and all children with ASD were additionally assessed for intelligence and the Childhood Autism Rating Scale to confirm their diagnosis. We have developed a 40-item, 4-factor structure of SCQ with two domains (social communication and social interaction; and restricted, repetitive, and stereotyped patterns of behavior), which showed adequate goodness of fit (comparative fit index [CFI] = 0.96, Tucker-Lewis index [TLI] = 0.95, standardized root mean squared residual [SRMR] = 0.07, root mean square error of approximation [RMSEA] = 0.05), with good internal consistency (Cronbach's alpha = 0.92). We have provided different cut-offs to distinguish ASD cases from TD children (11 for children under 4 years [sensitivity: 0.96, specificity: 0.95], 12 for children 4 years and above [sensitivity: 0.93, specificity: 0.98]) or children with other neurodevelopmental disorders (14 [sensitivity: 0.85, specificity: 0.88]). Through this large sample validation, we confirmed that the simplified Chinese version of the SCQ could be used for children aged 2-12 years with relatively good psychometric properties. LAY SUMMARY: We aimed to develop the simplified Chinese version of the Social Communication Questionnaire (SCQ) for Chinese children aged 2-12 years as a screening tool to identified potential risk of autism spectrum disorder (ASD). We have developed a 40-item, 4-factor structure of SCQ with two domains, which showed adequate goodness of fit and good psychometric properties. We also provided different cut-offs to identify ASD cases in general or clinical populations.