Abstract
BackgroundIdentifying children with childhood-onset neurodevelopmental problems (NDPs, defined here as autism spectrum disorders [ASDs], attention-deficit/hyperactivity disorder [AD/HD], tic disorders [TDs], learning disorders [LDs] and development coordination disorder), using easily administered screening instruments, is a prerequisite for epidemiological research. Such instruments are also clinically useful to prioritize children for comprehensive assessments, to screen risk groups, and to follow controls.Autism–Tics, ADHD, and other Co-morbidities inventory (A-TAC) was developed to meet these requirements; here the A-TAC’s prospective and psychometric properties are examined, when used in a population-based, epidemiological setting.MethodsSince 2004, parents of all Swedish twins have been asked to take part in an ongoing, nation-wide twin study (The Child and Adolescent Twin Study in Sweden). The study includes the A-TAC, carried out as a telephone interview with parents of twins aged 9 or 12. In the present study, screen-positive twins from three birth year cohorts (1993–1995) were invited to a comprehensive clinical follow-up (blinded for previous screening results) together with their co-twins and randomly selected, healthy controls at age 15 (Total N = 452).ResultsSensitivity and specificity of A-TAC scores for predicting later clinical diagnoses were good to excellent overall, with values of the area under the receiver operating characteristics curves ranging from 0.77 (AD/HD) to 0.91 (ASDs). Among children who were screen-positive for an ASD, 48% received a clinical diagnosis of ASDs. For AD/HD, the corresponding figure was also 48%, for LDs 16%, and for TDs 60%. Between 4% and 35% of screen-positive children did not receive any diagnosis at the clinical follow-up three years later. Among screen-negative controls, prevalence of ASDs, AD/HD, LDs, and TDs was 0%, 7%, 4%, and 2%, respectively.ConclusionsThe A–TAC appeared to be a valid instrument to assess NDPs in this population-based, longitudinal study. It has good-to-excellent psychometric properties, with an excellent ability to distinguish NDPs (mainly ASDs) from non-NDPs at least three years after the screening evaluations, although specific diagnoses did not correspond closely to actual clinical diagnoses.
Highlights
Identifying children with childhood-onset neurodevelopmental problems (NDPs, defined here as autism spectrum disorders [Autism spectrum disorder (ASD)], attention-deficit/hyperactivity disorder [AD/HD], tic disorders [Tic disorder (TD)], learning disorders [Learning disorder (LD)] and development coordination disorder), using administered screening instruments, is a prerequisite for epidemiological research
It has been proposed that children with problems severe enough to warrant clinical examination suffer from an “early symptomatic syndrome eliciting neuropsychiatric clinical examination” (ESSENCE), which may later in life correspond to criteria for a specific NDP, or to any mixture or sequelae of NDP diagnoses
A-TAC screening compared to diagnostic outcome Among the 247 screen-positive cases, 198 children (80%) were screen-positive for an NDP: 27 children (14%) were screen-positive for ASDs, 95 (48%) for AD/HD, 74 (37%) for LDs, 35 (18%) for TDs, and 38 (19%) for developmental coordination disorder (DCD)
Summary
Identifying children with childhood-onset neurodevelopmental problems (NDPs, defined here as autism spectrum disorders [ASDs], attention-deficit/hyperactivity disorder [AD/HD], tic disorders [TDs], learning disorders [LDs] and development coordination disorder), using administered screening instruments, is a prerequisite for epidemiological research. Such instruments are clinically useful to prioritize children for comprehensive assessments, to screen risk groups, and to follow controls. NDPs refer to autism spectrum disorders (ASDs, comprising autistic disorder, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified, including atypical autism), attention-deficit/hyperactivity disorder (AD/HD), learning disorders (LDs), tic disorders (TDs), and developmental coordination disorder (DCD). Children with NDPs have been shown to be at risk of developing various functional impairments, mental health problems, and/or other difficulties, in severe cases requiring life-long intervention from medical and social services [2,6]
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