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Abdelhamid N, Thind R, Mohammad H, Thabtah F. Assessing Autistic Traits in Toddlers Using a Data-Driven Approach with DSM-5 Mapping. Bioengineering (Basel) 2023; 10:1131. [PMID: 37892861 PMCID: PMC10604105 DOI: 10.3390/bioengineering10101131] [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: 07/31/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 10/29/2023] Open
Abstract
Autistic spectrum disorder (ASD) is a neurodevelopmental condition that characterises a range of people, from individuals who are not able to speak to others who have good verbal communications. The disorder affects the way people see, think, and behave, including their communications and social interactions. Identifying autistic traits, preferably in the early stages, is fundamental for clinicians in expediting referrals, and hence enabling patients to access to required healthcare services. This article investigates various ASD behavioral features in toddlers and proposes a data process using machine-learning techniques. The aims of this study were to identify early behavioral features that can help detect ASD in toddlers and to map these features to the neurodevelopment behavioral areas of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To achieve these aims, the proposed data process assesses several behavioral features using feature selection techniques, then constructs a classification model based on the chosen features. The empirical results show that during the screening process of toddlers, cognitive features related to communications, social interactions, and repetitive behaviors were most relevant to ASD. For the machine-learning algorithms, the predictive accuracy of Bayesian network (Bayes Net) and logistic regression (LR) models derived from ASD behavioral data subsets were consistent pinpointing to the suitability of ML techniques in predicting ASD.
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Affiliation(s)
- Neda Abdelhamid
- Abu Dhabi School of Management, Abu Dhabi P.O. Box 6844, United Arab Emirates
| | - Rajdeep Thind
- Manukau Institute of Technology, Auckland 2023, New Zealand
| | - Heba Mohammad
- Higher Colleges of Technology, Abu Dhabi P.O. Box 25026, United Arab Emirates
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Soleymani Z, Koegel LK, Mohammadzaheri F, Peyghambari M, Bajalan M, Naderi Malek A, Bakhshi E. Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:245-256. [PMID: 35785791 DOI: 10.1080/21622965.2022.2092738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.
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Affiliation(s)
- Zahra Soleymani
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Lynn Kern Koegel
- Stanford University School of Medicine, Stanford, California, USA
| | - Fereshteh Mohammadzaheri
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Peyghambari
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadese Bajalan
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Naderi Malek
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Loubersac J, Michelon C, Ferrando L, Picot MC, Baghdadli A. Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987-2017). Eur Child Adolesc Psychiatry 2023; 32:375-393. [PMID: 33909143 DOI: 10.1007/s00787-021-01792-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
Autism Spectrum Disorder (ASD) is an early onset neurodevelopmental disorder in which the first signs generally emerge at approximately 12 months of age but its diagnosis is feasible only from the age of 18 months. According to the literature, the average age of diagnosis ranges from 2.7 to 7.2 years, which raises the question of factors associated with early diagnosis as a condition for early intervention. In this systematic review, we aim to identify clinical, social, and environmental factors associated with the age at which the diagnosis of ASD is confirmed in children. A literature search was performed in the Pubmed, Web of Sciences, PsycInfo, and Cochrane databases. Among the 530 publications identified, 50 were selected according to the inclusion criteria. This review focuses on studies conducted in 21 countries using data collected over a period from 1987 to 2017. These studies were published before December 31st, 2019. The results suggest that the diagnosis of ASD occurs earlier if there is a delay in social communication or the presence of intellectual disability. There is a low level of evidence concerning associations between the age at diagnosis and sex, race, parental education, or socioeconomic status and accessibility to health care. Further studies using large and well-characterized data sets are needed to simultaneously explore clinical and socio-environmental factors involved in early diagnosis.
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Affiliation(s)
- Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Laetitia Ferrando
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Marie-Christine Picot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Department of Medical Information, University Hospital, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
- Faculté de Médecine, Université de Montpellier, Montpellier, France.
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Ferrara R, Iovino L, Di Renzo M, Ricci P. Babies under 1 year with atypical development: Perspectives for preventive individuation and treatment. Front Psychol 2022; 13:1016886. [PMID: 36467138 PMCID: PMC9713249 DOI: 10.3389/fpsyg.2022.1016886] [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] [Received: 08/11/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2023] Open
Abstract
A baby's first year of life is a time of immense development and cerebral plasticity. Following today's research and clinical observation, the period of the first year of life provides a new challenge inasmuch it is presently clear that it is possible to identify developmental anomalies in this window of time. Effecting early screening procedures could prove very useful, especially where we find genetic vulnerabilities in brothers and sisters of autistic subjects. Interventions of this kind, already practiced by some Public Health systems, can mean taking early action and primary protective measures with significant impacts not only on the subjects (babies and family members) concerned, but also on the public purse. It is, therefore, essential to provide for specific professionalized procedures for psychologists, pediatricians and neuropsychologists to be introduced through personnel highly specialized in interventions during the first year of life.
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Affiliation(s)
- Rosaria Ferrara
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Leonardo Iovino
- Department of Economic and Legal Studies, “Parthenope” University of Naples, Naples, Italy
| | | | - Pasquale Ricci
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
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Matson JL, Callahan MM, Montrenes JJ. Development and initial testing of the BABY-BISCUIT in an at-risk population. Dev Neurorehabil 2022; 25:361-369. [PMID: 34962445 DOI: 10.1080/17518423.2021.2018736] [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] [Indexed: 10/19/2022]
Abstract
PURPOSE Early identification of autism spectrum disorder (ASD) via screeners for diagnostic measures are a high priority. At present, there is no consensus on one screener due to the need for better sensitivity and specificity. In this study, we report on the development and utility of the BABY-BISCUIT, a six-item screener based on a modified subset of items from the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). METHODS A sample of 504 children between 17-3 9months of age, who consisted of toddlers identified as at-risk for neurodevelopmental and other health disorders, were tested during an annual screening through the Louisiana EarlySteps program. RESULTS An exploratory factor analysis yielded a one-factor solution (X2 = 48.62, df = 9, p = <.001). High sensitivity (i.e., 100.0%) at the cost of reduced specificity (i.e., 33.3%, AUC = 0.957) was found for an optimal screening cutoff score of 1. CONCLUSIONS Findings from this study suggest that the BABY-BISCUIT has the potential to be a short and easily administered screener for ASD to inform whether further ASD assessment is necessary. Further investigation of convergent validity with established ASD measures is recommended.
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Zhang L, Xu Y, Li H, Li B, Duan G, Zhu C. The role of probiotics in children with autism spectrum disorders: A study protocol for a randomised controlled trial. PLoS One 2022; 17:e0263109. [PMID: 35202432 PMCID: PMC8870536 DOI: 10.1371/journal.pone.0263109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurological and developmental condition that begins in infancy or earlier and lasts through the individual’s lifetime. The aetiology and mechanisms of ASD are not yet fully understood, and current treatment comprises mainly education and rehabilitation, without significant improvement in the core symptoms. Recent studies suggest that microbiota change in children with ASD after the ingestion of probiotics may improve the balance of microbiota and thus ASD symptoms. Objective The objectives of this study are to evaluate the efficacy of probiotics on the symptoms of children with ASD and the possible mechanisms involved. Methods This is a prospective controlled trial. A total of 160 children with ASD will be stratified and allocated to placebo and probiotics groups randomised according to the severity of their ASD symptoms. The probiotics group will be given probiotics supplements orally twice a day for 3 months and the control group will be given a placebo at the same amount, in addition to the baseline therapy of education and rehabilitation. All the children will be evaluated systematically by using different scales, questionnaires before, during, and after 3 months’ treatment, as well as 3 months after discontinuation. The potential impact of probiotics on immunity and inflammation, metabolism, and metagenome will also be investigated. Discussion Our previous study showed that the abundance of intestinal flora was greatly different in children with ASD, and that Bifidobacterium was associated with the severity of ASD. In the present study, we will investigate the impact of probiotics supplementation on the symptoms of Children with ASD, with the purpose of evaluating the possible therapeutic effects of additives on ASD and of providing a reference for clinical treatment. The results will help to disclose as yet unknown relationship between probiotics and ASD. Trial registration This study has been registered with Chinese Clinical Trial Registry (ChiCTR-2000037941).
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Affiliation(s)
- Lingling Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Li
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingbing Li
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guiqin Duan
- Center for Child Behavioral Development, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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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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Abubakar A, Gona JK, Kipkemoi P, Rimba K, Amukambwa D, Newton CR. Perspectives of key stakeholders on educational experiences of children with autism spectrum disorders at the Kenyan Coast. Afr J Disabil 2022; 11:847. [PMID: 35280969 PMCID: PMC8905404 DOI: 10.4102/ajod.v11i0.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/21/2021] [Indexed: 11/02/2022] Open
Abstract
Background Objectives Methods Results Conclusion
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Affiliation(s)
- Amina Abubakar
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph K. Gona
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Patricia Kipkemoi
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Kenneth Rimba
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Dennis Amukambwa
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Charles R.J.C. Newton
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Rahbar MH, Dobrescu I, Gillani S, Hessabi M, Kim S, Stancu M, Rad F. Construct validity for the self-reported competency and sub-construct associated characteristics of Romanian physicians in autism spectrum disorder. BMC MEDICAL EDUCATION 2021; 21:588. [PMID: 34801018 PMCID: PMC8605522 DOI: 10.1186/s12909-021-02999-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Lack of physicians' knowledge regarding mental health, including Autism Spectrum Disorder (ASD) could have adverse effects on affected individuals' health and quality of life. The purpose of this study was to provide construct validity for a modified questionnaire in order to determine the self-reported competency for underlying sub-constructs in ASD, make inferences on perceived competence in ASD based on a sample of Romanian physicians, and identify physicians' characteristics associated with these sub-domains of competency. METHODS For this survey, we modified a questionnaire that was used in Pakistan and Turkey, and administered it to a sample of 383 practicing physicians in Romania to assess their perceived competency regarding ASD. Exploratory factor analysis on 12 knowledge questions revealed five sub-domains: stigma, potential causes, children's behavior, misconceptions, and educational needs associated with ASD knowledge. Using General Linear Models, we determined physicians' characteristics that predict the total competency score and various competency sub-scores. RESULTS Seventy-five percent of the responding physicians were female and 30% had over 30 years practicing medicine. The majority (73-94%) of physicians have correctly responded to some basic questions regarding knowledge about ASD. We also found that younger physicians were more knowledgeable about potential causes of ASD than older physicians (Adjusted Mean Score (AMS): 2.90 vs. 2.18, P < 0.01), while older physicians knew more about the behavior of children with ASD (AMS: 0.64 vs. 0.37, P = 0.02). We found a significant interaction (P < 0.01) between television as source of ASD knowledge and city where the clinic is located in relation to knowledge of the physicians regarding stigma related to ASD. However, the total score was not associated with the variables associated with sub-domains. CONCLUSION Using factor analysis, we demonstrated construct validity of five sub-domains related to Romanian physicians' knowledge about ASD that include stigma, potential causes, behavior in ASD children, special education needs, and misconceptions related to ASD. The lack of significant association of the knowledge of physicians on ASD neither with the Psychiatry nor the Pediatric ward rotations at medical school may support the need for improving the curriculum on ASD in Romanian medical schools.
