Baby And Infant Screen For Children With aUtIsm Traits Research Articles

Development and initial testing of the BABY-BISCUIT in an at-risk population

ABSTRACT Purpose: Early identification of autism spectrum disorder (ASD) via screeners for diagnostic measures are a high priority. At present, there is no consensus on one screener due to the need for better sensitivity and specificity. In this study, we report on the development and utility of the BABY-BISCUIT, a six-item screener based on a modified subset of items from the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). Methods: A sample of 504 children between 17–3 9months of age, who consisted of toddlers identified as at-risk for neurodevelopmental and other health disorders, were tested during an annual screening through the Louisiana EarlySteps program. Results: An exploratory factor analysis yielded a one-factor solution (X2 = 48.62, df = 9, p = <.001). High sensitivity (i.e., 100.0%) at the cost of reduced specificity (i.e., 33.3%, AUC = 0.957) was found for an optimal screening cutoff score of 1. Conclusions: Findings from this study suggest that the BABY-BISCUIT has the potential to be a short and easily administered screener for ASD to inform whether further ASD assessment is necessary. Further investigation of convergent validity with established ASD measures is recommended.

АДАПТАЦИЯ ОПРОСНИКА BISCUIT ДЛЯ РАННЕЙ ДИАГНОСТИКИ РАССТРОЙСТВ АУТИСТИЧЕСКОГО СПЕКТРА

The article presents the adaptation results for “Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)” questionnaire for early diagnosis of autism spectrum disorders (ASD) in the Russian-speaking sample (n=105). We evaluated the psychometric properties of the Russian version questionnaire: internal consistency reliability, construct validity, criterion-related validity and item discrimination. According to the results of the adaptation, BISCUIT questionnaire has good psychometric indicators, however, cutoff scores should be revised on a standardization sample with a larger number of clinical cases.

Development of a scale for identifying autism spectrum disorder during early childhood.

Context:Assessment forms an important part of the early intervention in autism spectrum disorders (ASD). However, there is not much choice with regard to tools and methods for early identification and assessment of ASD.Aims:The aim is to develop a scale for identifying ASD during infancy and early childhood by mapping empirically supported skill behaviors and excess behaviors.Settings and Design:The study was conducted in community-based organisations and the local communities. Moreover, it employed a post facto research design, with survey method.Materials and Methods:Following the standard procedures to pool items and standardization, a scale was developed and administered to three groups of children (N = 190) including children with autism (n = 100), global developmental delay suggestive of mental retardation (n = 40) and neurotypicals (n = 50) in the age range of 1.5–6 years. The ICD-10 Classification of Mental and Behaviooural Disorders and Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) were the gold standards to diagnose ASD.Statistical Analysis Used:Descriptive statistics (frequency, percentages, median, and quartile deviation), Pearson's correlation, Cronbach's α, factor analysis, and binary logistic regression analysis with receiver operating characteristic curve were performed.Results:The new scale also demonstrated a high diagnostic efficiency by yielding a hit rate of 0.89, specificity of 0.90, and sensitivity of 0.88.Conclusions:The new scale can be used for early identification of ASD in the Indian population, though further validation with large population is required.

An abbreviated scoring algorithm for the baby and infant screen for children with autism traits

ABSTRACTPurpose: Autism spectrum disorder (ASD) screening is recommended for all children aged 18–24 months. However, healthcare providers may be burdened with the responsibility of conducting these screens in addition to necessary services. Therefore, developing a time-efficient screener with sound psychometric properties is essential. Methods: This study sought to update the abbreviated scoring algorithm of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) and increase its clinical utility. Six thousand and three children with ASD or atypical development enrolled in an early intervention program participated. Results: A 6-item algorithm with a cutoff score of 3 was found to be optimal and yielded a sensitivity of 0.960 and a specificity of 0.864. Conclusion: Sensitivity and specificity estimates were similar to that of the complete BISCUIT-Part 1; thus, the 6-item algorithm can reliably differentiate children at-risk for ASD requiring further assessment. The algorithm appears to be a promising tool for early identification.

