Autism-specific Screening Research Articles

Validation of the Hindi Versions of Three Autism Specific Screening Tools (M-CHAT-R/F, RBSK-ASQ and TABC) Widely Used in India in 16–30-Month-Old Children

Validation of the Hindi Versions of Three Autism Specific Screening Tools (M-CHAT-R/F, RBSK-ASQ and TABC) Widely Used in India in 16–30-Month-Old Children

Improving Developmental Screening and Supporting Families with Paid Parent Partners.

The primary goals of the project were to improve rates of developmental screening and appropriate referral for atypical screens for children from birth to 3 years in participating practices and to integrate parent partners (PPs) into primary care. Parents' Place of Maryland, in collaboration with the Maryland Department of Health, developed a quality improvement project to improve rates of developmental screening, referral, and follow-up. Nine practices from across the state completed the project. Participating practices received training and technical assistance for screening, referral, and data collection as well as a paid part-time PP to assist with care coordination. Families of children with atypical developmental screening results were offered a referral to receive support in following through with referrals, including needed social services to address health care barriers. Developmental screening rates across practices increased from 65% to 95% during the 9-month project, and autism-specific screening increased from 75% to 94%. Appropriate referral rates tripled from 6% to 20% of children. After an initial learning curve, practices gradually increased referrals to PPs, and they served 292 individual families (total of 544 contacts) over 9 months. PPs helped families identify a variety of community services to meet their needs. While developmental screening rates can be improved using quality improvement processes, supporting families to connect to services requires additional resources. Integrating trained PPs into pediatric practices improves access to community-based services in a cost-efficient manner. More research is needed to identify the most efficient models for providing this service on a broader scale.

Current developmental screening practices in young children with sickle cell disease.

Despite recent developmental screening guidelines, rates of neurodevelopmental disorders (NDDs) remain lower than expected in children with sickle cell disease (SCD). A retrospective chart review identified 276 eligible patients; 214 charts were available for developmental screening and 207 charts for autism-specific screening. Developmental surveillance/screening was conducted in 70% of charts and autism-specific screening in 19% of charts. Validated tools were used in 32% of developmental screenings and 92% of autism-specific screenings. Many children (57%) were screened outside recommended ages. In conclusion, children with SCD are not regularly receiving appropriate developmental screening and surveillance by their healthcare providers.

Screening Vietnamese Children in the United States for Autism Risk: Examination of the Modified Checklist for Autism in Toddlers–Revision With Follow-Up Vietnamese

Purpose: This study examined the utility of the Vietnamese version of the Modified Checklist for Autism in Toddlers–Revised with Follow-Up (M-CHAT-R/F) for screening Vietnamese children for autism risk. Cultural reasons and/or limited access to health care has resulted in delays in receiving an autism diagnosis for children of racial minorities. Delays in receiving an autism diagnosis may subsequently result in delay in receiving early intervention services. Therefore, this study examined the feasibility of implementing autism screening for Vietnamese American children. Method: The M-CHAT-R/F is a well-validated autism screening test offered in multiple languages such as Vietnamese. It takes approximately 10 min for caregivers to complete 20 yes/no-response items and includes a follow-up interview for initial screen-failed items to reduce false-positive rates. We recruited 205 parents of children aged between 16 and 36 months in Southern California to conduct a broadband screening, not an autism-specific screening. The participants responded to a print or an online Qualtrics version of the M-CHAT-R/F in a language of their choice, either English or Vietnamese. Results: A total of 79 of the 205 participants provided complete responses. Of the 79 participants, 20% of the results were initially screened positive. Seven participants were not available for follow-up interviews. Screen-positive rates were estimated to range from 8% to 15% based on completed follow-ups. Conclusions: The estimated screen-positive rates in this exploratory study were higher than the reported screen-positive rates in a Vietnamese population sample using the Modified Checklist for Autism in Toddlers. Limitations of this study include participant recruitment difficulty, a small sample size, and the inability to conduct follow-up interviews with some participants. Future studies should use larger and more representative samples and examine potential cultural factors possibly impacting interest in screening Vietnamese children for autism risk.

The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program

ObjectiveChildren born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation. MethodChildren aged 18–36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the “at risk” range on either tool were referred for a full diagnostic ASD evaluation. ResultsSixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated “at risk” for ASD. Nine (13 %) scored “at risk” on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %). ConclusionThe ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.