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Affiliation(s)
- Mohammad H. Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1100.05, UT Professional Building, Houston, TX 77030 USA
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1100.05, UT Professional Building, Houston, TX 77030 USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030 USA
| | - Iuliana Dobrescu
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Child and Adolescent Psychiatry, “Prof. Dr.Alex. Obregia” Psychiatry Hospital, Bucharest, Romania
| | - Shezeen Gillani
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030 USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1100.05, UT Professional Building, Houston, TX 77030 USA
| | - Sori Kim
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1100.05, UT Professional Building, Houston, TX 77030 USA
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Mihaela Stancu
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Child and Adolescent Psychiatry, “Prof. Dr.Alex. Obregia” Psychiatry Hospital, Bucharest, Romania
| | - Florina Rad
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Child and Adolescent Psychiatry, “Prof. Dr.Alex. Obregia” Psychiatry Hospital, Bucharest, Romania
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Fekar Gharamaleki F, Bahrami B, Masumi J. Autism screening tests: A narrative review. J Public Health Res 2021; 11. [PMID: 34351096 PMCID: PMC8859712 DOI: 10.4081/jphr.2021.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
As screening tests are tools to quantify communication-interactive abilities of speech and language; therefore, to evaluate, screen, diagnose and treat various aspects of one’s abilities, they are necessary. The purpose of this study is to review the existing autism screening tools, their subtests, administration, scoring, and application in clinical and research contexts in children and adults. This study was a review of autism screening tools; hence, an electronic search through databases such as PubMed, Scopus, Medline, SID, and Magiran was performed from 2000 to 2021. The tests were examined in terms of year of publication, duration, age range, assessment method, subtests, and psychometric properties and furthermore, they were reviewed in details. In this study, 19 autism screening tests were evaluated and The Autism Spectrum Quotient was found to have the shortest administration time while The Gilliam Autism Rating Scale had the longest, and the only test that varied in duration was the Autism Screening Instrument for educational planning. Autism screening is a complex issue. Reviewing these articles reveals that some tests have been used more in recent years due to their specialized subtests or easy and fast administration. Prompt testing is extremely crucial especially in emergency situations like the current COVID-19 pandemic the world is struggling with today. A review of speech tone tests shows that the CARS-2 is one of the most widely validated autism assessments. Significance for public health Autism spectrum disorder is a neurodevelopmental disorder associated with communication deficits, repetitive patterns, behaviors, and activities. Autism screening is a complex procedure that requires a piece of standard information and validated tools to help professionals in this process. Early autism screening plays a crucial role in treating the disorder and enhancing the quality of life and increasing the health level. Studies show that symptoms of autism manifest in the first two years of life. Therefore, if there is a suitable screening tool with a simple procedure that specialists can administer in a short time, these children could get diagnosed at an early age and thus have the opportunity for positive interventions. Tests with short administration time are specially needed now since with the outbreak of the COVID-19. Therefore, we conducted to investigate autism screening tests to access to help therapists select the appropriate test.
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Affiliation(s)
| | - Boshra Bahrami
- School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz.
| | - Jafar Masumi
- Department of Speech Therapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Science, Tabriz.
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Clary B, Marengo-Sorli E, Oude-Engberink A, Million E, Pavageau S, Amouyal M, Serayet P, Carbonnel F, Bourrel G, Lognos B. General practitioners must acquire skills to communicate with child with Autism Spectrum Disorder to regain their values and role in the follow-up - phenomenological study. Scand J Prim Health Care 2021; 39:214-221. [PMID: 34154487 PMCID: PMC8293969 DOI: 10.1080/02813432.2021.1913905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/07/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To understand the perceptions and attitudes of general practitioners (GPs) regarding children with an Autism Spectrum Disorder (ASD). DESIGN Phenomenological qualitative study. SETTING Three focus groups, clinical settings. SUBJECTS French GPs. MAIN OUTCOME MEASURES 22 GPs took part in the study divided among three focus groups. They were volunteers to participate. Data were transcribed verbatim and analysed using a grounded theory data analysis, completed with a semiopragmatic analysis. RESULTS Representing autism as a strange disorder in the doctor-patient relationship, GPs perceive a loss of sensory contact with the child with ASD that prevents the usual professional relationship between doctor and patient. They disengage themselves from monitoring the subject, concentrating on supporting the family. According to them, their role was to refer the patient to a specialist in the case of clinical intuition, but they have several reasons to give themselves time, all the more so because once the diagnosis is made, they lose sight of the patient and their place in the care pathway. GPs expressed the need to acquire skills and strategies to communicate with the autistic child to recover their role and values. CONCLUSION GPs are disconcerted by the idea of communicating with children with ASD, as it takes them out of their usual professional benchmarks. They need communication tools that enable them to regain their role and relational value of the patient-centred approach. Beyond this, the question of the 'ethics of care' of the patient with a joint attention disorder is raised.KEY POINTSGPs are disconcerted with the idea of communicating with children with ASD.GPs need communication tools that enable them to regain their role and relational value of the patient-centred approach.The question of the 'ethics of care' of the patient with a joint attention disorder is raised.
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Affiliation(s)
- Bernard Clary
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
| | | | - Agnès Oude-Engberink
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
- Avicenne Multiprofessional Health Centre, Cabestany, France
| | - Elodie Million
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
| | - Sylvain Pavageau
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
| | - Michel Amouyal
- Department of General Practice, Montpellier University, Montpellier, France
| | - Philippe Serayet
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
| | - François Carbonnel
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
- Avicenne Multiprofessional Health Centre, Cabestany, France
| | - Gérard Bourrel
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
| | - Béatrice Lognos
- Department of General Practice, Montpellier University, Montpellier, France
- Institut Desbrest d’Epidémiologie et de Santé Publique (IDESP), Montpellier University, Montpellier, France
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12
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Does the M-Chat-R Give Important Information for the Diagnosis of the Autism Spectrum Disorder? Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42:67-75. [PMID: 33894115 DOI: 10.2478/prilozi-2021-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Having in mind the rising rates of the incidence for autism worldwide, the early diagnosis of this neuro-developmental disorder is of the high priority. For that purpose, several checklists have been constructed and used. Nevertheless, there are no universal and uniform criteria for assessing and diagnosing autism, and even if there existed, not every country has the resources to manage such an assessment for diagnosis.A recently validated, revised version of the M-CHAT, the M-CHAT-Revised with Follow up (M-CHAT-R/F) has demonstrated strong psychometric properties.The aim of this article is to discuss our results obtained with M-CHAT-R applied in a sample of 131 children aged 31,9 ±9,4 months, recruited for diagnosis and treatment at the University Children's Hospital in Skopje.Our results confirmed that for screening the use of M-CHAT-R/F is currently the very exact instrument which allows the early suspicion, but also possible follow up the symptoms of this disorder. Additionally, we showed the significant negative correlation between age and scores obtained on the checklist.
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13
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Vasileva M, Graf RK, Reinelt T, Petermann U, Petermann F. Research review: A meta-analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years. J Child Psychol Psychiatry 2021; 62:372-381. [PMID: 32433792 DOI: 10.1111/jcpp.13261] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Children younger than 7 years can develop mental disorders that might manifest differently than in older children or adolescents. However, little is known about the prevalence of mental disorders at this early age. METHODS We systematically searched the literature in the databases Web of Science, PsycINFO, PSYNDEX, MEDLINE, and Embase to identify epidemiological studies of community samples published between 2006 and 2020. A series of meta-analyses was conducted to estimate the pooled worldwide prevalence of mental disorders in general, specific mental disorders, and comorbidity in young children. RESULTS A total of ten epidemiological studies reporting data on N = 18,282 children (12-83 months old) from eight countries met the inclusion criteria. The pooled prevalence of mental disorders in general was 20.1%, 95% CI [15.7, 25.4]. Most common disorders were oppositional defiant disorder (4.9%, 95% CI [2.5, 9.5]) and attention-deficit hyperactivity disorder (4.3%, 95% CI [2.5, 7.2]). The prevalence of any anxiety disorders was 8.5%, 95% CI [5.2, 13.5], and of any depressive disorders was 1.1%, 95% CI [0.8, 1.6]. Comorbidity was estimated at 6.4%, 95% CI [1.3, 54.0]. CONCLUSIONS The literature search reveals that the epidemiology of mental disorders in children younger than 7 years is still a neglected area of research. The findings also indicate that there are a significant number of young children suffering from mental disorders who need appropriate age-adapted treatment.
