Development of a screening instrument for autism spectrum disorder: Chandigarh Autism Screening Instrument

Proposal of a screening instrument for autism spectrum disorder in children (Mini-TEA Scale)

BACKGROUND

 Autism spectrum disorder (ASD) requires trained professionals for its adequate diagnosis. There is a shortage of such professionals in Brazil. Screening tools could identify priority cases. The only instrument for that in Brazilian Portuguese is employed for toddlers up to 2.5 years old.

OBJECTIVE

 The Mini-TEA scale was conceived and tested as a screening for children from 2.5 to 12 years old.

METHODS

 After local ethics committee's approval, this study was conducted from December 2022 to April 2023 in the Associação de Pais e Amigos dos Excepcionais, Passo Fundo/RS, of invitations to children's parents/relatives who were under evaluation for ASD and by local advertisement. Inclusion criteria were age from 2.5 to 12 years old; consent from the child's legal guardians. 75 children's parents/relatives were interviewed using the 15-item Mini-TEA scale. After that, children were evaluated for the diagnosis of ASD by a pediatric neurologist. Sensibility and specificity for ASD diagnosis along the Mini-TEA scores were measured. Experts and target population evaluated the validity/reliability of the Mini-TEA scale. The reproducibility of the scores was assessed about 40 days later.

RESULTS

 From the 75 participants, 28 received a diagnosis of ASD. Scores ≥ 10 on the Mini-TEA scale require further evaluation of the children (sensitivity 100%; specificity 68%). Content validity coefficient (CVC) rendered values > 0.80 (acceptable). Test-retest analyzes with the intraclass correlation coefficient (ICC) indicated excellent reliability (> 0.90). The time spent for applying the screening was about 10 minutes.

CONCLUSION

 The Mini-TEA scale presents as an easy tool for screening ASD among children.

Feasibility and acceptability of the Indian Autism Screening Questionnaire in clinical and community settings

We developed and tested the Indian Autism Screening Questionnaire (IASQ), which was reported to be reliable and valid as compared to the Indian Scale for Assessment of Autism (ISAA) and the Childhood Autism Rating Scale -2 (CARS2). The present study describes the feasibility, acceptability, sociodemographic and developmental details of IASQ study participants in 5 settings- a psychiatry outpatients' clinic (n = 145), a specialised paediatric clinic (n = 24), a speciality disability centre (n = 174), a primary school (n = 41) and a government housing colony (n = 255). The IASQ could be easily administered and understood. Consistent with prior reports, the male-female ratio of participants with autism was 3.8:1. Developmental complications were reported more frequently in clinical settings, while delivery by Caesarean section was commoner among community-dwelling higher socioeconomic status mothers (53% of the officers' sample). Mothers of participants with autism more frequently reported Caesarean section birth for the proband (χ2 = 41.61, p < .0001) and prenatal and postnatal complications. Binary logistic regression confirmed that perinatal complications in the mother and father's (older) age at birth of the participant were associated with autism. The IASQ is a reliable, practical tool for screening for autism in clinical and non-clinical settings in India.

Development and preliminary validation of Nayak Autism Screening Instrument (NASI)

The study aims to develop and validate a video-based screening instrument for autism spectrum disorder that parents may use. Purposive sampling was used in all stages of this study to select distinct groups of participants in various stages such as development, judgement quantifying, pretest with sentences, and pretest with videos. Parents in India can use the Nayak Autism Screening Instrument which consists of 24 2-dimensional animated videos on a scale of 1-4 and one descriptive item to identify behavioural indications of ASD in children between the ages of 3 and 10.

Tools for early screening of autism spectrum disorders in primary health care – a scoping review

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests itself in early childhood. Early diagnosis of these disorders allows for the initiation of early therapy, which is crucial for the child's further functioning in society.

Objectives

This review aims to gather and present the existing ASD screening tools that can be used in primary care and adapted to different countries conditions linguistically and culturally.

Eligibility criteria

We searched for English-language publications on ASD screening tools for children aged 0–3 years suitable for use in primary care (i.e. free, requiring no additional training or qualifications).

Sources of evidence

Four databases were explored to find English studies on ASD screening tools intended for the rapid assessment of children aged 0–3.

