Checklist For Autism In Toddlers Research Articles

국내 자폐스펙트럼장애 영유아 대상 한국판 영유아 자폐 양적 체크리스트-10(KQ-CHAT-10)의 신뢰도 및 타당도 연구

This study examined reliability and validity of the Quantitative Checklist for Autism in Toddlers 10 (Q-CHAT-10) to verify its effectiveness for Korean children. Subjects included 50 children with ASD and 81 typical children. Instruments were the Korean version of the Q-CHAT-10 (KQ-CHAT-10), CBCL 1.5-5 and CARS. The KQ-CHAT-10 showed a significant inter-item correlation except the item number 10 and its reliability was verified by inter-item consistency and test-retest reliability. Exploratory factor analysis showed all items excluding the number 10 were loaded onto one factor. Also, concurrent validity was checked between the KQ-CHAT-10, CBCL'S Pervasive Developmental Problems DSM-Oriented Scales, and CARS. In the 2-point KQ-CHAT-10, the statistical cut-off value of 3 demonstrated the highest sensitivity and specificity. This study is of significance in that it is the first study to check the reliability and validity of Q-CHAT-10 with Korean children.

Differentiating Post-Digital Nannying Autism Syndrome from Autism Spectrum Disorders in Young Children: A Comparative Cross-Sectional Study.

Excessive exposure of young children to digital devices has increased in recent years. Much research has shown that early excessive screentime is associated with autistic-like symptoms. This study aimed to differentiate children with Post-Digital Nannying Autism Syndrome (PDNAS) from children with autism spectrum disorders (ASD) and typically developing children (TDC), both behaviorally and cognitively. This study is comparative and cross-sectional and included three groups of children. The first group consisted of 15 young children with subthreshold autism symptoms. They had not received a formal diagnosis of ASD and had been exposed to digital devices for more than half of their waking time. The second group consisted of 15 young children with ASD, and the third group consisted of 15 young TDC. A lifestyle checklist, a modified checklist for autism in toddlers (M-CHAT), a behavioral flexibility rating scale-revised (BFRS-R), the Gilliam autism rating scale (GARS-2), and a behavior rating inventory of executive functioning-preschool version (BRIEF-P) were used to compare the three groups. The results showed that executive functions and behavioral flexibility were more impaired in children with ASD than in children with PDNAS and in TDC. Also, we found that there was no significant difference in the severity of autism symptoms between the children with ASD and the children with PDNAS. Early excessive exposure to digital devices may cause autism-like symptoms in children (PDNAS). Children with PDNAS are different from children with ASD in executive functions and behavioral flexibility. Further research is needed in this area.

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.

Association of birthweight centiles and early childhood development of singleton infants born from 37 weeks of gestation in Scotland: A population-based cohort study.