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Affiliation(s)
- Mira Vasileva
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.,Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Ramona K Graf
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Tilman Reinelt
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Ulrike Petermann
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Franz Petermann
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
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14
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Jiménez-Espinoza C, Marcano Serrano F, González-Mora JL. N-Acetylaspartyl-Glutamate Metabolism in the Cingulated Cortices as a Biomarker of the Etiology in ASD: A 1H-MRS Model. Molecules 2021; 26:675. [PMID: 33525414 PMCID: PMC7866086 DOI: 10.3390/molecules26030675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
As brain functional resonance magnetic studies show an aberrant trajectory of neurodevelopment, it is reasonable to predict that the degree of neurochemical abnormalities indexed by magnetic resonance spectroscopy (1H-MRS) might also change according to the developmental stages and brain regions in autism spectrum disorders (ASDs). Since specific N-Acetyl-aspartate (NAA) changes in children's metabolism have been found in the anterior cingulate cortex (ACC) but not in the posterior cingulate cortex (PCC), we analyzed whether the metabolites of ASD youths change between the cingulate cortices using 1H-MRS. l-glutamate (Glu) and l-Acetyl-aspartate (NAA) are products from the N-Acetyl-aspartyl-glutamate (NAAG) metabolism in a reaction that requires the participation of neurons, oligodendrocytes, and astrocytes. This altered tri-cellular metabolism has been described in several neurological diseases, but not in ASD. Compared to the typical development (TD) group, the ASD group had an abnormal pattern of metabolites in the ACC, with a significant increase of glutamate (12.10 ± 3.92 mM; p = 0.02); additionally, N-Acetyl-aspartyl-glutamate significantly decreased (0.41 ± 0.27 mM; p = 0.02) within ASD metabolism abnormalities in the ACC, which may allow the development of new therapeutic possibilities.
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Affiliation(s)
- Carmen Jiménez-Espinoza
- Laboratory Neurochemistry & Neuroimages, Department of Basic Medical Sciences, Faculty of Health Sciences, Physiology Section, University of La Laguna, 38200 Tenerife, Spain; (F.M.S.); (J.L.G.-M.)
| | - Francisco Marcano Serrano
- Laboratory Neurochemistry & Neuroimages, Department of Basic Medical Sciences, Faculty of Health Sciences, Physiology Section, University of La Laguna, 38200 Tenerife, Spain; (F.M.S.); (J.L.G.-M.)
- Magnetic Resonance Service for Biomedical Research (SRMIB), IMETISA, Canary University Hospital, 38320 Tenerife, Spain
| | - José Luis González-Mora
- Laboratory Neurochemistry & Neuroimages, Department of Basic Medical Sciences, Faculty of Health Sciences, Physiology Section, University of La Laguna, 38200 Tenerife, Spain; (F.M.S.); (J.L.G.-M.)
- Magnetic Resonance Service for Biomedical Research (SRMIB), IMETISA, Canary University Hospital, 38320 Tenerife, Spain
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15
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Chericoni N, Balboni G, Costanzo V, Mancini A, Prosperi M, Lasala R, Tancredi R, Scattoni ML, Muratori F, Apicella F. A Combined Study on the Use of the Child Behavior Checklist 1½-5 for Identifying Autism Spectrum Disorders at 18 Months. J Autism Dev Disord 2021; 51:3829-3842. [PMID: 33394248 PMCID: PMC8510940 DOI: 10.1007/s10803-020-04838-0] [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] [Accepted: 12/09/2020] [Indexed: 01/15/2023]
Abstract
The capacity of the Child Behavior Checklist 1½-5 (CBCL 1½-5) to identify children with autism spectrum disorder (ASD) at 18 months was tested on 37 children clinically referred for ASD and 46 children at elevated likelihood of developing ASD due to having an affected brother/sister. At 30 months the clinically referred children all received a confirmatory diagnosis, and 10 out of 46 siblings received a diagnosis of ASD. CBCL 1½-5 profiles were compared with a group of matched children with typical development (effect of cognitive level controlled for). The capacity of the CBCL 1½-5 DSM Oriented-Pervasive Developmental Problems scale to differentiate correctly between children diagnosed with ASD and children with typical development appeared dependent on group ascertainment methodology.
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Affiliation(s)
- Natasha Chericoni
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy.
| | | | - Valeria Costanzo
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
| | - Alice Mancini
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
| | - Margherita Prosperi
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
| | - Roberta Lasala
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
| | - Raffaella Tancredi
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
| | | | - Filippo Muratori
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Fabio Apicella
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, Calambrone, 56128, Pisa, Italy
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16
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Qiu T, Zhang H, Zhou C, Tang Q, Wang L, Ke X. Application of Telemedicine for Preliminary Screening of Autism Spectrum Disorder. Front Pediatr 2021; 9:745597. [PMID: 35118027 PMCID: PMC8804290 DOI: 10.3389/fped.2021.745597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Preliminary screening for autism spectrum disorder (ASD) is mainly performed offline in China. This method is time consuming, labor intensive, inefficient and costly. These complications limit its routine implementation in some hospitals and child health institutions, especially community health service centers. Thus, the present study explored the clinical applicability of an online screening system for ASD detection based on telemedicine technology. METHODS The online screening system designed based on the WeChat platform and section A of the Chinese-validated version of the checklist for autism in toddlers (CHAT-23-A) and combined with an independent Research and Development (R&D) program. The sensitivity and specificity were 0.92 and 0.90, respectively, and the area under the receiver operating characteristic curve (AUC) values for all 23 items and 7 key items were 0.934 and 0.91, respectively. RESULTS The online screening system based on telemedicine technology was not limited by time, space, region, or medical resources and showed high sensitivity, specificity, and diagnostic efficiency for ASD. CONCLUSION The online screening system based on telemedicine technology is suitable for large-scale population ASD screening in childcare institutions.
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Affiliation(s)
- Ting Qiu
- Departments of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Nanjing Medical University, Wuxi, China
| | - Heng Zhang
- Departments of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Nanjing Medical University, Wuxi, China
| | - Conghua Zhou
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang, China
| | - Qilong Tang
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang, China
| | - Lizhen Wang
- Departments of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Nanjing Medical University, Wuxi, China
| | - Xiaoyan Ke
- Child Mental Health Research Center, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
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17
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Qiu C, Lin JC, Shi JM, Chow T, Desai VN, Nguyen VT, Riewerts RJ, Feldman RK, Segal S, Xiang AH. Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring. JAMA Pediatr 2020; 174:1168-1175. [PMID: 33044486 PMCID: PMC7551212 DOI: 10.1001/jamapediatrics.2020.3231] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Although the safety of labor epidural analgesia (LEA) for neonates has been well documented, the long-term health effects of LEA on offspring remain to be investigated. OBJECTIVE To assess the association between maternal LEA exposure and risk of autism spectrum disorders (ASDs) in offspring. DESIGN, SETTING, AND PARTICIPANTS Data for this retrospective longitudinal birth cohort study were derived from electronic medical records from a population-based clinical birth cohort. A total of 147 895 singleton children delivered vaginally between January 1, 2008, and December 31, 2015, in a single integrated health care system were included. Children were followed up from the age of 1 year until the first date of the following occurrences: clinical diagnosis of ASD, last date of health plan enrollment, death, or the study end date of December 31, 2018. EXPOSURES Use and duration of LEA. MAIN OUTCOMES AND MEASURES The main outcome was clinical diagnosis of ASD. Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) of ASD associated with LEA exposure. RESULTS Among the cohort of 147 895 singleton children (74 425 boys [50.3%]; mean [SD] gestational age at delivery, 38.9 [1.5] weeks), 109 719 (74.2%) were exposed to maternal LEA. Fever during labor was observed in 13 055 mothers (11.9%) in the LEA group and 510 of 38 176 mothers (1.3%) in the non-LEA group. Autism spectrum disorders were diagnosed in 2039 children (1.9%) in the LEA group and 485 children (1.3%) in the non-LEA group. After adjusting for potential confounders, including birth year, medical center, maternal age at delivery, parity, race/ethnicity, educational level, household income, history of comorbidity, diabetes during pregnancy, smoking during pregnancy, preeclampsia or eclampsia, prepregnancy body mass index, gestational weight gain, gestational age at delivery, and birth weight, the HR associated with LEA vs non-LEA exposure was 1.37 (95% CI, 1.23-1.53). Relative to the unexposed group, the adjusted HR associated with LEA exposure of less than 4 hours was 1.33 (95% CI, 1.17-1.53), with LEA exposure of 4 to 8 hours was 1.35 (95% CI, 1.20-1.53), and with LEA exposure of more than 8 hours was 1.46 (95% CI, 1.27-1.69). Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Adding fever to the model did not change the HR estimate associated with LEA exposure (adjusted HR for LEA vs non-LEA, 1.37 [95% CI, 1.22-1.53]). CONCLUSIONS AND RELEVANCE This study suggests that maternal LEA may be associated with increased ASD risk in children. The risk appears to not be directly associated with epidural-related maternal fever.
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Affiliation(s)
- Chunyuan Qiu
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jiaxiao M. Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vimal N. Desai
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Vu T. Nguyen
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California,Department of Internal Medicine, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Robert J. Riewerts
- Department of Pediatrics, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - R. Klara Feldman
- Department of Obstetrics & Gynecology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Scott Segal
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
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18
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Abstract
An early diagnosis of autism spectrum disorder, leading to a timely enabling intervention, is associated with a better long-term prognosis and allows the early detection of any medical comorbidities that are sometimes found in individuals with autism. It is, therefore, an important challenge to begin the diagnostic procedure of these children as soon as possible. Nowadays, much progress has been made in this respect compared with the past, but considerable work remains. A fundamental role in starting a correct and timely diagnostic procedure is obviously played by the pediatrician. Today, many tools are available for the early screening of autism in the general population, but unfortunately, their real effectiveness has yet to be established. In this narrative review, we address the topic of the early diagnosis of autism spectrum disorder, emphasizing, in particular, those that are now considered the first warning signs. We list a few of the most important signs to consider when a child aged around 18 months presents to a pediatrician, subdivided into three subgroups: social-communication skills; patterns of behavior, interests, or activities; and sensory behaviors and reactivity/temperament. We deal separately with the possible presence of slight motor signs, which can also go unnoticed, but probably they should be considered as very early signs appearing even before social-communication deficits.