Charting methods

The information sought (specific features of the questionnaires relevant to primary health care workers, psychometric and diagnostic values of a given cultural adaptation of screening tools, and the linguistic and cultural changes made) were extracted and collected to create profiles of these tools.

Results

We found 81 studies which met inclusion criteria and underwent full data extraction. Three additional data sources were included. These allowed to create 75 profiles of adaptations for 26 different screening tools and collect data on their psychometric values and characteristic features.

Conclusions

The results of our study indicate the availability of several diagnostic tools for early ASD screening in primary care setting concordant culturally and linguistically with a given population. They could be an effective method of accelerating the diagnostic process and starting personalized therapy faster. However, most tools have significant limitations – some are only available for research purposes, while others do not have scientific evidence to prove their effectiveness.

Psychometric properties of a screening tool for autism in the community-The Indian Autism Screening Questionnaire (IASQ)

INTRODUCTION

Currently available screening questionnaires for Autism spectrum disorders were tested in developed countries, but many require additional training and many are unsuitable for older individuals, thus reducing their utility in lower/ middle- income countries. We aimed to derive a simplified questionnaire that could be used to screen persons in India.

METHODS

We have previously validated Indian Scale for Assessment of Autism (ISAA), that is now mandated for disability assessment by the Government of India. This detailed tool requires intensive training and it is time consuming. It was used to derive a new screening questionnaire: 1) items most frequently scored as positive by participants with autism in original ISAA validation study were modified for binary scoring following expert review. 2) In a new sample, clinically diagnosed individuals with/without autism were administered the screening tool and ISAA following written informed consent. Its psychometric properties were determined.

RESULTS

A 10-item scale named Indian Autism Screening Questionnaire (IASQ) was prepared in Hindi and English. Thereafter 145 parents/caregivers of participants (autism, n = 90, other psychiatric disorders, n = 55) (ages 3-18), were administered IASQ and ISAA (parents/caregivers plus observation) by separate interviewers, blind to each other and to diagnosis. At a cutoff of 1, sensitivity was 99%, specificity 62%, Positive Predictive Value 81%, and Negative Predictive Value 95%. Test-retest reliability was r = 0.767 (CI = 0.62-0.86) and interrater reliability- Krippendorff"s-alpha was 0.872. The area under Receiver Operating Characteristic Curve (ROC) was 95%. There was a significant difference on IASQ-scores between participants with and without a clinical diagnosis of Autism (t = 14.57, p<0.0001).

DISCUSSION

The IASQ is a simple, easy to use screening tool with satisfactory reliability and validity, that can be administered to caregivers in 15 minutes and provides information about DSM 5 criteria for autism. It may be applicable outside India, following additional adaptation, for community-based studies.

Detection of Early Warning Signs in Autism Spectrum Disorders: A Systematic Review

Due to the exponential increase of autism spectrum disorders’ prevalence in Western countries, it is necessary to improve early detection and intervention to enhance developmental milestones. This systematic review identified the most effective screening instrument, which can be used at an early age and which identifies the maximum number of autism cases. We identified several instruments with adequate predictive properties—the Autism Parent Screen for Infants (APSI), Battelle Development Inventory, second edition (BDI-2); Brief Infant-Toddler Social and Emotional Assessment (BITSEA); First Year Inventory (FYI); Infant-Toddler Checklist/Communication and Symbolic Behavior Scales Developmental Profile (ITC/CSBS-DP); Program of Research and Studies on AUTISM (PREAUT-Grid); Checklist for Early Signs of Developmental Disorders (CESDD); Social Attention and Communication Study (SACS); and the Screening Tool for Autism in Toddlers and Young Children (STAT)—that can be applied from 12 months of age in Western countries. The ITC/CSBS-DP has been proposed for universal screening from 12 months of age onwards, complemented by the Modified Checklist for Autism in Toddlers, Revised/Revised with Follow-Up (M-CHAT-R/F), which can be used from 15 months of age onwards. This strategy could improve early detection in at-risk children within the current health system, thus allowing for early intervention.