BackgroundBirthweight centiles beyond the traditional thresholds for small or large babies are associated with adverse perinatal outcomes but there is a paucity of data about the relationship between birthweight centiles and childhood development among children born from 37 weeks of gestation. This study aims to establish the association between birthweight centiles across the whole distribution and early childhood development among children born from 37 weeks of gestation.Methods and findingsThis is a population-based cohort study of 686,284 singleton infants born from 37 weeks of gestation. The cohort was generated by linking pregnancy and delivery data from the Scottish Morbidity Records (2003 to 2015) and the child developmental assessment at age 2 to 3.5 years. The main outcomes were child’s fine motor, gross motor, communication, and social developmental concerns measured with the Ages and Stages Questionnaires—3 (ASQ-3) and Ages and Stages Questionnaire: Social & Emotional—2 (ASQ:SE-2), and for a subset of children with additional specialist tools such as the Modified Checklist for Autism in Toddlers (M-CHAT) if the ASQ3/SE indicate these are necessary. The ASQ score for each domain was categorised as “concern” and “no concern.”We used multivariate cubic regression splines to model the associations between birthweight centiles and early childhood developmental concerns. We used multivariate Poisson regression models, with cluster robust errors, to estimate the relative risks (RRs) of developmental concerns below and above the established thresholds. We adjusted for maternal age, early pregnancy body mass index (BMI), parity, year of delivery, gestational age at delivery, smoking history, substance misuse in pregnancy, alcohol intake, ethnicity, residential area deprivation index, maternal clinical conditions in pregnancy (such as diabetes and pre-eclampsia), induction of labour, and child’s sex.Babies born from 37 weeks of gestation with birthweight below the 25th centile, compared to those between the 25th and 74th centile, were at higher risk of developmental concerns. Those born between the 10th and 24th centile had an RR of 1.07 (95% CI: 1.03 to 1.12, p < 0.001), between the 3rd and 9th centile had an RR: 1.18 (95% CI: 1.12 to 1.25, p < 0.001), and <3rd centile had an RR of 1.37 (95% CI: 1.24 to 1.50, p < 0.001). There was no substantial increase in the risk of early childhood developmental concerns for larger birthweight categories of 75th to 89th (RR: 1.01; 95% CI: 0.97 to 1.05; p = 0.56), 90th to 96th (RR: 0.99; 95% CI: 0.94 to 1.05; p = 0.86), and ≥97th centiles (RR: 1.04; 95% CI: 0.97 to 1.12; p = 0.27), referent to birthweight between 25th and 74th centile.The percentage of developmental concerns attributable to birthweight between the 10th and 24th centile was more than that of birthweight <3rd centile (p = 0.023) because this group includes more of the population. Approximately 2.50% (95% CI: 1.26 to 3.61) of social skills concerns and 3.00% (95% CI: 1.33 to 4.67) of fine motor developmental concerns were attributable to birthweight between the 10th and 24th centile compared to 0.90% (95% CI: 0.48 to 1.26) and 2.30% (95% CI: 1.73 to 2.67) respectively for birthweight <3rd centile. We acknowledge the limitation of ASQ as a screening tool, the subjective nature of developmental assessments (particularly for speech) among young children, and inability to control for early childhood illness and upbringing factors may have an impact on our findings.ConclusionsWe observed that from 37 weeks of gestation birthweight below the 25th centile was associated with child developmental concerns, with an association apparent at higher centiles above the conventional threshold defining small for gestational age (SGA, 3rd or 10th centile). Mild to moderate SGA is an unrecognised potentially important contributor to the prevalence of developmental concerns. Closer surveillance, appropriate parental counselling, and increased support during childhood may reduce the risks associated with lower birthweight centiles.

Families with high-risk characteristics and diagnoses of attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, and learning disability in children: A national birth cohort study.

BackgroundA national birth cohort study was used to investigate whether high-risk family factors at 1.5-year-olds can increase the risk of attention-deficit/hyperactivity disorder (ADHD) diagnosis when children reach 5.5 years. The pathway relationship of high-risk family factors, children's developmental conditions, risk of autism spectrum disorder (ASD), and diagnosis of intellectual disability (ID), learning disability (LD), and ASD was also investigated.MethodsThe 1.5-, 3- and 5.5-year-old Taiwan Birth Cohort Study (TBCS) dataset was used (N = 19,185). The high-risk familial factor was measured using five questions assessing whether parents are currently unmarried, unemployed, do not have any social insurance, perceive a “very heavy” economic childcare burden, and at least one of the parents has a disability certification. Developmental conditions were assessed using the Taiwan Birth Cohort Study—Developmental Instrument (TBCS-DI), and ASD risk was measured using the Modified Checklist of Autism in Toddlers. Data on ADHD, ID, LD, and ASD diagnoses were collected at age 5.5. The odds ratio model investigated whether children from families with high-risk factors at 1.5-years were at increased risk of ADHD, ID, LD, or ASD diagnosis at 5.5-years, compared to those children from families without such risks. Structural equation modeling investigated the logistic regression pathway relationship of high-risk familial characteristics, children's developmental conditions, autism screening, and diagnosis.ResultsIn the national birth cohort dataset of 19,185 children, 2070 (10.8%) met at least one of the high-risk familial factors. Children who met one high-risk familial factor had a 1.21-fold increased risk for ADHD diagnosis, 1.36-fold increased risk for LD diagnosis, and 1.80-fold increased risk for ASD diagnosis, compared to children from families without risks. High-risk familial factors directly increased the risk of ADHD and ID diagnosis, and indirectly increased the risk of ADHD, ID, LD, and ASD diagnosis through the mediating factor of children's development.ConclusionsChildren who met more high-risk familial characteristics were at higher risk of ADHD, ID, LD, and ASD diagnosis. Development at three years was predictive of diagnosis at 5.5 years. Thus, developmental screening at age three is vital for interventions. Preventive, family-focused, and/or child-rearing services for at-risk families are important for improving outcomes for these children and their families.