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19
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Jo H, Eckel SP, Chen JC, Cockburn M, Martinez MP, Chow T, Lurmann FW, Funk WE, Xiang AH, McConnell R. Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder. ENVIRONMENT INTERNATIONAL 2019; 133:105110. [PMID: 31610366 PMCID: PMC7250244 DOI: 10.1016/j.envint.2019.105110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Ambient air pollution and maternal diabetes may affect common biological pathways underlying adverse neurodevelopmental effects. However, joint effects of maternal diabetes and air pollution on autism spectrum disorder (ASD) have not been studied. OBJECTIVE We evaluated whether prenatal and early-life air pollution exposure interacts with maternal diabetes status to affect ASD risk. METHODS This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California hospitals in 1999-2009. Children were followed from birth until age 5, during which 2471 ASD cases were diagnosed. Ozone (O3), particulate matter < 2.5 μm (PM2.5) and <10 μm in aerodynamic diameter, and nitrogen dioxide measured at regulatory air monitoring stations were interpolated to estimate exposures during preconception and each pregnancy trimester, and first year of life at each child's birth address. Hazard ratios (HRs) for ASD were estimated adjusting for birth year, KPSC service areas, and relevant maternal and child characteristics. For each exposure window, interactions were tested between pollutants and a 4-category maternal diabetes variable (none, GDM ≥ 24 and <24 weeks' gestation, and pre-existing type 2 diabetes). For an exposure window with statistically significant global interaction between pollutant and diabetes (p < 0.05), pollutant-associated HRs were estimated separately for each category of maternal diabetes. RESULTS There were associations of ASD with preconception, first and third trimesters, and first year of life PM2.5, but not with other pollutants. There were, however, interactions of maternal diabetes with first trimester and first year of life O3. Increased ASD risk was associated with first trimester O3 among mothers with GDM < 24 weeks' gestation [adjusted HR 1.50 per 15.7 ppb O3 (95% CI: 1.08-2.09)]. No O3 associations with ASD were observed in other categories of maternal diabetes. CONCLUSIONS GDM onset early in pregnancy may increase children's susceptibility to prenatal O3-associated ASD risk. These novel findings merit further investigation.
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Affiliation(s)
- Heejoo Jo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Epidemiology, University of Colorado School of Public Health, United States of America
| | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | | | - William E Funk
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
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20
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Giovagnoli AR. Theory of mind across lifespan from ages 16 to 81 years. Epilepsy Behav 2019; 100:106349. [PMID: 31375413 DOI: 10.1016/j.yebeh.2019.05.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Impaired theory of mind (ToM) is a neurobehavioral phenotype of epilepsy. Given that the age transitions affect cognitive development and decline, it is important to refine ToM across the lifespan. This study evaluated ToM in healthy subjects, taking into account education, gender, and other functions, aiming to clarify its specificity and relationships to major demographic and cognitive domains. METHODS A hundred and seventy subjects from ages 16 to 81 years (68 men) who received five to 17 years of schooling were evaluated using a Faux Pas Task (FPT) that is solved at the end of childhood and is highly sensitive to brain damage and tests for language, memory, praxis, visual perception, initiative, attention, shifting, and planning. Factor analysis, analysis of variance, and correlation and regression analyses were used to assess the data. RESULTS The analysis yielded six factors: Beliefs, Delusions, and Facts, which express the understanding of mental states and contextual details; Matching-Learning, Executive, and Working Memory. On this basis, six composite scores (CSs) were computed. Age and schooling showed significant effects on the Matching-Learning, Executive, and Working Memory CSs. The FPT raw scores and CSs were unrelated to age or schooling, while females showed better performance than males. The Beliefs CS and FPT scores were predicted by the Executive, Working Memory, Delusions, and Facts CSs and gender. CONCLUSIONS Theory of mind is a specific cognitive domain independent of age and formal education, but related to gender. Working memory, executive functions, and reality examination support some ToM processes. These findings may provide reference points against which impairment can be assessed. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan".
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Affiliation(s)
- Anna Rita Giovagnoli
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy.
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21
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Jo H, Eckel SP, Wang X, Chen JC, Cockburn M, Martinez MP, Chow T, Molshatzki N, Lurmann FW, Funk WE, Xiang AH, McConnell R. Sex-specific associations of autism spectrum disorder with residential air pollution exposure in a large Southern California pregnancy cohort. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 254:113010. [PMID: 31554142 PMCID: PMC6764604 DOI: 10.1016/j.envpol.2019.113010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 05/22/2023]
Abstract
Autism spectrum disorder (ASD) affects more boys than girls. Recent animal studies found that early life exposure to ambient particles caused autism-like behaviors only in males. However, there has been little study of sex-specificity of effects on ASD in humans. We evaluated ASD risk associated with prenatal and first year of life exposures to particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) by child sex. This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California (KPSC) hospitals between 1999 and 2009. The cohort was followed from birth through age five to identify 2471 ASD cases from the electronic medical record. Ambient PM2.5 and other regional air pollution measurements (PM less than 10 μm, ozone, nitrogen dioxide) from regulatory air monitoring stations were interpolated to estimate exposure during each trimester and first year of life at each geocoded birth address. Hazard ratios (HRs) were estimated using Cox regression models to adjust for birth year, KPSC medical center service areas, and relevant maternal and child characteristics. Adjusted HRs per 6.5 μg/m3 PM2.5 were elevated during entire pregnancy [1.17 (95% confidence interval (CI), 1.04-1.33)]; first trimester [1.10 (95% CI, 1.02-1.19)]; third trimester [1.08 (1.00-1.18)]; and first year of life [1.21 (95% CI, 1.05-1.40)]. Only the first trimester association remained robust to adjustment for other exposure windows, and was specific to boys only (HR = 1.18; 95% CI, 1.08-1.27); there was no association in girls (HR = 0.90; 95% CI, 0.76-1.07; interaction p-value 0.03). There were no statistically significant associations with other pollutants. PM2.5-associated ASD risk was stronger in boys, consistent with findings from recent animal studies. Further studies are needed to better understand these sexually dimorphic neurodevelopmental associations.
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Affiliation(s)
- Heejoo Jo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xinhui Wang
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Noa Molshatzki
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - William E Funk
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Modi N, Ashby D, Battersby C, Brocklehurst P, Chivers Z, Costeloe K, Draper ES, Foster V, Kemp J, Majeed A, Murray J, Petrou S, Rogers K, Santhakumaran S, Saxena S, Statnikov Y, Wong H, Young A. Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background
Clinical data offer the potential to advance patient care. Neonatal specialised care is a high-cost NHS service received by approximately 80,000 newborn infants each year.
Objectives
(1) To develop the use of routinely recorded operational clinical data from electronic patient records (EPRs), secure national coverage, evaluate and improve the quality of clinical data, and develop their use as a national resource to improve neonatal health care and outcomes. To test the hypotheses that (2) clinical and research data are of comparable quality, (3) routine NHS clinical assessment at the age of 2 years reliably identifies children with neurodevelopmental impairment and (4) trial-based economic evaluations of neonatal interventions can be reliably conducted using clinical data. (5) To test methods to link NHS data sets and (6) to evaluate parent views of personal data in research.
Design
Six inter-related workstreams; quarterly extractions of predefined data from neonatal EPRs; and approvals from the National Research Ethics Service, Health Research Authority Confidentiality Advisory Group, Caldicott Guardians and lead neonatal clinicians of participating NHS trusts.
Setting
NHS neonatal units.
Participants
Neonatal clinical teams; parents of babies admitted to NHS neonatal units.
Interventions
In workstream 3, we employed the Bayley-III scales to evaluate neurodevelopmental status and the Quantitative Checklist of Autism in Toddlers (Q-CHAT) to evaluate social communication skills. In workstream 6, we recruited parents with previous experience of a child in neonatal care to assist in the design of a questionnaire directed at the parents of infants admitted to neonatal units.
Data sources
Data were extracted from the EPR of admissions to NHS neonatal units.
Main outcome measures
We created a National Neonatal Research Database (NNRD) containing a defined extract from real-time, point-of-care, clinician-entered EPRs from all NHS neonatal units in England, Wales and Scotland (n = 200), established a UK Neonatal Collaborative of all NHS trusts providing neonatal specialised care, and created a new NHS information standard: the Neonatal Data Set (ISB 1595) (see http://webarchive.nationalarchives.gov.uk/±/http://www.isb.nhs.uk/documents/isb-1595/amd-32–2012/index_html; accessed 25 June 2018).
Results
We found low discordance between clinical (NNRD) and research data for most important infant and maternal characteristics, and higher prevalence of clinical outcomes. Compared with research assessments, NHS clinical assessment at the age of 2 years has lower sensitivity but higher specificity for identifying children with neurodevelopmental impairment. Completeness and quality are higher for clinical than for administrative NHS data; linkage is feasible and substantially enhances data quality and scope. The majority of hospital resource inputs for economic evaluations of neonatal interventions can be extracted reliably from the NNRD. In general, there is strong parent support for sharing routine clinical data for research purposes.
Limitations
We were only able to include data from all English neonatal units from 2012 onwards and conduct only limited cross validation of NNRD data directly against data in paper case notes. We were unable to conduct qualitative analyses of parent perspectives. We were also only able to assess the utility of trial-based economic evaluations of neonatal interventions using a single trial. We suggest that results should be validated against other trials.
