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Mata-Iturralde S, Alonso-Esteban Y, Alcantud-Marín F, Young R. Autism Detection in Early Childhood (ADEC) in a Low-Income Spanish-Speaking Population in Guayaquil (Ecuador). J Autism Dev Disord 2024:10.1007/s10803-024-06413-3. [PMID: 38819703 DOI: 10.1007/s10803-024-06413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
Autism Spectrum Disorder (ASD) must be present early in development, but may not fully manifest until social demands exceed capacities. In the absence of adequate biological or brain imaging markers to detect and diagnose autism, diagnosis relies on clinical judgment based on observation of symptoms. Many tools have been developed in English-speaking countries (questionnaires for parents, symptom checklists for professionals, observation systems, etc.). Screening in countries with other languages requires cultural and linguistic adaptation of these instruments. This paper presents the adaptation of the ADEC (Autism Detection in Early Childhood). METHODS The original version of the ADEC was translated and culturally and linguistically adapted to the characteristics of the population of Guayaquil (Ecuador). PARTICIPANTS A pilot study was conducted with a sample of 613 children aged 18-48 months. RESULTS Cronbach's alpha values (0.89) indicate high internal consistency. The correlation between the MCHAT-R/F follow-up interview and the ADEC (mean r = 0.93) indicates high construct validity. In terms of predictive validity, using the original cut-off points of the ADEC, they show excellent diagnostic ability. The sensitivity and specificity results (sensitivity 1.00; specificity 0.92; positive predictive value 0.83; negative predictive value 0.99) are even better than those obtained in a similar study in the Mexican population. CONCLUSIONS Considering that the MCHAT R/F is a parent-reported instrument, the Guayaquil Spanish version of the ADEC (ADEC-GU) seems to be a suitable instrument to be used in a complementary way as a second-level screening instrument for autism, before resorting to a full diagnostic process.
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Rah SS, Jung M, Lee K, Kang H, Jang S, Park J, Yoon JY, Hong SB. Systematic Review and Meta-analysis: Real-World Accuracy of Children's Developmental Screening Tests. J Am Acad Child Adolesc Psychiatry 2023; 62:1095-1109. [PMID: 36592715 DOI: 10.1016/j.jaac.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This review presents a list of developmental screening tests used in clinical settings worldwide and provides a broad estimate of their accuracy (PROSPERO: CRD42021236474). METHOD Following the PRISMA Diagnostic Test Accuracy (DTA) guidelines, this review involved searching PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, and Google Scholar (for manual searching). Inclusion criteria included studies published in English through 2020 that compared the accuracy of developmental screening tests against developmental diagnostic tests among children under 13 years of age. Six researchers, in pairs, independently selected the studies and extracted the data. A hierarchical model was applied to meta-analyze the diagnostic accuracy of the tests, and meta-regression was used to identify the moderators using R 4.1.3 software. RESULTS The meta-analysis included 56 studies (17 screening tests and 61 outcomes). The most frequently used screening tests were the Ages and Stages Questionnaire (ASQ), Denver Developmental Screening Test (DDST), and Parent's Evaluation of Developmental Status (PEDS). The pooled sensitivity and specificity were 0.75 (95% CI = 0.69-0.80) and 0.76 (95% CI = 0.71-0.80), and the overall diagnostic accuracy of the total outcomes (area under the curve) was 0.80. High heterogeneity was observed between the included studies with various thresholds of the tests. Participants' developmental concerns at the baseline significantly moderated the accuracy of the screening tests, resulting in double the positive predictive value and prevalence compared to those without the concerns. CONCLUSION We recommend a standardized process of validation studies for diagnostic accuracy, to ensure the effectiveness of developmental screening tests in clinical settings. STUDY PREREGISTRATION INFORMATION Accuracy of Developmental Screening Tools among Children in Real World: a Systematic Review and Meta Analysis; https://www.crd.york.ac.uk/; CRD42021236474.
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Affiliation(s)
- Sung Sil Rah
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minho Jung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungmin Lee
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Hannah Kang
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Soyoung Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Junghyun Park
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Soon-Beom Hong
- Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Choueiri R, Garrison WT, Tokatli V. Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities. Indian J Pediatr 2023; 90:377-386. [PMID: 35604589 PMCID: PMC9125962 DOI: 10.1007/s12098-022-04172-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identification may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identification of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identified. The goal is to recommend models that are culturally appropriate and scientifically valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identification of ASD. Starting locally by simplifying and demystifying the ASD identification process and building community connections will inform global researchers and policymakers while making a difference in the lives of the children and families affected by ASD.
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Affiliation(s)
- Roula Choueiri
- Autism Spectrum Center, Department of Neurology, Boston Children's Hospital, 2 Brookline Place, Brookline, MA, 02445, USA.
| | - William T Garrison
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Tokatli
- Autism Spectrum Center, Department of Neurology, Boston Children's Hospital, 2 Brookline Place, Brookline, MA, 02445, USA.,Division of Developmental and Behavioral Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Do Autism-Specific and General Developmental Screens Have Complementary Clinical Value? J Autism Dev Disord 2022:10.1007/s10803-022-05541-y. [PMID: 35579791 PMCID: PMC10214166 DOI: 10.1007/s10803-022-05541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18 months, reinforcing the need for recurrent screening as autism emerges in early development.
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Niedźwiecka A, Pisula E. Symptoms of Autism Spectrum Disorders Measured by the Qualitative Checklist for Autism in Toddlers in a Large Sample of Polish Toddlers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053072. [PMID: 35270764 PMCID: PMC8910243 DOI: 10.3390/ijerph19053072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to assess some early symptoms of autism spectrum disorders (ASD) measured by a screening tool developed for an early detection of ASD. We investigated if the early symptoms were associated with toddlers’ age, gender or ASD familial risk status. We used the Polish version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT) to assess 1024 children aged 16 to 36 months. The sample included four groups of participants: typically developing toddlers, toddlers with parent-reported ASD-specific concerns, toddlers at risk for autism due to having an older sibling with ASD, and toddlers with a developmental delay. We found that mean Q-CHAT scores were significantly higher in boys than in girls. We did not find any associations between Q-CHAT scores and age. We observed that toddlers with a familial risk for ASD and those with a developmental delay scored significantly higher than controls. We collated these results with previous studies that used the Q-CHAT and other instruments.
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Rare diseases - rare outcomes: Assessing communication abilities for the developmental and epileptic encephalopathies. Epilepsy Behav 2022; 128:108586. [PMID: 35158285 DOI: 10.1016/j.yebeh.2022.108586] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Developmental and epileptic encephalopathies (DEE) entail moderate to profound communication and other impairments that are poorly measured by typical clinical outcomes assessments (COA). We examined the potential of alternative approaches, specifically, the use of raw scores and COAs outside of their intended age ranges. METHODS In a cross-sectional survey, 120 parents of children with Dravet Syndrome, Lennox-Gastaut syndrome, KCNQ2-DEE, KCNB1-DEE, and SCN2A-DEE (ages 1-35 years) completed the Adaptive Behavior Assessment System-3 for ages 0-5 years, modified checklist for autism (mCHAT), communication and social behavior scales (CSBS), communication matrix (CM), and several parent-reported classifiers of communication. Adaptive Behavior Assessment System communication and social raw scores were the primary and adjunctive outcomes. Floor and ceiling effects, dispersion and convergence with related measures were assessed with appropriate parametric and nonparametric statistical techniques. RESULTS Median chronological age (CA) was 8.7 years (Interquartile range (IQR): 5.3-13.5). Adaptive Behavior Assessment Systemcommunication and social age equivalents were 12.5 months (IQR 7.5-28) and 16.5 months (IQR 9-31). Most raw scores corresponded to standardized scores indicating performance <3 standard deviations below the general population mean. Adaptive Behavior Assessment System raw scores demonstrated minimal floor and ceiling effects (<1-2.5%). In linear regression models, scores correlated with age under 6 years (communication, p = 0.001; social, p = 0.003) but significantly flattened out thereafter. Scores varied substantially by DEE group (both p < 0.001) and decreased with higher convulsive seizure frequency (communication, p = 0.01, social, p = 0.02). There was good convergence with mCHAT, CSBS, and CM scores (all r > 0.8). SIGNIFICANCE Raw scores and out-of-range COAs may provide measures that are sensitive at the very limited levels of functioning typical of profoundly impaired, older patients with DEEs. To ensure that targeted trial outcomes are responsive to meaningful change, development of these approaches will be essential to clinical trial readiness for novel therapies for rare DEEs.