The Early Screening for Autism and Communication Disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age.

There is a critical need for validated screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. Few screeners exist for children between the recommended screening ages of 18–24 months. This study examined the utility of a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children 12–36 months. Field-testing was conducted from five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was evaluated in three age groups: 12–17, 18–23, and 24–36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Receiver operating characteristic curves were examined for all 46 items and the 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Area under the curve estimates for the total were greater than 0.90 across age groups. Cutoffs were established for each age group with sensitivity between 0.86 and 0.92 and specificity between 0.74 and 0.85. Results provide preliminary support for the validity of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12–36 months with elevated risk of communication delay or autism spectrum disorder.Lay abstractThere is a critical need for accurate screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. However, there are few screeners designed for children 18–24 months. Developing screeners that pick up on the signs of autism spectrum disorder in very young children has proved even more challenging. In this study, we examined a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children between 12 and 36 months of age. Field-testing was done in five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was tested in three age groups: 12–17, 18–23, and 24–36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Analyses examined all 46 items and identified 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Cutoffs were established for each age group with good sensitivity and specificity. Results provide preliminary support for the accuracy of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12–36 months with elevated risk of communication delay or autism spectrum disorder.

Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in a Population Sample of 30-Month-Old Children in Iceland: A Prospective Approach.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up was validated on a population sample in Reykjavik, Iceland. The participants (N = 1585) were screened in well-child care at age 30months and followed up for at least 2years to identify autism cases. The sensitivity, specificity, positive and negative predictive values were 0.62, 0.99, 0.72, and 0.99, respectively. True-positive children were diagnosed 10months earlier than false-negative children. Autism symptom severity and the proportions of children with verbal and performance IQs/DQs < 70 were similar between groups. Although the sensitivity was suboptimal, the screening contributed to lowering the age at diagnosis for many children. Adding autism-specific screening to the well-child care program should be considered.

Autism and General Developmental Screening Practices Among Primary Care Providers.

Using standardized screening tools increases accuracy in early identification of autism. The American Academy of Pediatrics recommends systematic developmental screening at all 9-, 18-, and 24- or 30-month well-child visits (WCVs) and autism-specific screening at all 18- and 24-month WCVs. The study objectives were to examine the extent to which these guidelines have been adopted in practice among primary care providers (PCPs) and to identify potential provider-level factors associated with screening practices. Participants included 94 PCPs (79% pediatricians) from 13 states enrolled in a study of an autism training program. Self-report and chart-review data collected before training were examined. Screening practices were assessed through chart review of all 9-, 18-, and 24-month WCVs within a 30-day window. Sixty-four percent of PCPs administered developmental screening tools at all 9-month WCVs, and 62% at all 18-month WCVs. Fifty-one percent administered autism screening tools at all 18-month WCVs, and 41% at all 24-month WCVs. Screening practices varied by provider type (pediatrician vs other PCP), self-efficacy in screening and identification, and previous autism training (autism screening only), but not by years of experience. Overall, general developmental and autism-specific screenings are not being consistently administered across recommended WCVs in primary care practices. Provider self-efficacy in autism identification and screening and previous autism training were associated with increased autism screening. As such, these results suggest a need for increased training and dissemination of information on screening implementation for practicing PCPs.

T-STAT for detecting autism spectrum disorder in toddlers aged 18-24 months.

The benefits of early intervention for young children with autism spectrum disorder highlight the importance of early diagnosis. Reliable diagnoses of autism spectrum disorder can be made before 24 months of age. However, many children are diagnosed with autism spectrum disorder at a later age. Delayed diagnosis can occur for children with less severe symptoms and lead to missed opportunities for early intervention. This current study was executed to examine the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds in detecting autism spectrum disorder in toddlers between 18 and 24 months of age. One strength of this study was the inclusion of toddlers with autism spectrum disorder or mild-autism spectrum disorder using the strict and relaxed Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism spectrum disorder simultaneously. The results of this study supported that diagnosis of toddlers with autism spectrum disorder could be made reliable before 24 months of age. And the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds was a Level 2 autism-specific screening tool for toddlers aged from 18 to 24 months in Taiwan.