Conclusions
We show that it is possible to obtain research-standard data from neonatal EPRs, and achieve complete population coverage, but we highlight the importance of implementing systematic examination of NHS data quality and completeness and testing methods to improve these measures. Currently available EPR data do not enable ascertainment of neurodevelopmental outcomes reliably in very preterm infants. Measures to maintain high quality and completeness of clinical and administrative data are important health service goals. As parent support for sharing clinical data for research is underpinned by strong altruistic motivation, improving wider public understanding of benefits may enhance informed decision-making.
Future work
We aim to implement a new paradigm for newborn health care in which continuous incremental improvement is achieved efficiently and cost-effectively by close integration of evidence generation with clinical care through the use of high-quality EPR data. In future work, we aim to automate completeness and quality checks and make recording processes more ‘user friendly’ and constructed in ways that minimise the likelihood of missing or erroneous entries. The development of criteria that provide assurance that data conform to prespecified completeness and quality criteria would be an important development. The benefits of EPR data might be extended by testing their use in large pragmatic clinical trials. It would also be of value to develop methods to quality assure EPR data including involving parents, and link the NNRD to other health, social care and educational data sets to facilitate the acquisition of lifelong outcomes across multiple domains.
Study registration
This study is registered as PROSPERO CRD42015017439 (workstream 1) and PROSPERO CRD42012002168 (workstream 3).
Funding
The National Institute for Health Research Programme Grants for Applied Research programme (£1,641,471). Unrestricted donations were supplied by Abbott Laboratories (Maidenhead, UK: £35,000), Nutricia Research Foundation (Schiphol, the Netherlands: £15,000), GE Healthcare (Amersham, UK: £1000). A grant to support the use of routinely collected, standardised, electronic clinical data for audit, management and multidisciplinary feedback in neonatal medicine was received from the Department of Health and Social Care (£135,494).
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Affiliation(s)
- Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kate Costeloe
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | | | - Victoria Foster
- Department of Social Sciences, Edge Hill University, Ormskirk, UK
| | - Jacquie Kemp
- National Programme of Care, NHS England, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | | | - Stavros Petrou
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Katherine Rogers
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Alys Young
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Abstract
Specific developmental concerns can distinguish between an early versus later diagnosis of autism spectrum disorder (ASD). Caregiver survey responses of children ≥ 9 years-of-age (2012) with ASD were used to evaluate developmental concerns and associations with age of diagnosis [early (< 3 years: n = 106) vs. later (≥ 3 years: n = 432)] using logistic regression. Concerns arose at mean age 18 and 35-months for children diagnosed early versus later, respectively. Concerns about poor eye contact (aOR 1.81, CI 1.08, 3.05), pointing/gesturing (aOR 2.74, CI 1.60, 4.70), response to own name (aOR 3.03, CI 1.75, 5.23), and babbling/speaking (aOR 1.67, CI 0.98, 2.82) were associated with an early diagnosis. Caregivers and pediatricians are critical in early identification and timely entry into intervention.
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Sun X, Allison C, Wei L, Matthews FE, Auyeung B, Wu YY, Griffiths S, Zhang J, Baron-Cohen S, Brayne C. Autism prevalence in China is comparable to Western prevalence. Mol Autism 2019; 10:7. [PMID: 30858963 PMCID: PMC6394100 DOI: 10.1186/s13229-018-0246-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Autism prevalence in the West is approximately 1% of school age children. Autism prevalence in China has been reported to be lower than in the West. This is likely due to at least two reasons: (1) most studies in China only included the special school population, overlooking the mainstream school population; and (2) most studies in China have not used contemporary screening and diagnostic methods. To address this, we tested total autism prevalence (mainstream and special schools) in Jilin City, and mainstream school autism prevalence in Jiamusi and Shenzhen cities. Methods The study included a three-step process: (1) screening; (2) clinical assessment of 'screen positives' plus controls; and (3) research diagnostic assessment of those meeting clinical threshold for concerns at step 2. Prevalence estimates per 10,000 children aged 6-10 years old were weighted for study design using diagnostic criteria applied at the research assessment stage. Results In Jilin City, 77 cases of autism were identified from a total population of 7258, equating to a prevalence of 108 per 10,000 (95% confidence interval (CI) 89, 130). In Shenzhen City: 21,420 children were screened and 35 cases of autism were identified, resulting in a mainstream prevalence of 42 per 10,000 (95% CI 20-89). In Jiamusi City, 16,358 children were screened, with 10 autism cases being identified, with a mainstream prevalence of 19 per 10,000 (95% CI 10-38). Conclusions Results from Jilin City, where both mainstream and special school data were available, revealed a similar prevalence of autism in China to the West, at around 1%. Results from Shenzhen and Jiamusi cities, where only mainstream data were available, prevalence is also in line with Western estimates. In all three cities, new cases of autism were identified by the study in mainstream schools, reflecting current under-diagnosis. Non-significant variation across different cities is seen indicating the need to explore potential variation of autism across diverse Chinese regions with large sample sizes to achieve a fully robust national picture.
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Affiliation(s)
- Xiang Sun
- Cambridge Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
- Department of Psychology, The Chinese University of Hong Kong, 3rd Floor, Sino Building, Shatin, NT Hong Kong
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
| | - Liping Wei
- Centre for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871 People’s Republic of China
- National Institute of Biological Sciences, Beijing, China
| | - Fiona E. Matthews
- Institute of Health and Society, Newcastle University, Newcastle, NE4 5PL UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, EH8 9JZ UK
| | - Yu Yu Wu
- YuNing Psychiatry Clinic, YuNing Growing With You Mental Health Centre, Taipei, Taiwan
| | - Sian Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT Hong Kong
| | - Jie Zhang
- Centre for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871 People’s Republic of China
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
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Arun P, Chavan BS. Authors' Response. Indian J Med Res 2019; 149:75-77. [PMID: 31115381 PMCID: PMC6507532 DOI: 10.4103/0971-5916.256712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Priti Arun
- Department of Psychiatry, Government Medical College & Hospital, Chandigarh 160 030, India
| | - Bir Singh Chavan
- Department of Psychiatry, Government Medical College & Hospital, Chandigarh 160 030, India
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Hinnebusch AJ, Miller LE, Fein DA. Autism Spectrum Disorders and Low Mental Age: Diagnostic Stability and Developmental Outcomes in Early Childhood. J Autism Dev Disord 2018; 47:3967-3982. [PMID: 28861732 DOI: 10.1007/s10803-017-3278-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Some children with autism spectrum disorders (ASDs) exhibit low mental age (Low-MA; i.e., cognitive functioning below 12 months). We examined diagnosis, symptom severity, and development in children with ASD-low MA (n = 25), autistic disorder (n = 111), and PDD-NOS (n = 82) at ages two and four. We predicted that some ASD-low MA children would demonstrate just intellectual impairment and not autism symptoms on follow-up, with social deficits at age two attributable to global delays. Instead, most ASD-low MA children (96%) had an ASD at follow-up, compared to children initially diagnosed with autistic disorder (86.5%) or PDD-NOS (73.2%). They showed the least developmental progress and highest symptom severity. Results support diagnosing ASDs in children functioning below a 12-month level.
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Affiliation(s)
- Alexander J Hinnebusch
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 East Eisenhower Parkway, Suite 100, Ann Arbor, MI, 48108, USA
| | - Lauren E Miller
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA.
| | - Deborah A Fein
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
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Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries. Int J Ment Health Syst 2018; 12:22. [PMID: 29760771 PMCID: PMC5941599 DOI: 10.1186/s13033-018-0200-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/12/2018] [Indexed: 01/30/2023] Open
Abstract
Background Screening children for autism has gained wider acceptance within clinical practice, and early intervention has improved outcomes. Increasingly, adapting an existing screening instrument is a common, fast method to create a usable screening tool, especially for countries with limited resources and/or expertise. However, concerns have been raised regarding adaptation adequacy and the feasibility of screening across cultural groups. This study systematically examined the levels of cultural adaptation and feasibility aspects considered when screening for autism in non-English speaking countries to build upon the sparse knowledge that exists on this topic in the literature. Methods Nineteen studies, obtained from five electronic databases, were examined. PRISMA guidance was used for this review. The Ecological Validity Framework model, and Bowen Recommendations for Feasibility were adopted to extract relevant data, which was synthesised narratively. Results Cultural adaptation within the included studies mostly involved language translation with little information offered to enable conclusions on how the processes were guided and maintained. Few cultural adjustments involved modifying screening methods; clarifying difficult concepts and changing instrument content were employed to address the core values, competence, beliefs, and norms of the adapted culture. However, less attention was given to adapt the screening goals within the context of cultural values, and customs or to consider interactional match between the clients and assessors. The review also highlighted an acceptable level of practicality to screen for autism but did not encourage integrating autism screening within routine practice or beyond the study context for different cultures. Conclusion Concurring with previous literature, we agree that knowledge on cultural adaptation for autism screening instruments is limited and not sufficiently documented to establish adaptation levels (process and/or contents), and prove adequacy. However, this review provides an infrastructure to improve future adaptation processes. Integrating autism screening as routine medical practice is not encouraged and warrants further feasibility studies to minimize wasted resources and improve screening effectiveness in various health care systems.