3.36 The Prevalence and Nature of Developmental Concerns Evident Prior to Receiving a Positive ASD Screening in Primary Care

3.36 The Prevalence and Nature of Developmental Concerns Evident Prior to Receiving a Positive ASD Screening in Primary Care

Postnatal maternal depressive symptoms and behavioural outcomes in term-born and preterm-born toddlers: a longitudinal UK community cohort study

ObjectivesTo examine the association between maternal depressive symptoms in the immediate postnatal period and offspring’s behavioural outcomes in a large cohort of term-born and preterm-born toddlers.Design and participantsData were drawn...

Impact of caesarean delivery on children’s autism-like behaviours: the mediation of exclusive breastfeeding

BackgroundThe rate of autism spectrum disorder (ASD) has been rising worldwide, and therefore it is important to identify potential causes of ASD to facilitate early prevention. This study examined the role of breastfeeding and the association between caesarean delivery (CD) and children’s autism spectrum disorder.MethodsThe data were from the Ma’anshan birth cohort (MABC) in China, that was set up between May 2013 and September 2014. Women within 14 gestational weeks were recruited. The delivery mode was extracted from medical notes and infant feeding was obtained from questionnaire surveys. Autism-like behaviour was assessed using the Checklist for Autism in Toddlers (CHAT-23) when children were 18 months old, and 3 years of age. At 5 years of age, autism-like behaviour was assessed using the Clancy Autism Behavior Scale behavior. Structural equation models tested the mediation effects of breastfeeding between CD and children’s autism spectrum disorder.ResultsIn all, 1520 (48.89%) women gave birth via CD, and 406 (13.86%) children were identified with autism-like behaviours at 18 months. Compared with women giving birth via vaginal delivery, those giving birth via CD were more likely to experience a higher proportion of delayed initiation of breastfeeding (p < 0.01), and delayed onset of lactogenesis (p < 0.01). CD was associated with a lower proportion of exclusive breastfeeding at 4 months after delivery (p = 0.02). Autism-like behaviour was less likely amongst infants with exclusively breastfeeding at 4 months than amongst those not exclusively breastfeeding at 4 months (p < 0.01). SEM indicated that women who gave birth by CD were more likely to stop exclusive breastfeeding in the first 4 months (standard estimations = − 0.04, p = 0.02), and those children who were not exclusively breastfed at 4 months were more likely to have autism-like behaviours (standard estimations = − 0.05, p < 0.01). The associations persisted at 3 years, but not at 5 years.ConclusionsExclusive breastfeeding at 4 months of age mediated the association between caesarean delivery and children’s autism-like behaviours.

The Screening Program for Autism Spectrum Disorders in the West of Iran

Background: There are few epidemiological data regarding the autism spectrum disorders (ASD) screening program in Iran, and as yet, screening for children at the age of 18 months has not been performed. Aim: The present study aimed to perform a screening program for children with ASD in Iran. Method: This cross-sectional study was conducted for screening children with ASD. The age and stages Questionnaire-18 (ASQ-18) month questionnaire was sent to all parents of children via a mobile-based application.The Modified Checklist for Autism in Toddlers (MCHAT) questionnaire was mailed if the child's score was below the cutoff. For those with positive M-CHATs, the M-CHAT/F Follow-up interview was performed. Finally, children with ASD, according to The Autism Diagnostic Interview-Revised (ADI-R) and examination, were diagnosed. Result: Of these children, 1221 (48%) were girls and 1341 (52%) were boys. Of the parent respondents, 232 (9%) children had a positive ASQ-18 questionnaire. For this purpose, the MCHAT was sent to the parents of these children. Of the 232 children with ASQ positive, 179 (77.1%) parents completed M-CHAT. On the M-CHAT, 43 (24.0%) children screened positive and 136 (76.0%) children passed on M-CHAT-R screening. In this stage of the 43 screenpositive children, health care providers asked parents to refer to their children for performing the M-CHAT at follow up. For a total of 33 children, the M-CHAT follow-up was performed. Of these samples, 7 children had positive M-CHAT follow-up. Therefore, ADI-R was conducted for these children to diagnose ASD. In the end, based on ADI-R and diagnostic evaluation performed by the child and adolescent psychologists, 7 children had ASD. Conclusion: The findings of the present study show that a mobile-based application can be utilized for screening children at risk of ASD. Therefore, we suggest that the application be used for screening children with ASD.