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Sturner R, Howard B, Bergmann P, Attar S, Stewart-Artz L, Bet K, Allison C, Baron-Cohen S. Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners. Mol Autism 2022; 13:2. [PMID: 34980240 PMCID: PMC8722322 DOI: 10.1186/s13229-021-00480-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.
Methods This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.
Results While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Limitations Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Conclusions Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00480-4.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA. .,Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Paul Bergmann
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,Foresight Logic, Inc., St. Paul, MN, USA
| | - Shana Attar
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,University of Washington, Seattle, WA, USA
| | - Lydia Stewart-Artz
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA
| | - Kerry Bet
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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8
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Thi Vui L, Duc DM, Thuy Quynh N, Giang NTH, Mai VTT, Ha BTT, Van Minh H. Early screening and diagnosis of autism spectrum disorders in Vietnam: A population-based cross-sectional survey. J Public Health Res 2021; 11. [PMID: 34850618 PMCID: PMC8973207 DOI: 10.4081/jphr.2021.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Early detection of autism spectrum disorders (ASDs) is essential given the under-reported cases in low- and middle-income countries. This first national representative survey was conducted to explore the prevalence of ASDs amongst 18 and 30 months in seven provinces in Vietnam. Design and methods: During 2017-2018, a national cross-sectional and population-based survey for autism spectrum disorder (ASD) amongst 40,243 children aged 18 to 30 months was conducted in 7 provinces representing the socio-economic regions of Vietnam. M-CHAT was used to screen children and then confirmed by diagnostic assessment using DSM-IV criteria. Results: The prevalence of ASDs amongst children aged 18 and 30 months in Vietnam was high (0.758% or 1 in 132 children). Urban setting, male gender, and hereditable genes were associated with ASD prevalence. Conclusions: ASDs amongst children aged 18 and 30 months in Vietnam tend to be increasing and are similar to this rate in other middle-income countries but lower than that in Western countries. This under-recognized public health problem amongst children should be addressed by early detection and intervention for families with affected children. Significance for public health This first nationally representative and population-based survey adds empirical data about autism spectrum disorder (ASD) amongst children aged 18 to 30 months in Vietnam. Using M-CHAT as screening tool and DSM-IV criteria for confirmation, ASD amongst children aged 18 and 30 months shows an increasing trend with the prevalence as high as 0.758% in 2018. Early detection and intervention should be conducted to provide affected child with the potential for a better life.
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Affiliation(s)
- Le Thi Vui
- Hanoi University of Public Health, Hanoi.
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9
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Abstract
We looked at existing recommendations and supporting evidence on the effectiveness of screening young children for autistic spectrum disorder (ASD) for improving short- and long-term outcomes.We conducted a literature search up to the 8th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.There are discrepancies among the recommendations given by different institutions on universal screening for ASD in children. Some recommend that all children should be screened with an ASD-specific instrument during well-child visits at ages 18 and 24 months in conjunction with ongoing developmental surveillance and broadband developmental screening; some conclude that the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician; and others recommend against universal screening, but for a screening among children with high risks.There is adequate evidence that ASD screening tools applied to children between 12 and 36 months accurately identify those with ASD. There is some evidence showing benefit of early interventions applied to children with ASD, from children identified with developmental concern by their family, teacher or clinicians. We found no evidence on the effectiveness of interventions applied to children with ASD detected through screening.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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10
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Coulter KL, Barton ML, Boorstein H, Cordeaux C, Dumont-Mathieu T, Haisley L, Herlihy L, Jashar DT, Robins DL, Stone WL, Fein DA. The Toddler Autism Symptom Inventory: Use in diagnostic evaluations of toddlers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2386-2399. [PMID: 34128412 DOI: 10.1177/13623613211021699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
LAY ABSTRACT Determining whether a young child has an autism spectrum disorder requires direct observation of the child and caregiver report of the child's everyday behaviors. There are few interviews for parents that are specifically designed for children under 3 years of age. The Toddler Autism Symptom Inventory is a new interview that asks caregivers of children age 12-36 months about symptoms of possible autism spectrum disorder. The Toddler Autism Symptom Inventory uses a cutoff score to indicate likelihood for autism spectrum disorder; this cutoff score appears to accurately identify most children who are diagnosed with autism spectrum disorder without identifying too many who do not have autism spectrum disorder. The Toddler Autism Symptom Inventory interview can help clinicians to determine whether a young child shows symptoms suggestive of an autism spectrum disorder.
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Affiliation(s)
| | | | | | - Cara Cordeaux
- Massachusetts General Brigham Psychology Assessment Center, USA
| | | | - Lauren Haisley
- University of Colorado Aurora, USA.,Children's Hospital Colorado, USA
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Stenberg N, Schjølberg S, Shic F, Volkmar F, Øyen AS, Bresnahan M, Svendsen BK, von Tetzchner S, Thronæs NT, Macari S, Cicchetti DV, Chawarska K, Suren P, Øien RA. Functional Outcomes of Children Identified Early in the Developmental Period as at Risk for ASD Utilizing the The Norwegian Mother, Father and Child Cohort Study (MoBa). J Autism Dev Disord 2021; 51:922-932. [PMID: 32424708 PMCID: PMC7954713 DOI: 10.1007/s10803-020-04539-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Early identification of autism spectrum disorder (ASD) is regarded as crucial for swift access to early intervention and, subsequently, better outcomes later in life. However, current instruments miss large proportions of children who later go on to be diagnosed with ASD, raising a question of what these instruments measure. The present study utilized data from the Norwegian Mother, Father, and Child Cohort Study and the Autism Birth Cohort study to explore the subsequent developmental and diagnostic characteristics of children raising developmental concern on the six-critical discriminative item criterion of the M-CHAT (DFA6) at 18 months of age (N = 834). The DFA6 identified 28.8% of children diagnosed with ASD (N = 163), but 4.4% with language disorder (N = 188) and 81.3% with intellectual disability (N = 32) without ASD. Scoring in the «at-risk» range was associated with lower IQ, impaired functional language, and greater severity of autism symptoms whether children had ASD or not.
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Affiliation(s)
| | | | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Fred Volkmar
- School of Medicine, Child Study Center, Yale University, New Haven, USA
| | - Anne-Siri Øyen
- Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway
| | | | | | | | - Nina Torheim Thronæs
- Department of Education, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway
| | - Suzanne Macari
- School of Medicine, Child Study Center, Yale University, New Haven, USA
| | | | | | - Pål Suren
- Norwegian Institute of Public Health, Oslo, Norway
| | - Roald A Øien
- Department of Education, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway.
- School of Medicine, Child Study Center, Yale University, New Haven, USA.