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Ben-Sasson A, Robins DL, Yom-Tov E. Risk Assessment for Parents Who Suspect Their Child Has Autism Spectrum Disorder: Machine Learning Approach. J Med Internet Res 2018; 20:e134. [PMID: 29691210 PMCID: PMC5941093 DOI: 10.2196/jmir.9496] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/04/2018] [Accepted: 02/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Parents are likely to seek Web-based communities to verify their suspicions of autism spectrum disorder markers in their child. Automated tools support human decisions in many domains and could therefore potentially support concerned parents. Objective The objective of this study was to test the feasibility of assessing autism spectrum disorder risk in parental concerns from Web-based sources, using automated text analysis tools and minimal standard questioning. Methods Participants were 115 parents with concerns regarding their child’s social-communication development. Children were 16- to 30-months old, and 57.4% (66/115) had a family history of autism spectrum disorder. Parents reported their concerns online, and completed an autism spectrum disorder-specific screener, the Modified Checklist for Autism in Toddlers-Revised, with Follow-up (M-CHAT-R/F), and a broad developmental screener, the Ages and Stages Questionnaire (ASQ). An algorithm predicted autism spectrum disorder risk using a combination of the parent's text and a single screening question, selected by the algorithm to enhance prediction accuracy. Results Screening measures identified 58% (67/115) to 88% (101/115) of children at risk for autism spectrum disorder. Children with a family history of autism spectrum disorder were 3 times more likely to show autism spectrum disorder risk on screening measures. The prediction of a child’s risk on the ASQ or M-CHAT-R was significantly more accurate when predicted from text combined with an M-CHAT-R question selected (automatically) than from the text alone. The frequently automatically selected M-CHAT-R questions that predicted risk were: following a point, make-believe play, and concern about deafness. Conclusions The internet can be harnessed to prescreen for autism spectrum disorder using parental concerns by administering a few standardized screening questions to augment this process.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Diana L Robins
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
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Olliac B, Crespin G, Laznik MC, Cherif Idrissi El Ganouni O, Sarradet JL, Bauby C, Dandres AM, Ruiz E, Bursztejn C, Xavier J, Falissard B, Bodeau N, Cohen D, Saint-Georges C. Infant and dyadic assessment in early community-based screening for autism spectrum disorder with the PREAUT grid. PLoS One 2017; 12:e0188831. [PMID: 29216234 PMCID: PMC5720624 DOI: 10.1371/journal.pone.0188831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/14/2017] [Indexed: 12/04/2022] Open
Abstract
Background The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome. Methods We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children. Results Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0–36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65–220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%]. Conclusions The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.
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Affiliation(s)
- Bertrand Olliac
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Esquirol, Limoges, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1094, Tropical Neuroepidemiology, Limoges, France
| | - Graciela Crespin
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Marie-Christine Laznik
- Department of Child and Adolescent Psychiatry, Association Santé Mentale du 13ème, Paris, France
| | | | - Jean-Louis Sarradet
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Colette Bauby
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
- PMI Center (Center for Protection of Mother and Infant), Paris, France
| | - Anne-Marie Dandres
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
- PMI Center (Center for Protection of Mother and Infant), Paris, France
| | - Emeline Ruiz
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Claude Bursztejn
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, Strasbourg, France
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
| | - Bruno Falissard
- INSERM U669, Université Paris-Sud and Université Paris-Descartes, Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
| | - Catherine Saint-Georges
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
- Association CEREP-PHYMENTIN, Paris, France
- * E-mail:
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Morales-Hidalgo P, Hernández-Martínez C, Voltas N, Canals J. EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder. Int J Clin Health Psychol 2017; 17:269-281. [PMID: 30487902 PMCID: PMC6220918 DOI: 10.1016/j.ijchp.2017.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/22/2017] [Indexed: 02/03/2023] Open
Abstract
Teacher's reports about child psychopathology are often useful because they make it possible to compare children's development within their normative peer group. The EDUTEA questionnaire aims to provide clinicians and researchers with a brief tool that can be used to screen autism spectrum disorders and social communication disorders in school settings. Method: It was designed according to DSM-5 criteria and validated in a sample of 2,660 Spanish schoolers. Results: The EDUTEA showed a two-factor structure with high internal reliability: Social communication impairments (α=.95) and Restricted behaviour patterns (α=.93). The ROC curve showed that the area under the curve was highly predictive (.90). We propose using a cut-off score of 10, which gives high values of sensitivity (87%), specificity (91.2%) and positive predictive value (.87). Moderate correlations were found with the severity score of the Autism Diagnostic Observation Schedule (ADOS-2) and the child pragmatic competence. Conclusions: The EDUTEA could be useful in ASD screening protocols in schools.
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Affiliation(s)
| | | | | | - Josefa Canals
- Nutrition and Mental Health Research Group (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Spain
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32
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Rudra A, Belmonte MK, Soni PK, Banerjee S, Mukerji S, Chakrabarti B. Prevalence of autism spectrum disorder and autistic symptoms in a school-based cohort of children in Kolkata, India. Autism Res 2017; 10:1597-1605. [PMID: 28544637 PMCID: PMC5655917 DOI: 10.1002/aur.1812] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/07/2017] [Accepted: 04/27/2017] [Indexed: 11/10/2022]
Abstract
Despite housing ∼18% of the world's population, India does not yet have an estimate of prevalence of autism. This study was carried out to estimate the prevalence of autism in a selected population of school-children in India. N = 11,849 children (mean age = 5.9 [SD = 1.3], 39.5% females) were selected from various school types from three boroughs in Kolkata, India. Parents/caregivers and teachers filled in the social and communication disorders checklist (SCDC). Children meeting cutoff on parent-reported SCDC were followed up with the social communication questionnaire (SCQ). SCQ-positive children were administered the autism diagnostic observation schedule (ADOS). Teacher report on SCDC was available on all 11,849 children. Parent-report SCDC scores were obtained for 5,947 children. Mean scores on teacher SCDC were significantly lower than parent SCDC. Out of 1,247 SCDC-positive children, 882 answered the SCQ, of whom 124 met the cutoff score of 15. Six of these children met criteria for autism, autism spectrum disorder (ASD), or broader autism spectrum on the ADOS. The weighted estimate of supra-threshold SCQ scores was 3.54% (CI: 2.88-4.3%). The weighted prevalence estimate of positive scores (for broader autism spectrum + ASD + autism) was 0.23% (0.07-0.46%). As ∼20% children in this state are known to be out of the school system, and ASD prevalence is likely to be higher in this group, this estimate is likely to represent the lower-bound of the true prevalence. This study provides preliminary data on the prevalence of broader-spectrum autism and supra-threshold autistic traits in a population sample of school children in Eastern India. Autism Res 2017, 10: 1597-1605. ©2017 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.
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Affiliation(s)
- Alokananda Rudra
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Department of Psychology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew K Belmonte
- The Com DEALL Trust, Bangalore, Karnataka, India.,School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | | | - Saoni Banerjee
- Creating Connections, Kolkata, West Bengal, India.,Graduate School of Creative Art Therapies, University of Haifa, Haifa, Israel
| | | | - Bhismadev Chakrabarti
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Towle PO, Patrick PA. Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review. AUTISM RESEARCH AND TREATMENT 2016; 2016:4624829. [PMID: 28116159 PMCID: PMC5220395 DOI: 10.1155/2016/4624829] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/26/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022]
Abstract
Research on ASD in infancy has provided a rationale for developing screening instruments for children from the first year of life to age of 18 months. A comprehensive literature search identified candidate screening tools. Using methodological probe questions adapted from the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), two Level 1 and three Level 2 screening instruments were reviewed in detail. Research evidence conclusions were that instrument development was in beginning phases, is not yet strong, and requires further development. Clinical recommendations were to continue vigilant developmental and autism surveillance from the first year on but to use the screening instruments per se only for high-risk children rather than for population screening, with considerations regarding feasibility for individual settings, informing caregivers about strengths and weaknesses of the tool, and monitoring new research.
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Affiliation(s)
- Patricia O. Towle
- Westchester Institute for Human Development, Valhalla, NY, USA
- School of Health Sciences & Practice, New York Medical College, Valhalla, NY, USA
| | - Patricia A. Patrick
- Westchester Institute for Human Development, Valhalla, NY, USA
- School of Health Sciences & Practice, New York Medical College, Valhalla, NY, USA
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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Low HM, Zailan F. Medical students' perceptions, awareness, societal attitudes and knowledge of autism spectrum disorder: an exploratory study in Malaysia. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2016; 64:86-95. [PMID: 34141295 PMCID: PMC8115475 DOI: 10.1080/20473869.2016.1264663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives: This study aimed to investigate the perception, awareness, societal attitude, and knowledge about Autism Spectrum Disorder (ASD) in Malaysian medical students. Methods: An exploratory survey was conducted with 83 medical students in Malaysia. In the survey, the medical students were required to rate their perception, awareness, societal attitude, and their recognition of ASD symptoms. Results: The results showed the senior medical students had increased knowledge about ASD symptoms compared to the juniors, but there was no clear indicator that they had obtained the knowledge through formal training. Specifically, the medical students could better identify symptoms related to restrictive and fixation behavioral patterns than social communicative deficits. While considering the effects of societal attitude, year of study, perception about ASD course and other demographic variables, the year of study emerged as the sole predictor of the medical students' knowledge about ASD. Conclusion: The findings from this study provided evidence for the need of compulsory training on ASD in medical schools in improve the knowledge and skills of prospective medical practitioners to identify individuals with ASD. Such effort is fundamental for the early identification and intervention of ASD in developing countries such as Malaysia.