Hearing Impairment, Autism Spectrum Disorder, and Developmental Functioning in Infants and Toddlers

Autism spectrum disorder (ASD) tends to co-occur with other psychiatric disorders and medical conditions, and identification of comorbidities is crucial for appropriate intervention. Currently, little research has examined the relationship between ASD and deafness or hearing impairment (D/HI). The present study aimed to examine the effects of ASD and D/HI on autism symptomology as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), and developmental functioning in infants and toddlers as measured by the Battelle Developmental Inventory, Second Edition (BDI-2). Specific developmental domains were also investigated. This study compared children with atypical development (n = 24), comorbid atypical development and D/HI (n = 24), ASD only (n = 24), and comorbid ASD and D/HI (n = 24). The results indicated that an ASD diagnosis was a stronger indicator of ASD symptomology, overall developmental functioning, adaptive skills, personal-social skills, and communication skills than D/HI. However, the interaction between ASD and D/HI was more dynamic for the motor and cognitive domains. The results of the current study emphasize the importance of improved assessment techniques to identify both ASD and D/HI when they co-occur. Future research should be conducted to further elucidate the interaction of ASD and D/HI, as well as investigate these comorbidities in older samples.

RETRACTED: The relationship of comorbid anxiety symptom severity and challenging behaviors in infants and toddlers with autism spectrum disorder

• Researchers have found comorbid psychopathologies exacerbate the rate of challenging behaviors in individuals with ASD. • Differences in challenging behaviors were explored in children with ASD demonstrating varying levels of anxiety impairment. • Significant differences in the overall rate of challenging behaviors as well as in specific types of behaviors were found between groups. The rates of comorbid anxiety as well as the presentation of challenging behaviors are elevated within the autism spectrum disorder (ASD) population. The current study utilizes the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) to explore the relationship of anxiety/repetitive behavior symptom severity and challenging behaviors in infants and toddlers with ASD. Children with ASD who evinced more severe impairment associated with anxiety/repetitive behavior ( n = 94) demonstrated higher rates of overall challenging behaviors than those with ASD who evinced no to minimal anxiety impairment ( n = 291). Specifically, a comparison of individual challenging behavior items indicated that the infants and toddlers with moderate to severe anxiety impairment exhibited more significant challenging behaviors under the domains of aggression/destruction, stereotypies, and self-injurious behavior than children with no to minimal impairment. This study adds to the literature evidencing an exacerbation of challenging behaviors by comorbid psychopathology in individuals with ASD. Clinical implications of these results are discussed.

Factor Structure for Autism Spectrum Disorders with Toddlers Using DSM-IV and DSM-5 Criteria

With the publication of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, autism spectrum disorders are defined by two symptom clusters (social communication and restricted/repetitive behaviors) instead of the current three clusters. The current study examined the structure of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). First, an exploratory factor analysis was replicated whose results were largely comparable to the previous findings. Then, confirmatory factor analyses compared a two and three factor structure for the BISCUIT. Measures of model fit supported both the two and three factor models relatively well. When directly compared, the three factor model was found to be preferred over the two factor model. Implications are discussed.

Autism severity as a predictor of inattention and impulsivity in toddlers

Objective: Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.Method: Parents/caregivers of 2300 atypically developing toddlers’ ages 18–37 months were assessed about their children’s behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.Results: ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R2 = 0.49, F (1, 2298) = 2234.72, p < 0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β = 0.70, t (2298) = 47.27, p < 0.001.Conclusions: ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.