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12
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May T, Brignell A, Williams K. Parent-reported Autism Diagnostic Stability and Trajectories in the Longitudinal Study of Australian Children. Autism Res 2021; 14:773-786. [PMID: 33442959 DOI: 10.1002/aur.2470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/25/2020] [Accepted: 12/23/2020] [Indexed: 11/06/2022]
Abstract
This study aimed to explore the stability of parent-reported diagnosis of Autism Spectrum Disorder (ASD) and factors influencing the trajectories in two cohorts from the prospective Longitudinal Study of Australian Children (LSAC). Parent-reported ASD diagnosis was collected for children from 6 years of age in a Birth cohort and 10 years of age in a Kinder cohort; allowing for exploration of diagnostic stability at age 6, 8, 10, and 12 years (Birth cohort) and 10, 12, 14, 16 years (Kinder cohort). Children were grouped based on persisting, desisting, inconsistent and late (diagnosis after 6 years-Birth cohort; after 10 years-Kinder) subgroups over four timepoints. Multinomial logistic regression explored predictors of diagnostic trajectories; generalized estimating equations examined trajectories of emotional and behavioral problems. Of 66 Birth cohort children parent-reported to have ASD at age 6, with data at all four time points, 14% did not at 12 years; of 73 Kinder cohort children at age 10 years, 26% no longer had parent-reported ASD at 16 years. Children with late diagnoses showed increasing trajectories of emotional and behavioral problems, while children with persisting or desisting diagnoses showed decreasing trajectories. Between 86% and 74% had a reported ASD diagnosis after 6 years. Findings indicate that children with ASD need services and supports that can adapt to their changing needs, which may be increasing, decreasing or different. This has implications for the provision of services and funding. LAY SUMMARY: This study explored how consistent parent-reported ASD diagnosis is over time in two groups of children from the Longitudinal Study of Australian Children (LSAC). Although up to 26% of children no longer had parent-reported ASD after 6-years follow up, persisting or late trajectories were more common. The outcome of late onset trajectories requires ongoing review. Autism Res 2021, 14: 773-786. © 2021 International Society for Autism Research and Wiley Periodicals LLC.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Brignell
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Monash Children's Hospital, Clayton, Victoria, Australia
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13
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Choueiri R, Lindenbaum A, Ravi M, Robsky W, Flahive J, Garrison W. Improving Early Identification and Access to Diagnosis of Autism Spectrum Disorder in Toddlers in a Culturally Diverse Community with the Rapid Interactive screening Test for Autism in Toddlers. J Autism Dev Disord 2021; 51:3937-3945. [PMID: 33423215 PMCID: PMC8510911 DOI: 10.1007/s10803-020-04851-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The objective of this study was to test a screening model that employs the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), in an underserved community to improve ASD detection. We collaborated with a large Early Intervention (EI) program and trained 4 providers reliably on the RITA-T. Toddlers received the Modified Checklist for Autism in Toddlers (MCHAT-R/F), the RITA-T, developmental and autism testing, and a best-estimate clinical diagnosis. Eighty-One toddlers were enrolled: 57 with ASD and 24 with Developmental Delay (DD) non-ASD. Wait-time for diagnosis was on average 6 weeks. The RITA-T correlated highly with autism measures and EI staff integrated this model easily. The RITA-T significantly improved the identification and wait time for ASD in this underserved community.
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Affiliation(s)
- Roula Choueiri
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | | | - Manasa Ravi
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - William Robsky
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - William Garrison
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Allison C, Matthews FE, Ruta L, Pasco G, Soufer R, Brayne C, Charman T, Baron-Cohen S. Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism. BMJ Paediatr Open 2021; 5:e000700. [PMID: 34131593 PMCID: PMC8166626 DOI: 10.1136/bmjpo-2020-000700] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/22/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This is a prospective population screening study for autism in toddlers aged 18-30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4. DESIGN Observational study. SETTING Luton, Bedfordshire and Cambridgeshire in the UK. PARTICIPANTS 13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18-30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4. INTERVENTIONS A stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT. MAIN OUTCOME MEASURES Consensus diagnostic outcome at phase 1 and phase 2. RESULTS At phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2. CONCLUSIONS The Q-CHAT can be used at 18-30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4-5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.
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Affiliation(s)
- Carrie Allison
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Liliana Ruta
- Institute for Biomedical Research and Innovation (IRIB) - National Research Council of Italy (CNR), Messina, Italy
| | - Greg Pasco
- Dept of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Renee Soufer
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Tony Charman
- Dept of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Baron-Cohen
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
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15
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Brewer N, Young RL, Lucas CA. Autism Screening in Early Childhood: Discriminating Autism From Other Developmental Concerns. Front Neurol 2020; 11:594381. [PMID: 33362696 PMCID: PMC7758341 DOI: 10.3389/fneur.2020.594381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022] Open
Abstract
Early identification of autism, followed by appropriate intervention, has the potential to improve outcomes for autistic individuals. Numerous screening instruments have been developed for children under 3 years of age. Level 1 screeners are used in large-scale screening to detect at-risk children in the general population; Level 2 screeners are concerned with distinguishing children with signs of autism from those with other developmental problems. The focus here is evaluation of Level 2 screeners. However, given the contributions of Level 1 screeners and the necessity to understand how they might interface with Level 2 screeners, we briefly review Level 1 screeners and consider instrument characteristics and system variables that may constrain their effectiveness. The examination of Level 2 screeners focuses on five instruments associated with published evaluations in peer-reviewed journals. Key criteria encompass the traditional indices of test integrity such as test reliability (inter-rater, test-retest) and construct validity, including concurrent and predictive validity, sensitivity (SE), and specificity (SP). These evaluations reveal limitations, including inadequate sample sizes, reliability issues, and limited involvement of independent researchers. Also lacking are comparative test evaluations under standardized conditions, hindering interpretation of differences in discriminative performance across instruments. Practical considerations constraining the use of such instruments—such as the requirements for training in test administration and test administration time—are canvassed. Published Level 2 screener short forms are reviewed and, as a consequence of that evaluation, future directions for assessing the discriminative capacity of items and measures are suggested. Suggested priorities for future research include targeting large and diverse samples to permit robust appraisals of Level 2 items and scales across the 12–36 month age range, a greater focus on precise operationalization of items and response coding to enhance reliability, ongoing exploration of potentially discriminating items at the younger end of the targeted age range, and trying to unravel the complexities of developmental trajectories in autistic infants. Finally, we emphasize the importance of understanding how screening efficacy is dependent on clinicians' and researchers' ability not only to develop screening tests but also to negotiate the complex organizational systems within which screening procedures must be implemented.
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Affiliation(s)
- Neil Brewer
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
| | - Robyn L Young
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
| | - Carmen A Lucas
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
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16
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Rescorla LA, Adams A, Ivanova MY. The CBCL/1½-5's DSM-ASD Scale: Confirmatory Factor Analyses Across 24 Societies. J Autism Dev Disord 2020; 50:3326-3340. [PMID: 31559509 DOI: 10.1007/s10803-019-04189-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous research supports the CBCL/1½-5's DSM-ASD scale (and its precursor, the DSM-PDP scale) as a Level 1 ASD screener. Confirmatory factor analyses (CFAs) with data from population samples in 24 societies (N = 19,850) indicated good measurement invariance across societies, especially for configural and metric invariance. Items 4. 25, 67, 80, and 98 may be especially good discriminators of ASD because they have tend to have low base rates, strong loadings on the ASD latent construct, and the best measurement invariance across societies. Further research is needed to test the discriminative power of these items in predicting ASD, but our strong measurement findings support the international psychometric robustness of the CBCL/1½-5's DSM-ASD scale.
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Affiliation(s)
- Leslie A Rescorla
- Department of Psychology, Bryn Mawr College, 101 N. Merion Avenue, Bryn Mawr, PA, 19010, USA.
| | - Allison Adams
- Department of Psychology, Bryn Mawr College, 101 N. Merion Avenue, Bryn Mawr, PA, 19010, USA
| | - Masha Y Ivanova
- University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA
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17
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Young RL, Nah Y. Examining Autism Detection in Early Childhood (ADEC) in the Early Identification of Young Children with Autism Spectrum Disorders (ASD). AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Dai YG, Miller LE, Ramsey RK, Robins DL, Fein DA, Dumont-Mathieu T. Incremental Utility of 24-Month Autism Spectrum Disorder Screening After Negative 18-Month Screening. J Autism Dev Disord 2020; 50:2030-2040. [PMID: 30830489 DOI: 10.1007/s10803-019-03959-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American Academy of Pediatrics recommends Autism Spectrum Disorder (ASD) screening at 18 and 24 months. However, utility of rescreening at 24 months, after a negative 18-month screening, remains unknown. We identified cases of ASD detected at 24 months after a negative 18-month screening (i.e., Catch-24 group; n = 10) and compared them to toddlers detected by 18-month screening (i.e., Early Diagnosis group; n = 203). Repeated ASD-specific screening at 24 months detected children who were missed at their 18-month screening. Thus, our findings support repeated screening for ASD at both 18 and 24 months in order to maximize identification of toddlers with ASD and other neurodevelopmental disorders who require intervention.