The Caregiver Reported Autistic Symptoms in Preschool Children: Findings of Chandigarh Autism Screening Instrument (CASI) Linked Screening from North India

Background  Autism is a neurodevelopmental disorder and can be early detected with the aid of screening tools. Chandigarh autism screening instrument (CASI) is a newly developed tool to screen autistic symptoms among children aged between 1.5 to 10 years in the north Indian Hindi speaking population. Objective  In this study, we evaluated the caregiver report of autistic symptoms in preschool children (3-6 years) attending selected schools of Rohtak. Materials and Methods  The index study was conducted among 225 caregivers of school-going children aged between 3 to 6 years. Social and communication disorders checklist (SCDC-Hindi) and CASI was used to measure autistic symptoms. The modified Kuppuswamy scale was used for assessing the socioeconomic status of the caregivers. Results  The autistic symptoms varied from 2.2 to 18.7%, depending upon the CASI (cutoff score of 10) and SCDC (cutoff score of 9) measurements. The items in the shorter four-item version (CASI Bref) of CASI were found to be the predictors of autistic symptoms in this population. Children's gender, age, and socioeconomic status were not found to have any association with autistic symptoms in this setting. Conclusion  The study provides preliminary evidence in relation to the CASI-linked screening for autistic symptoms among preschool children. The shorter version of CASI (CASI Bref) can be an efficient quick screener for autistic traits, but the full version of CASI needs to be validated as per age-appropriate autism screening tools.

Autism spectrum disorder in India: a scoping review

Autism is a grand challenge in global mental health to be dealt with on a priority basis. Phenotypic knowledge, biological understanding, and evidence-based intervention studies are all from western countries. We know very little about autism in the low- and middle-income countries (LMIC). Lack of infrastructure and difficulties in operationalizing research has widened the knowledge gap. We performed a comprehensive scoping review of research in Autism Spectrum Disorder in India to have an overall impression, identify gaps, and formulate evidence-based recommendations for further study. We searched PubMed, SCOPUS, and Cochrane Library to identify relevant Indian studies. A hundred and fifty-nine publications met the inclusion criteria. Most of the research contribution in autism is from few tertiary care medical centres, technological institutes, and not-for-profit organizations. We identified various themes of research like clinical profile, interventions, biomarkers, psychological, social, epidemiological, and risk factors. Evidence-based intervention studies, translation and adaptation of standard diagnostic instruments, and qualitative research on the experience of autism appeared to be state of the art. However, epidemiological studies, biomarkers identification, risk assessment studies were of low quality. There is a need for nationwide studies with representative sampling on epidemiology, biomarkers, and risk factors for a complete evaluation of the actual burden and biology of autism in India. Also, there is a need to design implementation research to evaluate the effectiveness of evidence-based interventions in routine healthcare settings. We recommend that future research should fill these gaps in understanding autism and improving its outcome in India.

Protocol for Development of the Indian Autism Screening Questionnaire: The Screening Version of the Indian Scale for Assessment of Autism

INTRODUCTION

Autism is included as a certifiable disability in the Indian Rights of Persons with Disability Act, 2016. The Indian Scale for Assessment of Autism (ISAA), developed by the Government of India and mandated for certifying disability, is a detailed instrument that needs trained mental health experts and takes time to administer. The current project was planned to develop a simple, easy to use screening tool based on the ISAA to identify possible cases in the community.

METHODS

The project is planned in three phases. During the first phase, data collected during the development of the ISAA (N = 433/436 children with autism) will be used to identify questions answered as frequently, mostly, and always. During the second phase, the psychometric properties of the screening tool based on these items will be evaluated among research participants recruited from hospitals and special schools (n = 100). In the third phase, the screening questionnaire will be administered in the community (n = 500).

RESULTS

The most frequently answered questions will be selected for inclusion in the proposed screening tool. The number of items in the screening tool will be kept as few as possible, with yes or no responses.

DISCUSSION

Indian Autism Screening Questionnaire (IASQ) will be tested as a screening version of ISAA, which can be used by community health workers, teachers, or school counselors. The IASQ will not provide a diagnosis of autism. A positive screening result should be followed by a thorough assessment by a trained specialist. Analyzing the psychometric properties of the test can help ensure cost-effective screening of the community to identify autism.