Challenging behaviors in toddlers diagnosed with autism spectrum disorders with the DSM-IV-TR and the proposed DSM-5 criteria

With publication of the DSM-5 slated for May 2013, it has been predicted that the new diagnostic criteria will cause a decrease in the prevalence of autism spectrum disorders (ASDs), seriously impacting children no longer meeting criteria for the disorder. A majority of individuals with ASD have behavior problems which are not considered core features of the disorder but are significantly impairing and often the focus of intervention. The aim of the current study was to investigate types of challenging behaviors in toddlers who may no longer meet diagnostic criteria for ASD using a psychometrically sound measure, the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) – Part 3. The study included 3339 toddlers, 501 who will retain ASD diagnosis according to the DSM-5; 439 who will no longer meet criteria, and a comparison group of 2399 toddlers referred for evaluation due to atypical development. Though toddlers diagnosed under the DSM-5 exhibited the most challenging behaviors, those who did not meet DSM-5 criteria exhibited significantly more challenging behaviors than the atypically developing toddlers. The effect of the changes in ASD diagnostic criteria on access to early behavioral interventions warrants careful consideration as the new DSM-5 criteria are adopted.

The relationship of early communication concerns to developmental delay and symptoms of autism spectrum disorders

Objective: Parental concerns related to communication are an oft-cited reason that children present to early intervention clinics. We examine the relationship between early communication first concerns (FCs) and symptoms of ASD.Methods: The present study included 3173 toddlers at risk for developmental delay. The Battelle Developmental Inventory, 2nd edition and the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) were used to examine developmental quotient scores and autism symptoms.Results: Significant results were observed with respect to FC group and gender. A significant effect of FC-Communication group was observed with respect to developmental quotient overall and subscale scores, as well as autism symptom scores.Conclusion: Those with communication disorders are a heterogeneous population and do not account for all children who will meet criteria for a diagnosis of an ASD.

Early diagnosis of autism: Current status of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Parts 1, 2, and 3)

The benefits of early intervention for very young children with autism are now well established. Hand and hand with these interventions is the necessity of psychometrically sound diagnostic tools. Not only should these tools be instrumental in differentiating developmentally delayed and other at risk infants. These measures should also be structured to address challenging behaviors and psychopathology. The latter problems co-occur at high rates in infants who evince autism. Being able to identify these behaviors and symptoms, and to monitor the effectiveness of interventions to remediate these problems, is a high priority. The Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), is designed to address all of the issues listed. At this writing, the BISCUIT has the best psychometrics of any of the early childhood evaluation scales. Over 80 studies have been published to date using the BISCUIT. The purpose of this paper was to review the current status and future research trends using this test battery.

The effects of developmental quotient and diagnostic criteria on challenging behaviors in toddlers with developmental disabilities

Previous research has found that individuals with intellectual disability and/or autism spectrum disorder (ASD), and those with greater symptom severity within these diagnoses, show higher rates of aggressive/destructive behavior, stereotypic behavior, and self-injurious behavior. In this exploratory cross-sectional study, toddlers at-risk for a developmental disorder (n=1509) ranging from 17 to 36 months fell into one of three diagnostic categories: Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified [PDD-NOS], and atypically developing - no ASD diagnosis. Mental health professionals from EarlySteps, Louisiana's Early Intervention System, interviewed parents and guardians using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) -Part 3 (Matson, Boisjoli, & Wilkins, 2007) to obtain measures of challenging behaviors and the Battelle Developmental Inventory, 2nd Edition (BDI-2) (Newborg, 2005) to obtain developmental quotients (DQ). Toddlers diagnosed with Autistic Disorder or PDD-NOS showed a positive relationship between total DQ and challenging behavior; whereas, atypically developing toddlers with no ASD diagnosis showed a more adaptive, negative relationship. The DQ domains that were most influential on challenging behaviors varied by diagnosis, with communication and motor domains playing greater roles for toddlers with Autistic Disorder or PDD-NOS, and personal-social and cognitive domains playing greater roles for atypically developing toddlers with no ASD diagnosis.