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Affiliation(s)
- Yael G Dai
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
| | - Lauren E Miller
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Riane K Ramsey
- Department of Psychology, Georgia State University, 33 Gilmer Street, Atlanta, GA, 30303, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Deborah A Fein
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Thyde Dumont-Mathieu
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
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19
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Levy SE, Wolfe A, Coury D, Duby J, Farmer J, Schor E, Van Cleave J, Warren Z. Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review. Pediatrics 2020; 145:S47-S59. [PMID: 32238531 DOI: 10.1542/peds.2019-1895h] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). OBJECTIVES We systematically reviewed evidence for universal screening of children for ASD in PC. DATA SOURCES We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. STUDY SELECTION We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. DATA EXTRACTION At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. LIMITATIONS Potential limitations include publication bias, selective reporting within studies, and a constrained search. CONCLUSIONS ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4.
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Affiliation(s)
- Susan E Levy
- Center for Autism Research, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Audrey Wolfe
- Spaulding Rehabilitation Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Daniel Coury
- Autism Intervention Research Network on Physical Health and Autism Treatment Network, MassGeneral Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Nationwide Children's Hospital and School of Medicine, The Ohio State University, Columbus, Ohio
| | - John Duby
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Justin Farmer
- Autism Intervention Research Network on Physical Health and Autism Treatment Network, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Edward Schor
- Lucille Packard Foundation for Children's Health, Palo Alto, California
| | - Jeanne Van Cleave
- General Pediatrics, Children's Hospital Colorado and University of Colorado Anshutz Medical Campus, Aurora, Colorado; and
| | - Zachary Warren
- Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders, Departments of Pediatrics, Psychiatry, and Special Education, Vanderbilt University, Nashville, Tennessee
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20
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Petrocchi S, Levante A, Lecciso F. Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers. Brain Sci 2020; 10:brainsci10030180. [PMID: 32204563 PMCID: PMC7139816 DOI: 10.3390/brainsci10030180] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023] Open
Abstract
The present study provides a systematic review of level 1 and level 2 screening tools for the early detection of autism under 24 months of age and an evaluation of the psychometric and measurement properties of their studies. Methods: Seven databases (e.g., Scopus, EBSCOhost Research Database) were screened and experts in the autism spectrum disorders (ASD) field were questioned; Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and Consensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist were applied. Results: the study included 52 papers and 16 measures; most of them were questionnaires, and the Modified-CHecklist for Autism in Toddler (M-CHAT) was the most extensively tested. The measures' strengths (analytical evaluation of methodological quality according to COSMIN) and limitations (in term of Negative Predictive Value, Positive Predictive Value, sensitivity, and specificity) were described; the quality of the studies, assessed with the application of the COSMIN checklist, highlighted the necessity of further validation studies for all the measures. According to COSMIN results, the M-CHAT, First Years Inventory (FYI), and Quantitative-CHecklist for Autism in Toddler (Q-CHAT) seem to be promising measures that may be applied systematically by health professionals in the future.
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Affiliation(s)
- Serena Petrocchi
- Institute of Communication and Health, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, Via di Valesio, 73100 Lecce, Italy; (A.L.); (F.L.)
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy
- Correspondence:
| | - Annalisa Levante
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, Via di Valesio, 73100 Lecce, Italy; (A.L.); (F.L.)
- Department of History, Society and Human Studies, University of Salento, Via di Valesio, 73100 Lecce, Italy
| | - Flavia Lecciso
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, Via di Valesio, 73100 Lecce, Italy; (A.L.); (F.L.)
- Department of History, Society and Human Studies, University of Salento, Via di Valesio, 73100 Lecce, Italy
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21
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Schrader E, Delehanty AD, Casler A, Petrie E, Rivera A, Harrison K, Paterniti T, Sebastiany L, Nottke C, Sohl K, Levy SE, Wetherby AM. Integrating a New Online Autism Screening Tool in Primary Care to Lower the Age of Referral. Clin Pediatr (Phila) 2020; 59:305-309. [PMID: 31976757 DOI: 10.1177/0009922819900947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Alix Casler
- Physician Associates of Orlando Health, Orlando, FL, USA
| | | | | | | | | | | | | | | | - Susan E Levy
- University of Pennsylvania, Philadelphia, PA, USA
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22
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Abstract
OBJECTIVE Most autism spectrum disorder (ASD) screening measures have been developed for use with low-risk (LR) children; however, measures may perform differently in high-risk (HR) younger sibling populations. The current study sought to investigate the performance of an ASD screening measure, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), in a sample of HR younger siblings and directly compared its performance with that in an LR sample. METHODS High-risk younger siblings (n = 187) and LR children (n = 15,848) were screened using the M-CHAT-R/F. Screen-positive children completed comprehensive evaluations. The M-CHAT-R/F psychometric properties and clinical characteristics were compared across the samples. RESULTS The M-CHAT-R/F demonstrated a significantly higher screen-positive rate and ASD detection rate in the HR sample compared with the LR sample. Children with ASD in the HR sample had stronger verbal, nonverbal, and overall cognitive abilities compared with children with ASD in the LR sample despite comparable ASD severity and adaptive functioning. High positive predictive value of the M-CHAT-R at initial screen, with only incremental change after Follow-Up, suggests that Follow-Up is less critical in HR than LR samples. A significantly lower number of changed responses during Follow-Up further supports improved reporting accuracy of parents with ASD experience compared with parents less familiar with ASD. CONCLUSION The findings suggest that the M-CHAT-R/F can distinguish between ASD and non-ASD at 18 to 24 months in an HR sibling sample, with performance comparable with or better than its performance in the general population.
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23
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Al-Dewik N, Al-Jurf R, Styles M, Tahtamouni S, Alsharshani D, Alsharshani M, Ahmad AI, Khattab A, Al Rifai H, Walid Qoronfleh M. Overview and Introduction to Autism Spectrum Disorder (ASD). ADVANCES IN NEUROBIOLOGY 2020; 24:3-42. [PMID: 32006355 DOI: 10.1007/978-3-030-30402-7_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder generally manifesting in the first few years of life and tending to persist into adolescence and adulthood. It is characterized by deficits in communication and social interaction and restricted, repetitive patterns of behavior, interests, and activities. It is a disorder with multifactorial etiology. In this chapter, we will focus on the most important and common epidemiological studies, pathogenesis, screening, and diagnostic tools along with an explication of genetic testing in ASD.
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Affiliation(s)
- Nader Al-Dewik
- Clinical and Metabolic Genetics Section, Pediatrics Department, Hamad General Hospital (HGH), Women's Wellness and Research Center (WWRC) and Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha, Qatar. .,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar. .,Faculty of Health and Social Care Sciences, Kingston University, St. George's University of London, London, UK.
| | - Rana Al-Jurf
- Department of Biomedical Science, College of Health Science, Qatar University, Doha, Qatar
| | - Meghan Styles
- Health Profession Awareness Program, Health Facilities Development, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sona Tahtamouni
- Child Development Center, Hamad Medical Corporation, Doha, Qatar
| | - Dalal Alsharshani
- College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Mohammed Alsharshani
- Diagnostic Genetics Division (DGD), Department of Laboratory Medicine and Pathology (DLMP), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amal I Ahmad
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Newborn Screening Unit, Hamad Medical Corporation, Doha, Qatar
| | - M Walid Qoronfleh
- Research and Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar
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24
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Girault JB, Piven J. The Neurodevelopment of Autism from Infancy Through Toddlerhood. Neuroimaging Clin N Am 2019; 30:97-114. [PMID: 31759576 DOI: 10.1016/j.nic.2019.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Autism spectrum disorder (ASD) emerges during early childhood and is marked by a relatively narrow window in which infants transition from exhibiting normative behavioral profiles to displaying the defining features of the ASD phenotype in toddlerhood. Prospective brain imaging studies in infants at high familial risk for autism have revealed important insights into the neurobiology and developmental unfolding of ASD. In this article, we review neuroimaging studies of brain development in ASD from birth through toddlerhood, relate these findings to candidate neurobiological mechanisms, and discuss implications for future research and translation to clinical practice.