The Validity of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) Thai Version as the Autism Screening Application: A Pilot Study

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder where symptoms first appear during the first two years of life. Early screening and diagnosis are the keys to identifying toddlers with ASD so that early intervention could be recommended. The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a worldwide ASD screening instrument with adequate validity, which is used to screen ASD in toddlers between the ages of 16 and 30 months. Objective: To compute the sensitivity and specificity of the Thai version of the M-CHAT-R/F on the Autism Screening application (AS app) among children ranging from 16 to 30 months of age. Materials and Methods: The permission to translate M-CHAT-R/F into Thai and place it on an AS app on the computer website, on iOS, and on Android smartphones/tablets was granted. The forward translation of M-CHAT-R/F to Thai and the back translation into English were conducted by the language experts. The content was proofed and edited by two Child and Adolescent Psychiatrists and by one Developmental Pediatrician. The final Thai version of the M-CHAT-R/F was placed in the AS app and was used in the pilot study, which consisted of 15 toddlers with ASD and 15 toddlers with typical development. The screening results from the AS app were compared to the diagnoses from either Child and Adolescent Psychiatrists or Developmental Pediatricians to calculate the sensitivity and specificity. Results: The number of female(s) and male(s) among typical toddlers and toddlers with ASD were 1/14 and 2/13. The mean ages were 16 (SD 0)/26 (SD 4.31) and 23 (SD 9.90)/29.08 (SD 1.71) months old. The Thai M-CHAT-R/F gave the sensitivity and specificity of 100% at the cutoff score of 6 or greater from the full score of 20. Conclusion: The AS app had a high level of validity at the cutoff score of 6 or greater. Keywords: Application; Screening; Autism; Toddlers; Thai

Challenges in the early diagnosis of Autistic Spectrum Disorder

Early diagnosis of Autism Spectrum Disorder (ASD) is associated with significant gains in children's cognitive and adaptive functioning. For this, the use of screening tools for early signs of the disorder such as the Modifield Checklist for Autism in Toddlers (M-CHAT) is indicated. Thus, the objective of this study was to verify the use of M-CHAT for the early detection of suspected cases of ASD by physicians at the Family Health Units (USF) in Anápolis - GO. The work is a primary, observational, prevalence, cross-sectional, descriptive and quantitative study. The research was carried out at the following USF in Anápolis – GO: USF Recanto do Sol, USF Filostro Machado, USF Bairro de Lourdes, USF Bandeiras, USF Annex Itamaraty, ESF Vila União and USF Parque Iracema. The sample was for convenience (n=24), and data collection at the USF was performed by applying a questionnaire that verifies the use of the M-CHAT instrument among physicians. Among the participants, 33.3% knew the M-CHAT instrument and 50% of them used it, and this use was made after the initial consultation if they suspected ASD characteristics in the patient (75%) or during the initial consultation (25% ). This study was in agreement with the current literature, where the majority of physicians participating in the research do not recognize having knowledge and skills for the diagnosis of ASD and are unaware of a specific protocol to aid in screening.

252-OR: Maternal Obesity and Diabetes during Pregnancy and Quantitative Checklist for Autism in Toddlers (QCHAT) Scores in Offspring

In utero exposure to maternal obesity and diabetes has been associated with risk of autism spectrum disorders (ASD) in children. As early identification and support improves long-term outcomes in children with ASD, a 10-point Quantitative Checklist for Autism in Toddlers (QCHAT) screening questionnaire was developed and validated for clinical screening between 18-24 months at well-child visits. This study assessed associations between maternal metabolic exposures and offspring performance on early QCHAT screening. Data included 65699 singletons born in a single healthcare system, with QCHAT administered toddler well-child visits. Demographic and social data, maternal pregnancy obesity (BMI≥30 kg/m2) , pre-existing type 1/type 2 (T1D/T2D) , and gestational diabetes (GDM) status, and child’s QCHAT score were extracted from electronic medical records. Negative binomial regression was used to assess associations between maternal obesity and diabetes and QCHAT scores as a continuous measure, adjusting for covariates. Analyses included and excluded children with ASD diagnoses and were run with and without mutual adjustment for each metabolic condition. In this cohort, 18923 (28.8%) of children were exposed to maternal obesity, 2564 (3.9%) to T1/T2, 1946 (3.0%) to GDM diagnosed at ≤26 weeks, and 3290 (5.0%) GDM diagnosed &amp;gt;26 weeks. Of the total cohort, 1622 (2.5%) were later diagnosed with ASD. Maternal obesity (Incidence Rate Ratio: 1.12, 95% CI: 1.09,1.14) , T1D/T2D (1.13, 1.07-1.20) , and GDM ≤26 weeks (1.12, 1.05-1.19) were associated with one-unit increases in QCHAT scores. No associations were reported for GDM &amp;gt;26 weeks. Similar patterns were observed after excluding children with ASD diagnoses. Mutual adjustment did not change results. These data suggest maternal metabolic conditions during pregnancy are associated with increased social and communication impairment on early autism screening tools, even in typically developing children. Disclosure S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. J.M.Alves: None. R.Feldman: None. C.Qiu: None. K.A.Page: None. A.Xiang: None.