Autism spectrum disorders and motor skills: The effect on socialization as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)

Purpose: To examine the effects of ASD diagnosis and motor skills on socialization in young children.Methods: Two samples were used: gross motor skills sample (n = 408) and fine motor skills sample (n = 402). The Battelle Developmental Inventory–Second Edition assessed motor skills, while the Baby and Infant Screen for Children with aUtIsm Traits, Part 1 assessed socialization.Results: A main effect of diagnosis was found for both samples on socialization such that those with autism exhibited the most severe deficits followed by those with PDD-NOS and then atypically developing children. There was a main effect for gross motor skills, with high gross motor skills showing less social impairment. The interaction term was only significant in regards to fine motor skills.Conclusions: The individual effects of ASD diagnosis and motor impairment as well as the interaction have implications for the assessment and treatment in these individuals.

Comparison of problem behaviours in atypically developing infants and toddlers as assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)

Objective: Compares infants and toddlers with intellectual and developmental conditions in regard to the presence of challenging behaviour.Methods: Parents and caregivers to 140 children ranging from 17–35 months with five different conditions (Down syndrome (n = 23), developmental delay (n = 18), prematurity (n = 56), Cerebral Palsy (n = 15) and Seizure disorder (n = 28)) were administered the BISCUIT-Part 3. An ANOVA on overall scores and a MANOVA on the sub-scale scores were conducted to determine if groups differed significantly.Results: Results found no significant differences on total scores or differences on the sub-scales of the BISCUIT-Part 3: Aggressive/Destructive, Stereotypic and Self-Injurious. Some trends in individual item endorsement were found.Conclusions: It is possible that differences among individuals with these disorders are not apparent until later in life. These results emphasize the importance of monitoring challenging behaviours in all at-risk infants and toddlers to ensure that early interventions to treat these challenging behaviours are possible.

Development of a critical item algorithm for the Baby and Infant Screen for Children with aUtIsm Traits

Autism is defined by impairments in socialization, communication, with the presence of stereotyped behavior. It is also associated with various medical conditions, intellectual disability, comorbid psychopathology, and problem behavior. This is a concerning finding in that there may be a true increase in the disorder's prevalence and that it is associated with poor long-term outcomes. Fortunately, effective treatments exist that can alter the course of the disorder if administered early in a child's life. A method to facilitate early intervention is through the early screening of autism with instruments such as the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). The primary purpose of the current investigation was to further develop the utility of the BISCUIT by creating an abbreviated scoring algorithm. Participants included 2168 children ages 17–37 with an autism spectrum disorder or atypical development enrolled in an early intervention program. Discriminant function analysis (DFA) and receiver operating characteristic (ROC) analysis were conducted resulting in a 5 item scoring algorithm with comparable diagnostic accuracy to the existing scoring procedure. Implications for these data and directions for further research are discussed.

An examination of challenging behaviors in autistic disorder versus pervasive developmental disorder not otherwise specified: Significant differences and gender effects

Children with Autism Spectrum Disorders (ASDs) are well-known for engagement in challenging behaviors. Unfortunately, due to its absence as a criterion for diagnosis in the DSM-IV-TR, little attention has been paid to the endorsement rates of such behaviors. However, a recently developed measure to assist in the diagnosis of infants and toddlers with autism and PDD-NOS – the Baby and Infant Screen for Children with aUtIsm Traits ( BISCUIT) – has included a section designated for just this reason. This study used the BISCUIT to assess for significant differences in the endorsement rates of challenging behaviors between infants and toddlers with autism versus PDD-NOS as well as for significant differences between genders. There were significant differences between the diagnostic groups in endorsement rates of challenging behaviors as a whole, as well as among many specific behavior items. No significant differences between genders in endorsement rates of challenging behaviors were found. The implications of these findings are discussed.