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Affiliation(s)
- Jessica B Girault
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill School of Medicine, 101 Renee Lynne Court, Chapel Hill, NC 27599, USA.
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill School of Medicine, 101 Renee Lynne Court, Chapel Hill, NC 27599, USA
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25
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Guthrie W, Wallis K, Bennett A, Brooks E, Dudley J, Gerdes M, Pandey J, Levy SE, Schultz RT, Miller JS. Accuracy of Autism Screening in a Large Pediatric Network. Pediatrics 2019; 144:peds.2018-3963. [PMID: 31562252 DOI: 10.1542/peds.2018-3963] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children's Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F's sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS Universal screening in primary care is possible when supported by electronic administration. In this "real-world" cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.
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Affiliation(s)
- Whitney Guthrie
- Center for Pediatric Clinical Effectiveness, .,Center for Autism Research, and
| | - Kate Wallis
- Division of Developmental and Behavioral Pediatrics.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Elizabeth Brooks
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Marsha Gerdes
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juhi Pandey
- Center for Autism Research, and.,Departments of Psychiatry and
| | - Susan E Levy
- Division of Developmental and Behavioral Pediatrics.,Center for Autism Research, and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert T Schultz
- Center for Autism Research, and.,Departments of Psychiatry and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith S Miller
- Center for Autism Research, and.,Departments of Psychiatry and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Bjørk M, Riedel B, Spigset O, Veiby G, Kolstad E, Daltveit AK, Gilhus NE. Association of Folic Acid Supplementation During Pregnancy With the Risk of Autistic Traits in Children Exposed to Antiepileptic Drugs In Utero. JAMA Neurol 2019; 75:160-168. [PMID: 29279889 DOI: 10.1001/jamaneurol.2017.3897] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Strategies to prevent autism in children exposed to antiepileptic drugs (AEDs) during pregnancy are important. Objective To explore whether folic acid supplementation and folate status in pregnancy are associated with reduced risk of autistic traits owing to in utero AED exposure. Design, Setting, and Participants The population-based, prospective Norwegian Mother and Child Cohort Study approached Norwegian-speaking women attending routine ultrasonographic examinations from June 1999 through December 31, 2008 (163 844 of 277 702 women refused). No exclusion criteria were applied beyond language. Questionnaires during and after pregnancy, analysis of blood samples, and linkage to the Medical Birth Registry of Norway were performed. Children aged 18 to 36 months of women with available information on use of AEDs and of folic acid supplementation (n = 104 946) were included in the analysis from March 1, 2016, through June 13, 2017. Exposures Maternal folic acid supplementation 4 weeks before to 12 weeks after conception. Plasma folate concentration was analyzed at gestational weeks 17 to 19. Main Outcomes and Measures Autistic traits were evaluated using the Modified Checklist for Autism in Toddlers and Social Communication Questionnaire. Odds ratios (ORs) for autistic traits in children by maternal use vs nonuse of folic acid supplements were adjusted for maternal health and socioeconomic factors. Folate concentrations and folic acid doses were associated with the degree of autistic traits. Results The overall mean (SD) age of the 104 946 mothers of participating children was 29.8 (4.6) years, with complete information available for analysis in 103 868. Mean (SD) age of women with epilepsy who received AED treatment was 29.4 (4.9); women with epilepsy who did not receive AED treatment, 29.1 (4.9); and without epilepsy, 29.8 (4.6) years. In the 335 children exposed to AEDs, the risk for autistic traits was significantly higher at 18 months of age (adjusted OR [AOR], 5.9; 95% CI, 2.2-15.8) and 36 months of age (AOR, 7.9; 95% CI, 2.5-24.9) when their mothers had not used folic acid supplements compared with children of mothers who had used supplements. Among women without epilepsy, the corresponding risks were lower at 18 months of age (AOR, 1.3; 95% CI, 1.2-1.4) and 36 months of age (AOR, 1.7; 95% CI, 1.5-1.9); among the 389 children of women with untreated epilepsy, the corresponding risks were not significant at 18 months of age (AOR, 1.0; 95% CI, 0.4-3.0) and 36 months of age (AOR, 2.5; 95% CI, 0.4-16.6). Degree of autistic traits was inversely associated with maternal plasma folate concentrations (β = -0.3; P = .03) and folic acid doses (β = -0.5; P < .001). Concentrations of AEDs were not associated with the degree of autistic traits. Conclusions and Relevance Risk of autistic traits in children exposed to AEDs in utero may be mitigated by periconceptional folic acid supplementation and folate status. Fertile women using AEDs should take folic acid supplements continuously.
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Affiliation(s)
- Marte Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Bettina Riedel
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Section of Clinical Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gyri Veiby
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Eivind Kolstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
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27
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Cost-Effectiveness of Universal or High-Risk Screening Compared to Surveillance Monitoring in Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:2968-2979. [PMID: 29644584 DOI: 10.1007/s10803-018-3571-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Academy of Pediatrics recommends universal screening for autism spectrum disorder at 18 and 24 months. This study compared the cost-effectiveness of universal or high-risk screening to surveillance monitoring. Simulation models estimated the costs and outcomes from birth to age 6 years. The incremental cost per child diagnosed by 36 months was $41,651.6 for high-risk screening and $757,116.9 for universal screening from the societal perspective. Universal screening may not be a cost-effective approach to increase earlier treatment initiation, as most children initiated treatment after age 60 months. Eliminating wait times resulted in more children initiated treatment by 48 months, but at a high initial cost that may be offset by future cost-savings related to better outcomes.
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28
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ASD Screening with the Child Behavior Checklist/1.5-5 in the Study to Explore Early Development. J Autism Dev Disord 2019; 49:2348-2357. [PMID: 30739222 DOI: 10.1007/s10803-019-03895-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We analyzed CBCL/1½-5 Pervasive Developmental Problems (DSM-PDP) scores in 3- to 5-year-olds from the Study to Explore Early Development (SEED), a multi-site case control study, with the objective to discriminate children with ASD (N = 656) from children with Developmental Delay (DD) (N = 646), children with Developmental Delay (DD) plus ASD features (DD-AF) (N = 284), and population controls (POP) (N = 827). ASD diagnosis was confirmed with the ADOS and ADI-R. With a cut-point of T ≥ 65, sensitivity was 80% for ASD, with specificity varying across groups: POP (0.93), DD-noAF (0.85), and DD-AF (0.50). One-way ANOVA yielded a large group effect (η2 = 0.50). Our results support the CBCL/1½-5's as a time-efficient ASD screener for identifying preschoolers needing further evaluation.
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29
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Brief Report: Evaluation of the Short Quantitative Checklist for Autism in Toddlers (Q-CHAT-10) as a Brief Screen for Autism Spectrum Disorder in a High-Risk Sibling Cohort. J Autism Dev Disord 2019; 49:2210-2218. [PMID: 30694516 DOI: 10.1007/s10803-019-03897-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the potential of the short form of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10) to identify autism spectrum disorder (ASD) in a high-risk sibling cohort. High-risk (HR; siblings of children diagnosed with ASD) and low-risk (LR; no family history of ASD) toddlers were assessed prospectively at 18 and 24 months of age using the Q-CHAT-10 and underwent blind diagnostic assessment for ASD at 36 months of age. The results indicated that at 18 and 24 months, total score differentiated between HR toddlers subsequently diagnosed with ASD from other HR and LR toddlers. The sensitivity at both time points was acceptable; however, the specificity was below the level recommended for clinical application.