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Affiliation(s)
- Hui Min Low
- School of Educational Studies, Universiti Sains Malaysia, Minden, Malaysia
| | - Farhana Zailan
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Rogers CL, Goddard L, Hill EL, Henry LA, Crane L. Experiences of diagnosing autism spectrum disorder: A survey of professionals in the United Kingdom. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:820-31. [PMID: 26681687 DOI: 10.1177/1362361315611109] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To date, research exploring experiences of diagnosing autism spectrum disorder has largely focused on parental perspectives. In order to obtain a more complete account of the autism spectrum disorder diagnostic process, it is essential that the views and experiences of professionals are heard. In this study, 116 multidisciplinary professionals involved in diagnosing autism spectrum disorder in the United Kingdom completed an online questionnaire exploring their experiences and opinions of three key areas of service: accessibility, the diagnostic process and post-diagnostic support. Although professionals were largely satisfied with service accessibility, around 40% of services were failing to provide timely assessments. Standardised diagnostic tools were perceived as helpful and were used consistently, but concerns were raised about their validity in detecting atypical autism spectrum disorder presentations (e.g. females). Several challenges regarding giving autism spectrum disorder diagnoses were reported; these included making sure caregivers understood the diagnosis, pitching information at the correct level and managing distress. Furthermore, the practice of 'upgrading' to a diagnosis of autism spectrum disorder in uncertain or complex cases was reported by many, albeit infrequently, and reasons for this varied widely. Professionals expressed dissatisfaction with post-diagnostic provision, especially onward and long-term support options. They also felt that service improvements were required across populations and across the three key areas of service.
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Affiliation(s)
| | | | | | | | - Laura Crane
- Goldsmiths, University of London, UK City University London, UK
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Wong VCN, Fung CW, Lee SL, Wong PTY. Review of evolution of clinical, training and educational services and research program for autism spectrum disorders in Hong Kong. SCIENCE CHINA-LIFE SCIENCES 2015; 58:991-1009. [PMID: 26335731 DOI: 10.1007/s11427-012-4294-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The evolution of a local fragmented model of services for children with autism in Hong Kong emerged gradually over the past three decades with lack of government funding or support. This had been due to increasing number of children with autism being detected and referred for earlier assessment. With increasing pressure from parents due to long waiting time for assessment and training services and the increasing polarization by mass media there had been a gradual increasing public awareness over the past five years. Though still highly fragmented in the availability of services, there is a growing "business model" available in the community due to increasing need and lack of public funding for support. There is a lack of strategic planning for medical diagnostic and management issues in Hong Kong. Our University of Hong Kong based Autism Research Program was pioneered in 1985 based on the increasing load of autism cases referred for assessment for other developmental problems and diagnosed as Autism in the Duchess of Kent Children's Hospital. As the first author has been the staff of the University of Hong Kong, this program flourished as a research based program. The benefits of early identification and intervention of autism spectrum disorder (ASD) had been increasingly recognized, and with the increased public awareness and increasing trend of earlier diagnosis, there has been a continuously high demand from parents for earlier assessment and training for children suspected to have ASD. This model had not received extra funding for this integrated program for research, teaching and training in autism. We had to apply for various donations and grants to support the development of this pioneer program. The research output and organization of forums for public education and awareness are reviewed. The latter part of the paper reports the summary of clinical profile of autism cases (N=1441) assessed from 1985 to 2010 June under the University of Hong Kong. As the waiting time for initial developmental assessment for any children in Hong Kong is 12-24 months, we also report our preliminary experience with a newly launched triaging service provision for children suspected to be ASD since 2009, including multi-disciplinary assessment and parallel interim training in our university affiliated child assessment centre in Hong (N=89).
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Affiliation(s)
- Virginia Chun-Nei Wong
- Department of Paediatrics and Adolescent Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
| | - Cheuk-Wing Fung
- Department of Paediatrics and Adolescent Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - So-Lun Lee
- Department of Paediatrics and Adolescent Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Polly Tsz Yan Wong
- Department of Paediatrics and Adolescent Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Abstract
OBJECTIVE Parents rely on pediatricians to monitor their child's development. The American Academy of Pediatrics recommends routine developmental screening with both broadband and autism-specific instruments at specified ages. If broadband screeners can detect autism risk, this might minimize the burden of administering autism-specific screens to all children. The current study examines the ability of the Ages and Stages Questionnaire-Third Edition (ASQ-3) to identify children at risk for autism. We looked at ASQ-3 scores of children who screen positive on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), children who continue to screen positive on the M-CHAT-R Follow-up Interview, and children diagnosed with autism spectrum disorder (ASD). METHODS A total of 2848 toddlers, aged 16 to 30 months, were screened with the ASQ-3 and M-CHAT-R across 20 pediatric sites. Children who screened positive on the M-CHAT-R and its follow-up interview were offered a diagnostic evaluation. RESULTS Using the "monitor and/or fail" cutoff on any domain, the ASQ-3 identified 87% of the children who screened positive on the M-CHAT-R with follow-up and 95% (20/21) of those diagnosed with an ASD. Monitor and/or fail on the Communication domain alone also identified 95% of the diagnosed children. CONCLUSIONS Scores below the "monitor" cutoff on the Communication domain of the ASQ-3 can indicate initial concern requiring autism-specific follow-up. If these results are confirmed with a sample large enough to separately examine toddlers of different ages and different cultural backgrounds, it may be feasible to implement a 2-stage screening strategy, with autism-specific screening reserved for those who are positive on a broadband screen.
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Affiliation(s)
- Sarah Hardy
- *Department of Psychology, University of Rhode Island, Kingston, RI; †Department of Psychology, University of Connecticut, Storrs, CT
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Ashwood KL, Buitelaar J, Murphy D, Spooren W, Charman T. European clinical network: autism spectrum disorder assessments and patient characterisation. Eur Child Adolesc Psychiatry 2015; 24:985-95. [PMID: 25471824 DOI: 10.1007/s00787-014-0648-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/06/2014] [Indexed: 12/16/2022]
Abstract
The United Nations and World Health Organisation have identified autism spectrum disorder (ASD) as an important public health issue across global mental health services. Although a range of tools exist to identify and quantify ASD symptoms, there is a lack of information about which ASD measures are used in different services worldwide. This paper presents data from a large survey of measures used for patient characterisation in major ASD research and clinical centres across Europe collected between June 2013 and January 2014. The objective was to map the use of different instruments used to characterise ASD, comorbid psychopathology and cognitive and adaptive ability for patient diagnostic and characterisation purposes across Europe. Sixty-six clinical research sites diagnosing 14,844 patients per year contributed data. The majority of sites use the well-established Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI) instruments, though the proportion of sites in Western Europe using the ADI was almost double the rate in Eastern Europe. Approximately half the sites also used the Social Communication Questionnaire (SCQ) and Social Responsiveness Scale (SRS), although use of the SRS was over three times higher in Western Europe compared with Eastern Europe. The use of free/open access measures was lower than commercially available tools across all regions. There are clinical and scientific benefits in encouraging further convergence of clinical characterisation measures across ASD research and clinical centres in Europe to facilitate large-scale data sharing and collaboration, including clinical trials of novel medications and psychological interventions.
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Affiliation(s)
- Karen L Ashwood
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,
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Hurwitz S, Watson LR. Joint attention revisited: Finding strengths among children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:538-50. [PMID: 26148983 DOI: 10.1177/1362361315593536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Differences in joint attention are prominent for some children with autism and are often used as an indicator of the disorder. This study examined the joint attention competencies of young children with autism who demonstrated joint attention ability and compared them to children with developmental delays. A total of 40 children with autism and developmental delays were matched pairwise based on mental and chronological age. Videos of children engaging in play were coded for the frequency and forms (eye contact, gestures, affect, etc.) of joint attention. Additionally, concurrent language was compared among children with autism (N = 32) by their joint attention ability. Children with autism spectrum disorder entered into joint attention significantly less often than children with developmental delays, but once engaged used the forms of joint attention similarly. For the matched pairs, there were no differences in language, but the children with autism who used joint attention had significantly better language than children with autism who did not (even after controlling for mental age). There is a group of young children with autism who can use joint attention but do so at lower frequencies than children with developmental delays. Possible reasons include difficulty disengaging attention and limited intrinsic social motivation to share. Adult persistence is recommended to encourage joint attention.
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Hoffmann W, Heinzel-Gutenbrunner M, Becker K, Kamp-Becker I. [Screening interview for early detection of high-functioning autism spectrum disorders]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2015; 43:207-18; quiz 218-9. [PMID: 26098008 DOI: 10.1024/1422-4917/a000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities. METHOD The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD. RESULTS The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74. CONCLUSION The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.
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Affiliation(s)
- Wiebke Hoffmann
- 1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Phillips-Universität Marburg
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Sun X, Allison C, Matthews FE, Zhang Z, Auyeung B, Baron-Cohen S, Brayne C. Exploring the Underdiagnosis and Prevalence of Autism Spectrum Conditions in Beijing. Autism Res 2015; 8:250-60. [PMID: 25952676 PMCID: PMC4690159 DOI: 10.1002/aur.1441] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 11/17/2014] [Indexed: 01/07/2023]
Abstract
Previous studies reported that the prevalence of Autism Spectrum Conditions (ASC) in mainland China is much lower than estimates from developed countries (around 1%). The aim of the study is to apply current screening and standardized diagnostic instruments to a Chinese population to establish a prevalence estimate of ASC in an undiagnosed population in mainland China. We followed the design development used previously in the UK published in 2009 by Baron‐Cohen and colleagues. The Mandarin Childhood Autism Spectrum Test (CAST) was validated by screening primary school pupils (n = 737 children age 6–10 years old) in Beijing and by conducting diagnostic assessments using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview‐Revised. The prevalence estimate was generated after adjusting and imputing for missing values using the inverse probability weighting. Response was high (97%). Using the UK cutoff (≥15), CAST performance has 84% sensitivity and 96% specificity (95% confidence interval [CI]: 46, 98, and 96, 97, respectively). Six out of 103 children, not previously diagnosed, were found to the meet diagnostic criteria (8.5 after adjustment, 95% CI: 1.6, 15.4). The preliminary prevalence in an undiagnosed primary school population in mainland China was 119 per 10,000 (95% CI: 53, 265). The utility of CAST is acceptable as a screening instrument for ASC in large epidemiological studies in China. Using a comparable method, the preliminary prevalence estimate of ASC in mainland China is similar to that of those from developed countries. Autism Res2015, 8: 250–260. © 2015 The Authors. Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research
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Affiliation(s)
- Xiang Sun
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Fiona E Matthews
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Zhixiang Zhang
- Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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Bitton JY, Demos M, Elkouby K, Connolly M, Weiss SK, Donner EJ, Whiting S, Ronen GM, Bello-Espinosa L, Wirrell EC, Mohamed IS, Dooley JM, Carmant L. Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms? Epilepsia 2015; 56:856-63. [PMID: 25944453 DOI: 10.1111/epi.12997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome. METHODS Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule-Generic (ADOS-G). RESULTS Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80% ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009). SIGNIFICANCE ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.