Effects of symptoms of co-morbid psychopathology on challenging behaviours among infants and toddlers with Autistic Disorder and PDD-NOS as assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)

Purpose: To examine whether level of symptoms of co-morbid psychopathology exacerbated challenging behaviours in young children with autism spectrum disorders (ASD).Method: Using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)–Part 2 which measures co-morbid symptoms and the BISCUIT- Part 3 which examines challenging behaviours, 362 infants and toddlers with ASD were evaluated.Results: Findings showed that participants scoring high on symptoms of Avoidance and Tantrum/Conduct problems had greater rates of aggressive/destructive behaviours, self-injurious behaviours (SIB) and stereotypies compared to those with low scores. Participants with high levels of Inattention/Impulsivity or Eat/Sleep concerns, compared to those with low levels, demonstrated greater aggressive/destructive behaviour and stereotypies. For symptoms of Anxiety/Repetitive Behaviours, participants with high scores displayed greater levels of stereotypies.Conclusions: Symptoms of co-morbid psychopathology are present at a very early age for children with ASD and elevated levels of these symptoms may exacerbate challenging behaviours.

The effects of hearing impairment on symptoms of autism in toddlers

Objective: Individuals diagnosed with certain medical conditions, such as those with hearing loss or impairment, may present with symptoms that mimic those of Autism Spectrum Disorders (ASD). Therefore, the aim of this study was to investigate how hearing-compromised toddlers would score relative to toddlers diagnosed with an ASD on a measure of autism symptomatology.Methods: The Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) was utilized to compare toddlers diagnosed with an ASD or who had hearing problems.Results: The BISCUIT was effective in differentiating between children with ASD and those with hearing problems. However, atypically developing toddlers scored significantly lower than those with compromised hearing within the communication domain.Conclusion: Communication impairment, albeit lower than in toddlers with ASD, is present in toddlers with compromised hearing. As such, this factor should be taken into account when assessing for ASD in toddlers with hearing loss or impairment.

The impact of familial autism diagnoses on autism symptomatology in infants and toddlers

Debate regarding the etiology of Autism Spectrum Disorders (ASD) is on the rise with numerous theories being put forth. Currently, the theory with the most empirical support is the interaction of multiple genes. Many studies have provided evidence that as the incidence of ASD increases so do genetic similarities. However, very little research has focused on the presentation of ASD symptomatology in those individuals with or without ASD diagnoses who have biological relatives with or without ASD diagnoses. The aim of the current study was to first examine the percentage of toddlers with and without ASD who had biological relatives with ASD. Next, the impact familial ASD had on ASD symptomatology within infants and toddlers with and without diagnoses of ASD was investigated. In the first study, 438 toddlers with an ASD diagnosis and 1,071 who were atypically developing without an ASD diagnosis were examined. A greater percentage of toddlers with ASD were noted to have a biological relative with an identified ASD in comparison to atypically developing toddlers. In the second study, no significant differences emerged between groups dependent on familial ASD of symptoms of autism as measured by the Baby and Infant Screen for Children with aUtIsm Traits ( BISCUIT). As such, despite previous research indicating a strong genetic link to ASD, this link is undoubtedly complex and not necessarily related to ASD symptomatology. Suggestions for further research are provided.

Communication deficits in babies and infants with autism and pervasive developmental disorder–not otherwise specified (PDD-NOS)

Objective: To investigate if, and in what ways, communication impairments are present in toddlers (17–37 months) diagnosed with autism and Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS).Methods: Study 1—The scores of 20 toddlers with autism or PDD-NOS (i.e. ASD group) were compared to those of 20 typically-developing infants on the Communication sub-scale of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)–Part 1. Study 2—These same scores were compared between 660 toddlers who fell into three groups: autism, PDD-NOS and non-ASD-related developmentally delayed.Results: Infants with an ASD exhibited greater communication impairments than did typically-developing infants overall and on all items. Additionally, significant differences were found in overall communication impairments and the majority of individual items between all three groups in Study 2.Conclusions: Significant communication impairments are present in toddlers diagnosed with autism and PDD-NOS before 37 months.