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30
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Macari SL, Wu GC, Powell KK, Fontenelle S, Macris DM, Chawarska K. Do Parents and Clinicians Agree on Ratings of Autism-Related Behaviors at 12 Months of Age? A Study of Infants at High and Low Risk for ASD. J Autism Dev Disord 2019; 48:1069-1080. [PMID: 29181689 DOI: 10.1007/s10803-017-3410-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Given the emphasis on early screening for ASD, it is crucial to examine the concordance between parent report and clinician observation of autism-related behaviors. Similar items were compared from the First Year Inventory (Baranek et al. First-Year Inventory (FYI) 2.0. University of North Carolina, Chapel Hill, 2003), a parent screener for ASD, and the ADOS-2 Toddler Module (Lord et al. 2013), a standardized ASD diagnostic tool. Measures were administered concurrently to 12-month-olds at high and low risk for ASD. Results suggest that clinicians and parents rated behaviors similarly. In addition, both informants rated high-risk infants as more impaired in several social-communication behaviors. Furthermore, the format of questions impacted agreement across observers. These findings have implications for the development of a new generation of screening instruments for ASD.
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Affiliation(s)
- Suzanne L Macari
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Grace C Wu
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Stanford University, Stanford, CA, USA
| | - Kelly K Powell
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Scuddy Fontenelle
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Deanna M Macris
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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31
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Yuen T, Penner M, Carter MT, Szatmari P, Ungar WJ. Assessing the accuracy of the Modified Checklist for Autism in Toddlers: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:1093-1100. [PMID: 29992541 DOI: 10.1111/dmcn.13964] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 12/29/2022]
Abstract
AIM The Modified Checklist for Autism in Toddlers (M-CHAT) could be appropriate for universal screening for autism spectrum disorder (ASD) at 18 months and 24 months. Validation studies, however, reported differences in psychometric properties across sample populations. This meta-analysis summarized its accuracy measures and quantified their change in relation to patient and study characteristics. METHOD Four electronic databases (MEDLINE, PsycINFO, CINAHL, and Embase) were searched to identify articles published between January 2001 and May 2016. Bayesian regression models pooled study-specific measures. Meta-regressions covariates were age at screening, study design, and proportion of males. RESULTS On the basis of the 13 studies included, the pooled sensitivity was 0.83 (95% credible interval [CI] 0.75-0.90), specificity was 0.51 (95% CI 0.41-0.61), and positive predictive value was 0.53 (95% CI 0.43-0.63) in high-risk children and 0.06 (95% CI <0.01-0.14) in low-risk children. Sensitivity was higher for screening at 30 months compared with 24 months. INTERPRETATION Findings indicate that the M-CHAT performs with low to moderate accuracy in identifying ASD among children with developmental concerns, but there was a lack of evidence on its performance in low-risk children or at age 18 months. Clinicians should account for a child's age and presence of developmental concern when interpreting their M-CHAT score. WHAT THIS PAPER ADDS The Modified Checklist for Autism in Toddlers (M-CHAT) performs with low-to-moderate accuracy in children with developmental concerns. There is limited evidence supporting its use at 18 months or in low-risk children.
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Affiliation(s)
- Tracy Yuen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Melissa T Carter
- Regional Genetics Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
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32
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Shen MD, Piven J. Brain and behavior development in autism from birth through infancy. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29398928 PMCID: PMC5789210 DOI: 10.31887/dcns.2017.19.4/mshen] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous condition that affects 1 in 68 children. Diagnosis is based on the presence of characteristic behavioral impairments that emerge in the second year of life and thus is not typically made until 3 to 4 years of age. Recent studies of early brain and behavior development have provided important new insights into the nature of this condition. Autism-specific brain imaging features have been identified as early as 6 months of age, and age-specific brain and behavior changes have been demonstrated across the first 2 years of life, highlighting the developmental nature of ASD. New findings demonstrate that early brain imaging in the first year of life holds great promise for presymptomatic prediction of ASD. There is a general understanding in medicine that earlier treatment has better outcomes than later treatment, and in autism, there is an emerging consensus that earlier intervention results in more successful outcomes for the child. Examining early brain and behavior trajectories also has the potential to parse the etiologic heterogeneity in ASD, a well-recognized impediment to developing targeted, mechanistic treatments. This review highlights the current state of the science in the pursuit of early brain and behavioral markers of autism during infancy and examines the potential implications of these findings for treatment of this condition.
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Affiliation(s)
- Mark D Shen
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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33
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Sturner R, Howard B, Bergmann P, Morrel T, Landa R, Walton K, Marks D. Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months. J Autism Dev Disord 2018; 47:3296-3310. [PMID: 28762159 DOI: 10.1007/s10803-017-3231-0] [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: 10/19/2022]
Abstract
Accuracy of autism screening using M-CHAT plus the follow-up interview (M-CHAT/F) for children screened positive at 18-months was compared to screening at 24-months. Formal ASD testing was criterion for a community sample of M-CHAT positive children (n = 98), positive predictive value (PPV) was 0.40 for the M-CHAT and 0.58 for the M-CHAT/F. MCHAT/F PPV was 0.69 among children 20+ months compared to 0.36 for <20 months. Multivariate analyses incorporating data from the Ages and Stages Questionnaire, MacArthur-Bates Communicative Development Inventory, M-CHAT and M-CHAT/F results, and M-CHAT items suggest language variables carry greatest relative importance in contributing to an age-based algorithm with potential to improve PPV for toddlers <20 months to the same level as observed in older toddlers.
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Affiliation(s)
- Raymond Sturner
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. .,Center for Promotion of Child Development through Primary Care, Baltimore, MD, 21210, USA. .,, 6017 Altamont Place, Baltimore, MD, 21210, USA.
| | - Barbara Howard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Total Child Health, Baltimore, MD, 21210, USA
| | - Paul Bergmann
- Foresight Logic, Inc., Saint Paul, MN, USA.,PrairieCare Institute, Minneapolis, MN, USA
| | | | - Rebecca Landa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Kennedy Krieger Institute, Baltimore, MD, 21287, USA
| | - Kejuana Walton
- Total Child Health, Baltimore, MD, 21210, USA.,Baltimore Healthy Start, Baltimore, MD, 21218, USA
| | - Danielle Marks
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Sinai Hospital, Baltimore, MD, 21215, USA.,Maternal and Child Health Unit, Public Health Division, Wyoming Department of Health, Evanston, WY, USA
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34
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Øien RA, Schjølberg S, Volkmar FR, Shic F, Cicchetti DV, Nordahl-Hansen A, Stenberg N, Hornig M, Havdahl A, Øyen AS, Ventola P, Susser ES, Eisemann MR, Chawarska K. Clinical Features of Children With Autism Who Passed 18-Month Screening. Pediatrics 2018; 141:e20173596. [PMID: 29784756 DOI: 10.1542/peds.2017-3596] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.
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Affiliation(s)
- Roald A Øien
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway;
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Synnve Schjølberg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fred R Volkmar
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Frederick Shic
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Domenic V Cicchetti
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Nina Stenberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mady Hornig
- Department of Epidemiology, and
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexandra Havdahl
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anne-Siri Øyen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway; and
| | - Pamela Ventola
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Ezra S Susser
- Department of Epidemiology, and
- New York State Psychiatric Institute, New York, New York
| | - Martin R Eisemann
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Katarzyna Chawarska
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
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35
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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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36
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Nah YH, Young RL, Brewer N. Development of a brief version of the Autism Detection in Early Childhood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:494-502. [PMID: 29415559 DOI: 10.1177/1362361318757563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While autism spectrum disorder screening tools provide a useful resource for practitioners, the reality is they are underused. The justifications often provided include the time required for administration and the training involved. A brief tool with good psychometric properties that require minimal training is required. This study examined the development and the psychometric properties of a brief version of the Autism Detection in Early Childhood. The data showed the potential of the brief version of Autism Detection in Early Childhood for screening children age 12-36 months. Our dataset comprised 106 Diagnostic and Statistical Manual of Mental Disorders, 5th edition autism spectrum disorder, 86 non-typical development and 78 typical development participants age 12-36 months. Analyses comparing autism spectrum disorder and non-typical development groups supported the use of five critical items (i.e. response to name, social smiling, gaze switch, response to verbal command and use of gestures) to form the brief version Autism Detection in Early Childhood. The brief version of Autism Detection in Early Childhood's optimal cutoff score of 4 had sensitivity of 0.81, specificity of 0.78, positive predictive value of 0.81 and negative predictive value of 0.78. However, the results would need to be viewed as preliminary given the nature of the study sample and the findings might not be generalisable to samples with higher levels of cognitive functioning.
