A Two-Stage Screening Approach with I-TC and Q-CHAT to Identify Toddlers at Risk for Autism Spectrum Disorder within the Italian Public Health System.

Raffaella Devescovi,Costanza Colombi,Maura Bin,Giulia Bresciani,Alice Mancini,Lorenzo Monasta,Marco Carrozzi

doi:10.3390/brainsci10030184

Abstract

Standardized screening programs ensure that children are monitored for early signs of autism spectrum disorder (ASD) in order to promote earlier diagnosis and intervention. The aim of this study is to identify early signs of atypical development consistent with ASD or other developmental disorders in a population of 224 low-risk toddlers through a two-stage screening approach applied at 12 and 18 months of age. We adopted two screening tools combined: 1. the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant–Toddler Checklist (I-TC) and 2. The Quantitative Checklist for Autism in Toddlers (Q-CHAT). We assessed their sensitivity and specificity related to the diagnostic outcome at 36 months. The results showed that autistic signs can be detected as early as the first year even through a few questions extrapolated from both screeners and that our model could be used as a screening procedure in the Italian public health system.

Highlights

Autism spectrum disorder (ASD) is a heterogeneous complex of neurodevelopmental disorders distinguished by impairments in social communication, reciprocal interaction and repetitive pattern of behaviors and interests, as defined by the Diagnostic and Statistical Manual of Mental Disorders, FifthEdition (DSM-5) [1].Clear evidence exists that early detection and early intervention can lead to a better prognosis [2,3,4].According to the latest revision of the American Academy of Pediatrics (AAP) guidelines about promoting optimal development in infants and young children, the early identification of developmental disorders should be conducted through developmental surveillance and periodic screening at each pediatric health visit [5]
The AAP recommends that specific screeners for autism spectrum disorder (ASD) should be administered to all children at their 18- and 24-month visits because screening tests enhance the accuracy of the developmental surveillance process [6]
The aim of our study was to identify early signs of atypical development consistent with autism spectrum disorder (ASD) and broader autism phenotype (BAP) conditions in a population of low-risk toddlers through a two-stage screening approach

Summary

Introduction

According to the latest revision of the American Academy of Pediatrics (AAP) guidelines about promoting optimal development in infants and young children, the early identification of developmental disorders should be conducted through developmental surveillance and periodic screening at each pediatric health visit [5]. The AAP recommends that specific screeners for ASD should be administered to all children at their 18- and 24-month visits because screening tests enhance the accuracy of the developmental surveillance process [6]. Many prospective studies investigating siblings of children with ASD, a high-risk population for ASD, showed that early signs of ASD can be identified as early as 12 months of age [7,8]. Screenings conducted too early may not be able

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