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.

Highlights

  • One focus for autism researchers from various disciplinary backgrounds has been the identification of markers of the condition that can be detected reliably in infancy and early childhood, and incorporated into screening measures for identifying children showing early signs

  • After a brief review of Level 1 screeners which is important for understanding their relationship to Level 2 screeners, we provide a detailed evaluation of Level 2 screeners

  • Rather than describing all behaviors from the numerous existing screeners, and showing how they link to DSM criteria operating when they were developed, we provide an overview of behaviors captured in four of the five Level 2 screeners described in more than one published evaluation and scrutinized in a later section—the Screening Tool for Autism in 2-Year Olds [STAT; (21)], the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 [BISCUIT-Part 1; (25)], the Autism Detection in Early Childhood [ADEC; (22)], and an updated version of the Systematic Observation of Red Flags

Read more

Summary

INTRODUCTION

One focus for autism researchers from various disciplinary backgrounds (e.g., genetics, neuroscience, psychiatry, psychology, virology) has been the identification of markers of the condition that can be detected reliably in infancy and early childhood, and incorporated into screening measures for identifying children showing early signs. That in these studies, parents were reporting behaviors of younger siblings of an older child with autism and, may have been sensitized to the behaviors Another consideration relates to the age and developmental levels of the children sampled in the construction and evaluation of the screener. In the last two decades there has been a proliferation of Level 1 screeners, including (inter alia) well-documented instruments such as the Checklist of Autism in Toddlers [CHAT; (27)], the Checklist for Early Signs of Developmental Disorders [CESDD; (28)], the Early Screening of Autistic Traits Questionnaire [ESAT; (29)], The First Year Inventory [FYI; (30)], the Infant-Toddler Checklist [ITC; (31)], the modified Checklist for Autism in Toddlers [MCHAT; (32)], and the Social Attention and Communication Study [SACS; (33)]

Non-verbal social behavior
Developing relationships
Hyper- or hypo-sensitivity to sensory stimuli
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call