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Affiliation(s)
- Yong-Hwee Nah
- 1 Flinders University, Australia.,2 Nanyang Technological University, Singapore
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37
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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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38
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Use of an Online Clinical Process Support System as an Aid to Identification and Management of Developmental and Mental Health Problems. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017; 4:108-117. [PMID: 29545988 DOI: 10.1007/s40474-017-0124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Recent findings Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening. An online clinical process support system (CHADIS) shows promise in addressing these issues. Summary Use of a comprehensive panel of online pre-visit screens; linked decision support to provide moment-of-care training; and post-visit activities and resources for patient-specific education, monitoring and care coordination is an efficient way to make the entire process of screening and follow up care feasible in primary care. CHADIS fulfills these requirements and provides Maintenance of Certification credit to physicians as well as added income for screening efforts.
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39
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Srisinghasongkram P, Pruksananonda C, Chonchaiya W. Two-Step Screening of the Modified Checklist for Autism in Toddlers in Thai Children with Language Delay and Typically Developing Children. J Autism Dev Disord 2017; 46:3317-29. [PMID: 27460003 DOI: 10.1007/s10803-016-2876-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aimed to validate the use of two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening adapted for a Thai population. Our participants included both high-risk children with language delay (N = 109) and low-risk children with typical development (N = 732). Compared with the critical scoring criteria, the total scoring method (failing ≥3 items) yielded the highest sensitivity of 90.7 %; specificity was 99.7 %, positive predictive value 96.1 %, and negative predictive value 99.4 %. The two-step M-CHAT screening is a promising instrument that can be utilized to detect ASD in Thai children in both primary and clinical settings. Moreover, socio-cultural context should be considered when adopting the use and interpretation of the M-CHAT for each country.
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Affiliation(s)
- Pornchada Srisinghasongkram
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand
| | - Chandhita Pruksananonda
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand.,Division of Growth and Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Sor Kor Building 11th Floor, Bangkok, 10330, Thailand
| | - Weerasak Chonchaiya
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand. .,Division of Growth and Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Sor Kor Building 11th Floor, Bangkok, 10330, Thailand.
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40
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Sturner R, Howard B, Bergmann P, Stewart L, Afarian TE. Comparison of Autism Screening in Younger and Older Toddlers. J Autism Dev Disord 2017; 47:3180-3188. [PMID: 28733850 PMCID: PMC5711534 DOI: 10.1007/s10803-017-3230-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the effect of age at completion of an autism screening test on item failure rates contrasting older (>20 months) with younger (<20 months) toddlers in a community primary care sample of 73,564 children. Items related to social development were categorized into one of three age sets per criteria from Inada et al. (Research in Autism Spectrum Disorders 4(4):605-611, 2010). Younger toddlers produced higher rates of item failure than older toddlers and items in both of the later acquired item sets had higher probability rates for failure than the earliest acquired item set (prior to 8 months). Use of the same items and the same scoring throughout the target age range for autism screening may not be the best strategy for identifying the youngest toddlers at risk for autism.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Bergmann
- Foresight Logic, Inc., Saint Paul, MN, USA
- PrairieCare Institute, Minneapolis, MN, USA
| | - Lydia Stewart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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41
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Bradstreet LE, Juechter JI, Kamphaus RW, Kerns CM, Robins DL. Using the BASC-2 Parent Rating Scales to Screen for Autism Spectrum Disorder in Toddlers and Preschool-Aged Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:359-370. [PMID: 27177744 DOI: 10.1007/s10802-016-0167-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Early identification of toddlers and preschool-aged children with autism spectrum disorder (ASD) is important for ensuring that these youth receive targeted early intervention services. Identifying young children with ASD is complicated by overlap among symptoms of ASD and other developmental delays. Additionally, youth with ASD have a higher risk of experiencing co-occurring challenging behaviors that are beyond the diagnostic criteria for ASD (e.g., attention difficulties, anxiety). Given this, broadband behavioral assessments that measure symptoms of ASD as well as other behavioral and emotional challenges offer a cost-effective method for screening young children. The present study evaluated the utility of one such assessment, the Behavior Assessment System for Children, Second Edition, Parent Rating Scale-Preschool (BASC-2 PRS-P), for identifying young children with ASD from those with other diagnoses (including other developmental delays) and those without diagnoses. The sample included 224 toddlers and preschoolers (age range: 24-63 months, males n = 153 [68 % total sample]) who screened positive on an ASD-specific screening tool. Results demonstrated that the Developmental Social Disorders (DSD) scale on the BASC-2 PRS-P had adequate sensitivity and specificity values when distinguishing youth with ASD from those without any diagnoses, but not when differentiating between youth with ASD and those with other diagnoses. Similar to other multidimensional behavior rating scales, the BASC-2 PRS-P may be most useful for identifying young children who require comprehensive diagnostic evaluations.
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Affiliation(s)
- Lauren E Bradstreet
- A. J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Julia I Juechter
- Cherokee County School District, Buffington Educational Service Center, 4568 Cumming Highway, Canton, GA, 30115, USA
| | - Randy W Kamphaus
- Special Education and Clinical Sciences, College of Education, University of Oregon, 170 Lokey Education Building, Eugene, OR, 97403, USA
| | - Connor M Kerns
- A. J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Diana L Robins
- A. J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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42
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Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in Detecting Autism and Other Developmental Disorders in Community Clinics. J Autism Dev Disord 2017; 48:28-35. [DOI: 10.1007/s10803-017-3287-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Seize MDM, Borsa JC. Instrumentos para Rastreamento de Sinais Precoces do Autismo: Revisão Sistemática. PSICO-USF 2017. [DOI: 10.1590/1413-82712017220114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O rastreamento dos sinais precoces do autismo é crucial para um diagnóstico também precoce, viabilizando uma intervenção efetiva que possibilite a melhora no desenvolvimento e na qualidade de vida do indivíduo com autismo. O objetivo deste estudo foi identificar os instrumentos disponíveis para rastreamento dos sinais do autismo em crianças com até 36 meses de idade. Para tanto, foi conduzida uma revisão de artigos publicados entre 2004 e 2015 nas bases de dados eletrônicas SciELO, PubMed, PsycINFO e Lilacs. Foram encontrados 11 instrumentos em 34 artigos analisados, sendo que apenas um instrumento foi traduzido para o português, o que indica uma escassez desses instrumentos no Brasil. Considerando a relevância da identificação e do diagnóstico precoce do autismo para a melhoria da qualidade de vida do sujeito, acredita-se que é essencial que estudos sobre instrumentos para rastreamento precoce sejam conduzidos no país.