Training Pediatricians to Implement Autism Screening Tools: a Review of the Literature

The American Academy of Pediatrics recommends using an autism-specific screening tool for all young children at primary care well visits. Screening can detect risk of autism spectrum disorder (ASD) in young children whose parents and pediatrician may not otherwise have developmental concerns. The identification of children with or at-risk for ASD increases their access to early intervention services, which helps ameliorate skill deficits associated with ASD. Recent studies indicate pediatricians use autism-specific screening and diagnostic tools infrequently. Some research has been conducted to determine whether providing training to primary care providers increases screening practices; however, evidence-based practices for training pediatricians to conduct ASD screenings or use other ASD identification tools have not been identified. We conducted a review of the research on training primary care providers (e.g., pediatricians) on the use of ASD identification tools with young children and their families. The results of this review point to a lack of high-quality research in this area. The information can be used to advance research, policy, and practice.

Community-based Screening and Referrals for Autism

ABSTRACTThe average diagnosis of autism in the United States is after 4 years of age, even though a reliable diagnosis can be obtained as early as 2 years of age. Early identification of autism can help facilitate access to early intervention, yet many children experience significant delays in receiving a diagnosis and intervention. Various factors contribute to these challenges, including a lack of training among health-care providers and socioeconomic factors among families of young children. Community-based screening is one potential method to help address the need for early identification of children with autism. Some studies indicate that childcare workers can perform screenings for autism with minimal support. Occupational therapists frequently receive referrals for children with autism, but there is a lack of research on the role of interprofessional collaboration with early childcare providers to facilitate timely screening and referrals. The primary focus of this study is to determine the current practice of early childcare providers regarding developmental and autism-specific screening and referral practices within central Michigan. A total of 80 early childcare providers in central Michigan completed a quantitative survey. Results indicate that most early childcare providers are utilizing developmental screening tools such as the Ages and Stages Questionnaire, but only two participants report the use of autism specific screening tools and most did not feel prepared to assist with referrals for this population. Occupational therapists in early intervention have the opportunity and skill set to collaborate with early childhood professionals to facilitate the timely and appropriate use of screening tools for early identification and referrals for children with autism.

How Young Children Learn Language and Speech.

Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.

Evaluation of toddlers aged between 18 and 30 months for autism spectrum disorders using the Turkish version of the Modified Checklist for Autism in Toddlers Test: A cross-sectional study

Objective: American Academy of Pediatrics recommends autism-specific screening at 18 and 24 months of age. This study is a cross-sectional study involving a period of 4 months and investigating the validation and reliability of the Modified Checklist for Autism in Toddlers Test (M-CHAT) and the incidence of autism spectrum disorders (ASD) in our study population. Methods: Four hundred and seventy-one healthy toddlers aged 18-30 months were screened in well-child clinic between June 2017 and September 2017. It was administered to the caregivers by a nurse by face-to-face interview. Screen positive children were reffered to child and adolescent psychiatry clinic for psychiatric evaluation. Results: Of all participants, 264 were boys (56.1%) and 207 girls (43.9%). The mean age was found as 24.5 and 24 months in boys and girls, respectively. The risk of ASD was found as 8/1.000 with the M-CHAT and the incidence was found as 6/1.000 after the psychiatric assessment.We found a sensitivity of 100%; a specificity of 0.95; a positive predictive value of 0.75; and a negative predictive value of 100% and accurate discri-mination rate of 0.96. Cronbach’s α reliability coefficient, which was calculated for internal consistency to determine the reliability in the group which underwent the test was found to be 0.96 for the 23 items and 0.98 for the six critical items. Conclusion: M-CHAT is a useful tool in Turkey for screening children for ASD in primary care when adapted to populations with different cultures. (Anatolian Journal of Psychiatry 2019; 20(x):xx-xx)

Role of Participation of Pediatricians in the "Activated Autism Practice" Program in Practicing Children With Autism Spectrum Disorders at the Primary Care Setting.