Uno sguardo al neurosviluppo raggiunto ai 2 anni di età

When a child develops a psychological disorder, even a mild one, early diagnosis is essential to provide a timely and appropriate intervention that can improve the child’s symptoms and development. Early identification can prevent consequences of differing levels, in the short and long term, in the individual, in their family and in society as a whole. Hence the importance of the paediatrician’s point of view and clinical knowhow in identifying potential disorders early, but also of the parents’ views. It is therefore important to actively involve parents in initial diagnosis. In this regard, within the NASCITA Project, a study branch aimed to build a shared, active approach between parents, paediatricians and neuropsychiatrists/psychologists was activated for the 2-year health assessments (well-child visits) phase. Three tests were used: the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) to evaluate language, social skills, behaviour, sensory areas; the PSI-SF (Parenting Stress Index - Short Form) to verify the degree of discrepancy perceived by the parent between the child’s requests and their ability to deal with them properly; the DERS (Difficulties in Emotion Regulation Scale) to highlight the difficulties of each parent in recognising, interpreting, and managing their emotions. The tests were given to 380 parents (142 couples, 215 mothers and 23 fathers) by 45 family paediatricians during the well-child visit held at two years of age. In all, 33 children (9%) resulted at risk, with a score of ≥ 3, 1 of whom was found to be at high risk. For 64 children (16.8%) at least one of the parents tested positive for PSI-SF and for 19 (5%) children at least one parent tested positive with the DERS. After combining the results obtained from the three tests and the clinical evaluation and by assessing the child’s condition with respect to those results, the paediatrician can provide the parents with a concise description of what emerged and the specialist with a summarised report. Such an effort leads to timely, shared communication within the parent-paediatrician-neuropsychiatrist triad that includes specificity of intervention and that can contribute to the effectiveness of the response.

Emotional Prosodies Processing and Its Relationship With Neurodevelopment Outcome at 24 Months in Infants of Diabetic Mothers.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Hyperglycemia of pregnancy is a risk not only for later obesity of the offspring but also do harm to their neurodevelopment from fetus. An ERP research has shown that children with autism spectrum disorder (ASD) was characterized by impaired semantic processing. In this study, we used event-related potential (ERP) to assess the procession of different emotional prosodies (happy, fearful, and angry) in neonates of diabetic mothers, compared to the healthy term infants. And to explore whether the ERP measure has potential value for the evaluation of neurodevelopmental outcome in later childhood. A total of 43 full-term neonates were recruited from the neonatology department of Peking University First Hospital from December 1, 2017 to April 30, 2019. They were assigned to infants of diabetic mothers (IDM) group (n = 23) or control group (n = 20) according to their mother's oral glucose tolerance test's (OGTT) result during pregnancy. Using an oddball paradigm, ERP data were recorded while subjects listened to deviation stimulus (20%, happy/fearful/angry prosodies) and standard stimulus (80%, neutral prosody) to evaluate the potential prognostic value of ERP indexes for neurodevelopment at 24 months of age. Results showed that 1) mismatch response (MMR) amplitudes in IDM group were lower than the control; 2) lower MMR amplitude to fearful prosody at frontal lobe was a high risk for increased Modified Checklist for Autism in Toddlers (M-CHAT) scores at 24 months. These findings suggests that hyperglycemia of pregnancy may influence the ability to process emotional prosodies in neonatal brain; it could be reflected by decreased MMR amplitude in response to fearful prosody. Moreover, the decreased MMR amplitude at the frontal lobe may indicated an increased risk of ASD.

Two-year neurodevelopmental outcomes of preterm infants who received red blood cell transfusion.