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44
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Urban and Education Disparity for Autism Spectrum Disorders in Taiwan Birth Cohort Study. J Autism Dev Disord 2016; 47:599-606. [DOI: 10.1007/s10803-016-2980-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Sturner R, Howard B, Bergmann P, Morrel T, Andon L, Marks D, Rao P, Landa R. Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F. Pediatrics 2016; 138:peds.2015-3036. [PMID: 27542847 PMCID: PMC5005015 DOI: 10.1542/peds.2015-3036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Autism spectrum disorders (ASDs) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up Interview (M-CHAT/F) has been shown to improve detection and reduce over-referral. However, there is little evidence supporting the administration of the interview by a primary care pediatrician (PCP) during typical checkups. The goal of this study was to evaluate the feasibility, validity, and reliability of the M-CHAT/F by PCPs with online prompts at the time of a positive M-CHAT screen. DESIGN Forty-seven PCPs from 22 clinics completed 197 M-CHAT/Fs triggered by positive M-CHAT screens via the same secure Web-based platform that parents used to complete M-CHATs before an 18- or 24-month well-child visit. A second M-CHAT/F was administered live or by telephone by trained research assistants (RAs) at the Kennedy Krieger Institute Center for Autism and Related Disorders. The Autism Diagnostic Observation Schedule, Second Edition, and the Mullen Scales of Early Learning were administered as criterion measures. Measures of agreement between PCPs and RAs were calculated, and measures of test performance compared. RESULTS There was 86.6% agreement between PCPs and RAs, with a Cohen's κ of 0.72. Comparison of sensitivity, specificity, positive predictive value (PPV), and overall accuracy for M-CHAT/F between PCPs and RAs showed significant equivalence for all measures. Use of the M-CHAT/F by PCPs resulted in significant improvement in PPV compared with the M-CHAT alone. CONCLUSIONS Minimally trained PCPs can administer the M-CHAT/F reliably and efficiently during regular well-child visits, increasing PPV without compromising detection.
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Affiliation(s)
- Raymond Sturner
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Promotion of Child Development through Primary Care, Baltimore, Maryland;
| | - Barbara Howard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland;,Total Child Health, Baltimore, Maryland
| | - Paul Bergmann
- PrairieCare Institute, Minneapolis, Minnesota;,Foresight Logic, Inc, St Paul, Minnesota
| | | | - Lindsay Andon
- Population Health Research, Johns Hopkins HealthCare, Baltimore, Maryland
| | - Danielle Marks
- Woman and Infant Health Program, Wyoming Department of Health, Cheyenne, Wyoming; and
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46
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Brief Report: Best Discriminators for Identifying Children with Autism Spectrum Disorder at an 18-Month Health Check-Up in Japan. J Autism Dev Disord 2016; 45:4147-53. [PMID: 26189180 PMCID: PMC4653231 DOI: 10.1007/s10803-015-2527-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To determine the best discriminative items for identifying young children with autism spectrum disorders (ASD), we conducted a secondary analysis using longitudinal cohort data that included the Japanese version of the 23-item modified checklist for autism in toddlers (M-CHAT-JV). M-CHAT-JV data at 18 months of age and diagnostic information evaluated at age 3 or later from 1851 Japanese children was used to isolate six highly discriminative items. Using data from two different community samples (n = 1851, n = 665) these items were shown to have comparable psychometric values with those of the full version. Our results suggest that these items might work as a short form screener for early identification of ASD in primary care settings where there are time constraints on screening.
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47
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Brignell A, Williams K, Prior M, Donath S, Reilly S, Bavin EL, Eadie P, Morgan AT. Parent-reported patterns of loss and gain in communication in 1- to 2-year-old children are not unique to autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:344-356. [PMID: 27178996 DOI: 10.1177/1362361316644729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We compared loss and gain in communication from 1 to 2 years in children later diagnosed with autism spectrum disorder (n = 41), language impairment (n = 110) and in children with typical language development at 7 years (n = 831). Participants were selected from a prospective population cohort study of child language (the Early Language in Victoria Study). Parent-completed communication tools were used. As a group, children with autism spectrum disorder demonstrated slower median skill gain, with an increasing gap between trajectories compared to children with typical development and language impairment. A proportion from all groups lost skills in at least one domain (autism spectrum disorder (41%), language impairment (30%), typical development (26%)), with more children with autism spectrum disorder losing skills in more than one domain (autism spectrum disorder (47%), language impairment (15%, p = 0.0003), typical development (16%, p < 0.001)). Loss was most common for all groups in the domain of 'emotion and eye gaze' but with a higher proportion for children with autism spectrum disorder (27%; language impairment (12%, p = 0.03), typical development (14%, p = 0.03)). A higher proportion of children with autism spectrum disorder also lost skills in gesture (p = 0.01), sounds (p = 0.009) and understanding (p = 0.004) compared to children with typical development but not with language impairment. These findings add to our understanding of early communication development and highlight that loss is not unique to autism spectrum disorder.
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Affiliation(s)
- Amanda Brignell
- 1 The University of Melbourne, Australia.,2 Murdoch Childrens Research Institute, Australia
| | - Katrina Williams
- 1 The University of Melbourne, Australia.,2 Murdoch Childrens Research Institute, Australia.,3 The Royal Children's Hospital, Australia
| | | | - Susan Donath
- 1 The University of Melbourne, Australia.,2 Murdoch Childrens Research Institute, Australia
| | - Sheena Reilly
- 2 Murdoch Childrens Research Institute, Australia.,4 Menzies Health Institute Queensland, Australia
| | | | | | - Angela T Morgan
- 1 The University of Melbourne, Australia.,2 Murdoch Childrens Research Institute, Australia
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48
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Mikic B, Jotic A, Miric D, Nikolic M, Jankovic N, Arsovic N. Receptive speech in early implanted children later diagnosed with autism. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 Suppl 1:S36-9. [DOI: 10.1016/j.anorl.2016.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/13/2016] [Indexed: 10/21/2022]
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49
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Seung H, Ji J, Kim SJ, Sung I, Youn YA, Hong G, Lee H, Lee YH, Lee H, Youm HK. Examination of the Korean Modified Checklist of Autism in Toddlers: Item Response Theory. J Autism Dev Disord 2016; 45:2744-57. [PMID: 25847755 DOI: 10.1007/s10803-015-2439-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The study examined the clinical utility and psychometric properties of the Korean Modified Checklist of Autism in Toddlers (K-M-CHAT)-2. A sample of 2300 parents of 16- to 36-month-old children was recruited across South Korea. A phone interview was utilized to follow up with participants who initially screened positive for autism spectrum disorder (ASD). Item response theory was applied to assess the psychometric properties of the K-M-CHAT-2. Parents' responses were substantially changed after the follow-up, and the final screen-positive rate was 2.3 %. Results indicated that the psychometric properties of items 1, 3, 11, 18 and 22 were not as strong as the other items. The K-M-CHAT-2 is a useful ASD screening test when implemented with a follow-up.
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Affiliation(s)
- HyeKyeung Seung
- Department of Human Communication Studies, California State University, 2600 E Nutwood Ave., Suite 420-1, Fullerton, CA, 92831, USA,
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Prospective Longitudinal Studies of Infant Siblings of Children With Autism: Lessons Learned and Future Directions. J Am Acad Child Adolesc Psychiatry 2016; 55:179-87. [PMID: 26903251 PMCID: PMC4871151 DOI: 10.1016/j.jaac.2015.12.014] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objectives of this review are to highlight the impact of the first decade of high-risk (HR) infant sibling work in autism spectrum disorder (ASD) and to identify potential areas of translational focus for the next decade of research. METHOD A group of clinicians and researchers in ASD working both inside and outside of the HR design met on a regular basis to review the infant sibling research, and came to an agreement on areas that had changed clinical practice and areas that had the potential to change practice with further research. The group then outlined several methodological and translational challenges that must be addressed in the next decade of research if the field is to reach its potential. RESULTS The review concluded that the HR design has yielded an understanding that ASD often, but not always, begins to emerge between 6 and 18 months, with early signs affecting social communication. Research using the HR design has also allowed a better understanding of the sibling recurrence risk (between 10% and 20%). Emerging areas of interest include the developmental trajectories of social communications skills in the early years, the expression of a milder phenotype in siblings not affected with ASD, and the possibility that early intervention with infant siblings may improve outcomes for those with ASD. Important challenges for the future include linking screening to intervention, collecting large sample sizes while ensuring cross-site reliability, and building in capacity for replication. CONCLUSION Although there are significant methodological and translational challenges for high-risk infant sibling research, the potential of this design to improve long-term outcomes of all children with ASD is substantial.
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