Primary care of children with autism spectrum disorders (ASD) is an important public health concerns. In this survey study of 73 pediatricians, we determined whether pediatricians’ practice of autism screening and perception of management of ASD is associated with participation in a learning collaborative, “Activated Autism Practice”. Overall, the majority recognized the lack of care coordination, inadequate time, poor reimbursement, and language difference as barriers to the delivery of medical care to children with ASD. Pediatricians with prior training were more likely to report use of autism-specific screening and understanding the different aspects of ASD management including the need to coordinate special services and long-term surveillance at pediatric sites. Therefore, participation in “Activated Autism Practice” may facilitate use of ASD-specific screening and manage ASD cases as a complex of neurodevelopmental/underlying problems with the need for enhancement of clinical attention and coordination of medical care at the pediatric primary care level.

Early Identification of Young Children with Autism Spectrum Disorder

Early identification and treatment of children with autism and other developmental disorders is an international priority. Currently there is great interest in lowering the age of identification. Attention has been focused on public awareness campaigns and the regular use of developmental screening tests by health care providers, health workers and others. In this article the authors discuss the rationale for the use of autism specific screening tests, review the characteristics of selected tools, and make recommendations for the diagnostic evaluation of young children for autism spectrum disorder in an international context.

Can Screening with the Ages and Stages Questionnaire Detect Autism?

Parents rely on pediatricians to monitor their child's development. The American Academy of Pediatrics recommends routine developmental screening with both broadband and autism-specific instruments at specified ages. If broadband screeners can detect autism risk, this might minimize the burden of administering autism-specific screens to all children. The current study examines the ability of the Ages and Stages Questionnaire-Third Edition (ASQ-3) to identify children at risk for autism. We looked at ASQ-3 scores of children who screen positive on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), children who continue to screen positive on the M-CHAT-R Follow-up Interview, and children diagnosed with autism spectrum disorder (ASD). A total of 2848 toddlers, aged 16 to 30 months, were screened with the ASQ-3 and M-CHAT-R across 20 pediatric sites. Children who screened positive on the M-CHAT-R and its follow-up interview were offered a diagnostic evaluation. Using the "monitor and/or fail" cutoff on any domain, the ASQ-3 identified 87% of the children who screened positive on the M-CHAT-R with follow-up and 95% (20/21) of those diagnosed with an ASD. Monitor and/or fail on the Communication domain alone also identified 95% of the diagnosed children. Scores below the "monitor" cutoff on the Communication domain of the ASQ-3 can indicate initial concern requiring autism-specific follow-up. If these results are confirmed with a sample large enough to separately examine toddlers of different ages and different cultural backgrounds, it may be feasible to implement a 2-stage screening strategy, with autism-specific screening reserved for those who are positive on a broadband screen.

Barriers to autism screening in family medicine practice: a qualitative study.

We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits. The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism. Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis. Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.

Findings and Implications of Developmental Screening for High-Risk Children Referred to a Tertiary Developmental Disability Center

IntroductionThe primary goal of this article is to describe an intake process and results of screening for developmental and autism spectrum disorders in children referred to a tertiary center. A secondary analysis of abnormal screening results, demographic variables, and parental concerns of autism was conducted, along with a correlation analysis between developmental and autism-specific screening tools. MethodsA total of 379 children younger than 6 years were “prescreened” with the Ages and Stages Questionnaire-3 and the Modified Checklist for Autism in Toddlers or the Social Communication Questionnaire. Medical records were reviewed to identify demographic variables and parental primary concerns. ResultsIn approximately 11% of participants who screened positive for autism, no parental concerns of autism were present. Medium effect size correlations were found between the failed autism screening tools and delays in two domains on the Ages and Stages Questionnaire-3. DiscussionClinical implications are addressed concerning diligent use of developmental and autism-specific rating scales to identify children at risk.

Large-Scale Use of the Modified Checklist for Autism in Low-Risk Toddlers

The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening instrument in a large, geographically diverse pediatrics-based sample. The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18,989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation. Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of ≥3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of ≥7. This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.

Service Coordinators’ Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they had never received a referral from a physician or another early intervention provider because a child has failed an autism-specific screening. While service coordinators identified that early intervention providers have a role in conducting autism-specific screening, more than 50% of the respondents indicated that they do not see autism-specific screening completed in early intervention settings. More than 80% of the respondents identified “a lack of knowledge” as the most significant barrier to autism-specific screening. Together, these findings suggest that early intervention providers may benefit from professional development that imparts knowledge, teaches skills, and addresses potential concerns of parents related to autism.