Studies aimed at reducing neonatal anaemia or transfusing higher blood volumes did not find improvement in neurodevelopmental function at two years of age. This study investigated the relationship between the receipt, timing, and number of red blood cell (RBC) transfusions and neurodevelopmental outcomes among preterm infants. This is a retrospective review of preterm infants (gestational age <34 weeks) with a full neurodevelopmental assessment at 18-36 months corrected age from October 2008 to September 2020. Bayley Scales of Infant and Toddler Development, third edition and the Modified Checklist for Autism in Toddlers were collected. Multivariable regressions were used to evaluate neurodevelopmental outcomes. 654 preterm infants were evaluated with a mean follow-up of 25 months. 295 infants (45%) received a total of 1,322 blood transfusions. After adjustment for gestational age, baseline morbidity, and socioeconomic status, receipt of RBC transfusion was associated with decreased two-year cognitive and motor function, but not language (p=0.047, 0.025, and 0.879, respectively). There was no significant difference in outcomes between receipt of transfusion in the first week of life compared to after. Number of transfusions was associated with decreased cognitive, language, and motor function (all p<0.001), and increased likelihood to develop severe neurodevelopmental impairment (adjusted-odds ratio, 1.09; 95% confidence interval, 1.03-1.15; p=0.004). Our study demonstrates an association between RBC transfusion and lower cognitive and motor outcomes at two-years after adjustment for prematurity and illness at birth. Increasing number of transfusions worsened neurodevelopmental outcomes.

Executive functions predict restricted and repetitive behaviors in toddlers under 36 months old with autism spectrum disorder

BackgroundExecutive functions (EFs) and restricted and repetitive behaviors (RRBs) have been studied mainly in older individuals with autism spectrum disorder (ASD), while little is known about the relationship between EFs and RRBs in toddlers. AimsThe purpose of this study was to investigate the relationship between EFs and RRBs of toddlers with ASD symptoms. In addition, we tested whether EFs were predictive of RRBs in toddlers. MethodsCross-sectional data were collected from parents of forty-five toddlers under 36 months old. The modified checklist for autism in toddlers (M-CHAT), the Gilliam autism rating scale (GARS-2), the behavior rating inventory of executive functioning-preschool version (BRIEF-P), and the repetitive behavior scale- revised (RBS-R) administered to parents. ResultsWe found significant associations between EFs and (1) stereotyped behaviors, (2) self-injurious behaviors, (3) ritualistic behaviors, (4) sameness behaviors, (5) restricted behaviors, (6) compulsive behaviors, and (7) repetitive behaviors total score. Increases in EFs differences predicted an increase in RRBs. ConclusionsOur results indicate a link between EFs and RRBs. Future research on RRBs in ASD may benefit from focusing on specific EFs rather than general categories.

Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits.

ObjectiveEarly screening contributes to the early detection of children with autism spectrum disorder (ASD). We conducted a longitudinal ASD screening study in a large community setting. The study was designed to investigate the diagnostic rate of ASD screening and determine the effectiveness of ASD screening model in a community-based sample.MethodsWe enrolled children who attended 18- and 24-month well-child care visits in Shanghai Xuhui District. Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Binomial Observation Test (BOT) were selected as screening instruments. Screen-positive children were referred to a tertiary diagnostic center for comprehensive ASD diagnostic evaluation. Screen-negative children received well-child checkups and follow-up every 3–6 months until age three and were referred if they were suspected of having ASD.ResultsA total of 11,190 toddlers were screened, and 36 screen-positive toddlers were diagnosed with ASD. The mean age at diagnosis for these children was 23.1 ± 4.55 months, diagnosed 20 months earlier than ASD children not screened. The diagnostic rate of ASD was 0.32% (95% CI: 0.23–0.45%) in this community-based sample. In addition, 12 screen-negative children were diagnosed with ASD during subsequent well-child visit and follow-up. The average diagnostic rate of ASD rose to 0.43% (95% CI: 0.32–0.57%) when toddlers were followed up to 3 years old. The positive predictive values (PPVs) of M-CHAT-R/F, M-CHAT-R high risk, and BOT for ASD were 0.31, 0.43, and 0.38 respectively.ConclusionOur findings provide reliable data for estimating the rate of ASD detection and identifying the validity of community-based screening model. M-CHAT-R/F combined with BOT can be an effective tool for early detection of ASD. This community-based screening model is worth replicating.