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Affiliation(s)
- Jonathan Y Bitton
- Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada
| | - Michelle Demos
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katia Elkouby
- Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada
| | - Mary Connolly
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelly K Weiss
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth J Donner
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Whiting
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel M Ronen
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, McMaster Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Luis Bello-Espinosa
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Elaine C Wirrell
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.,Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ismail S Mohamed
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.,Division of Neurology, Department of Pediatrics, Faculty of Medicine, Izaak Walton Killam (IWK) Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph M Dooley
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Izaak Walton Killam (IWK) Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lionel Carmant
- Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada
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Sun X, Allison C, Auyeung B, Baron-Cohen S, Brayne C. Parental concerns, socioeconomic status, and the risk of autism spectrum conditions in a population-based study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3678-88. [PMID: 25262013 DOI: 10.1016/j.ridd.2014.07.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 05/02/2023]
Abstract
A total number of 11,635 screening packs were distributed to 5-10 year-old children in 136 schools in Cambridgeshire to investigate the associations between levels of parental concern (none/minor/strong), socioeconomic status and the risk of having Autism Spectrum Conditions (ASC). The variables for investigating associations and possible confounders were extracted for analysis, including parental concern question score, SES, age of the child, sex, maternal age at birth, paternal age at birth, mother's age of leaving education, father's age of leaving education, birth order and the number of children in the family. The SES, age of the child, sex and mother's age at leaving education were associated with parental concern. Parents with higher SES reported higher levels of concern (Chi-square = 11.8; p = 0.02). However, a higher SES was not associated with the risk of having ASC (p = 0.50). After adjusting for potential confounders, the odds of children meeting ASC criteria whose parents had reported strong parental concern were 8.5 times (odds ratio: 8.5; 95%CI: 4.5, 16.2; p < 0.001) the odds of children having ASC whose parents reported minor concern. No child met ASC criteria where parents expressed no concerns. Parents with higher social class express more concerns than those from lower social classes. However, the concerns reported by parents in higher SES did not appear to be specific for ASC as there was no relationship between ASC and SES.
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Affiliation(s)
- Xiang Sun
- Cambridge Institute of Public Health, Cambridge University School of Medicine, Forvie Site, University of Cambridge, CB2 0SR, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; The Jockey Club School of Public Health and Primary Care, Shatin, NT, Hong Kong.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; Department of Psychology, University of Edinburgh, EH8 9JZ, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Cambridge University School of Medicine, Forvie Site, University of Cambridge, CB2 0SR, UK
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Scarpa A, Reyes NM, Patriquin MA, Lorenzi J, Hassenfeldt TA, Desai VJ, Kerkering KW. The modified checklist for autism in toddlers: reliability in a diverse rural American sample. J Autism Dev Disord 2014; 43:2269-79. [PMID: 23386118 DOI: 10.1007/s10803-013-1779-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated the psychometric properties of the modified checklist for autism in toddlers (M-CHAT) in a diverse rural American low-socioeconomic status (SES) sample. Four hundred and forty-seven English (n = 335) and Spanish (n = 112) speaking caregivers completed the M-CHAT during their toddler's 18- or 24-month well visit in a Southwest Virginia pediatric clinic. The M-CHAT did not show acceptable internal consistency in groups with low maternal education or minority status. Caregivers reporting low maternal education and minority status were more likely to endorse items suggestive of autism. These results indicate that the M-CHAT may require modifications to be more internally consistent and accurate across ethnic and educational groups in rural areas with low levels of SES. Recommendations to increase the utility of the M-CHAT are discussed.
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Affiliation(s)
- Angela Scarpa
- Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA, 24061-0436, USA,
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Rudra A, Banerjee S, Singhal N, Barua M, Mukerji S, Chakrabarti B. Translation and Usability of Autism Screening and Diagnostic Tools for Autism Spectrum Conditions in India. Autism Res 2014; 7:598-607. [DOI: 10.1002/aur.1404] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 07/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Alokananda Rudra
- School of Psychology and Clinical Language Sciences; University of Reading; Reading UK
| | | | - Nidhi Singhal
- Action for Autism; National Centre for Autism; Delhi India
| | - Merry Barua
- Action for Autism; National Centre for Autism; Delhi India
| | | | - Bhismadev Chakrabarti
- School of Psychology and Clinical Language Sciences; University of Reading; Reading UK
- Autism Research Centre; University of Cambridge; Cambridge UK
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A quarter century of progress on the early detection and treatment of autism spectrum disorder. Dev Psychopathol 2014; 25:1455-72. [PMID: 24342850 DOI: 10.1017/s0954579413000710] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The last 25 years have witnessed tremendous changes in our ability to detect autism very early in life and provide interventions that can significantly influence children's outcomes. It was once questioned whether autism could be recognized before children had developed language and symbolic play skills; now changes in early behaviors, as well as structural brain changes, have been documented in infants 6-12 months of age who later develop autism. Advances in brain imaging and genetics offer the possibility of detecting autism before the syndrome is fully manifest, thereby reducing or preventing symptoms from developing. Whereas the primary mode of behavioral intervention a few decades ago relied on operant conditioning, recent approaches integrate the methods of applied behavioral analysis within a developmental, relationship-focused intervention model that are implemented by both parents and clinicians. These interventions have been found to have positive effects on children's developmental trajectory, as measured by both behavioral and neurophysiological assessments. Future approaches will likely combine both behavioral and pharmacological treatments for children who have less robust responses to behavioral interventions. There has been a paradigm shift in the way that autism is viewed, evolving from a lifelong condition with a very poor prognosis to one in which significant gains and neuroplasticity is expected, especially when the condition is detected early and appropriate interventions are provided. The grand challenge for the future is to bridge the tremendous gap between research and the implementation of evidence-based practices in the broader community, both in the United States and worldwide. Significant disparities in access to appropriate health care for children with autism exist that urgently require advocacy and more resources.
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Soto S, Linas K, Jacobstein D, Biel M, Migdal T, Anthony BJ. A review of cultural adaptations of screening tools for autism spectrum disorders. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:646-61. [PMID: 25008216 DOI: 10.1177/1362361314541012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Screening children to determine risk for Autism Spectrum Disorders has become more common, although some question the advisability of such a strategy. The purpose of this systematic review is to identify autism screening tools that have been adapted for use in cultures different from that in which they were developed, evaluate the cultural adaptation process, report on the psychometric properties of the adapted instruments, and describe the implications for further research and clinical practice. A total of 21 articles met criteria for inclusion, reporting on the cultural adaptation of autism screening in 19 countries and in 10 languages. The cultural adaptation process was not always clearly outlined and often did not include the recommended guidelines. Cultural/linguistic modifications to the translated tools tended to increase with the rigor of the adaptation process. Differences between the psychometric properties of the original and adapted versions were common, indicating the need to obtain normative data on populations to increase the utility of the translated tool.
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Affiliation(s)
- Sandra Soto
- San Diego State University/University of California, USA
| | - Keri Linas
- Georgetown Center for Child and Human Development, USA
| | | | | | - Talia Migdal
- Georgetown Center for Child and Human Development, USA
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Sun X, Allison C, Auyeung B, Matthews FE, Zhang Z, Baron-Cohen S, Brayne C. Comparison between a Mandarin Chinese version of the Childhood Autism Spectrum Test and the Clancy Autism Behaviour Scale in mainland China. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1599-1608. [PMID: 24769432 DOI: 10.1016/j.ridd.2014.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/09/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
A Mandarin Chinese version of the Childhood Autism Spectrum Test (CAST) and Clancy Autism Behaviour Scale (CABS) were applied to 150 children aged 4-11 years old from clinical settings and mainstream schools in Beijing. All the children were further assessed using the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). The validity of two instruments on screening of ASC was examined and compared using receiver operating characteristic (ROC) curve analysis. The validity of CAST (sensitivity: 89%, specificity: 80%, PPV: 70%) was better than the CABS (sensitivity: 58%, specificity: 84%, PPV: 65%). The area under the curve (AUC) of the CAST (AUC=0.90) was significantly higher than the CABS (AUC=0.79, p=0.0002). The Mandarin CAST demonstrated a better validity in distinguishing children with ASC from children without ASC. It is an acceptable candidate as a screening instrument for ASC in large epidemiological study in Chinese population.
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Affiliation(s)
- Xiang Sun
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; Department of Psychology, University of Edinburgh, EH8 9JZ, UK
| | - Fiona E Matthews
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, CB2 0SR, UK
| | - Zhixiang Zhang
- Paediatrics Department, Peking University First Hospital, No. 8, Xishiku Avenue, Xicheng District, Beijing 100034, China
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
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50
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Children with autism in the People's Republic of China: diagnosis, legal issues, and educational services. J Autism Dev Disord 2014. [PMID: 23179346 DOI: 10.1007/s10803-012-1722-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the late 1970s, special education in the People's Republic of China has experienced significant reform and fast development. However, education for children with severe developmental disabilities, especially autism spectrum disorders (ASDs), is still the greatest challenge in the field. This paper aims to give readers an overview of what is happening to children with ASDs in China. We first address the issue of prevalence of ASDs, and then offer an introduction to the diagnostic process. After that, a review of disability-related legislation is provided, followed by a description of current treatment options and available educational services. Finally we introduce all extent service providers and their roles.
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