Autism Spectrum Disorder Screening During the COVID-19 Pandemic in a Large Primary Care Network.

ObjectiveTo assess the impact of the COVID-19 pandemic on screening for autism spectrum disorder (ASD) and screening equity among eligible children presenting for well-child care in a large primary care pediatric network, we compared rates of ASD screening completion and positivity during the pandemic to the year prior, stratified by sociodemographic factors.MethodsPatients who presented for in-person well-child care at 16 to 26 months between March 1, 2020 and February 28, 2021 (COVID-19 cohort, n = 24,549) were compared to those who presented between March 1, 2019 and February 29, 2020 (pre-COVID-19 cohort, n = 26,779). Demographics and rates of completion and positivity of the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT/F) were calculated from the electronic health record and compared by cohort using logistic regression models.ResultsTotal eligible visits decreased by 8.3% between cohorts, with a greater decline in Black and publicly insured children. In the pre-COVID-19 cohort, 89.0% of eligible children were screened at least once, compared to 86.4% during the pandemic (P < 0.001). Significant declines in screening completion were observed across all sociodemographic groups except among Asian children, with the sharpest declines among non-Hispanic White children. Sociodemographic differences were not observed in screen-positive rates by cohort.ConclusionsWell-child visits and ASD screenings declined across groups, but with different patterns by race and ethnicity during the COVID-19 pandemic. Findings regarding screen-completion rates should not be interpreted as a decline in screening disparities, given differences in who presented for care. Strategies for catch-up screening for all children should be considered.

Symptoms of Autism Spectrum Disorders Measured by the Qualitative Checklist for Autism in Toddlers in a Large Sample of Polish Toddlers.

This study aimed to assess some early symptoms of autism spectrum disorders (ASD) measured by a screening tool developed for an early detection of ASD. We investigated if the early symptoms were associated with toddlers’ age, gender or ASD familial risk status. We used the Polish version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT) to assess 1024 children aged 16 to 36 months. The sample included four groups of participants: typically developing toddlers, toddlers with parent-reported ASD-specific concerns, toddlers at risk for autism due to having an older sibling with ASD, and toddlers with a developmental delay. We found that mean Q-CHAT scores were significantly higher in boys than in girls. We did not find any associations between Q-CHAT scores and age. We observed that toddlers with a familial risk for ASD and those with a developmental delay scored significantly higher than controls. We collated these results with previous studies that used the Q-CHAT and other instruments.

Modified checklist for autism in toddlers, revised, with follow-up application in Central Kazakhstan

Objectives: One of the commonly used screening tools (Modified Checklist for Autism in Toddlers, Revised, with Follow-Up, M-CHAT-R/F, 2014) is designed for diagnosis of ASD in children aged 16-30 months. Given the known effectiveness of the M-CHAT-R/F and the need to adjust the tool to the cultural differences of the caregivers, the purpose of this research to test the M-CHAT-R/F test effectiveness and to adapt its Kazakh and Russian versions for the caregivers of Kazakhstan. Study design: Cross-sectional study Material and methods: This study was conducted among caregivers of children aged 24-48 months in the period October-November 2020 in Central Kazakhstan. Internal consistency of the Russian and Kazakh versions of the questionnaire was assessed by Cronbach's Alpha. To assess the reliability of the Russian version of M-CHAT-R/F, Guttman's lambda-6 indicator was calculated to consider the variance in each element of the scale explained by linear regression of other elements. Results: The final size of the analyzed sample was 171 children, among whom the mean age was 30.75 months and 92 (53.8%) were female. The results of the M-CHAT-R/F survey were distributed as follows: the low-risk group included 141 (82.5%) children, the medium-risk group included 23 (13.5%) children, and the high-risk group also included 7 (4.1%) children. The average score for M-CHAT-R and Follow-Up is 1.6 (SD=2.16) and 1.5 (SD=2.3) points, respectively. Both the Russian and Kazakh versions of M-CHAT-R/F demonstrated high internal consistency, with Cronbach's alpha (CI=0.95) calculated as 0.87 and 0.93, respectively. Guttman's lambda-6 also showed an excellent result in the Russian version of the checklist (0.94). Conclusion: The study findings support the appropriateness of using M-CHAT-R/F in Kazakhstan as an ASD screening tool. The effectiveness of this tool is emphasized by its ease of use and can reduce the average age of diagnosis of ASD in Kazakhstan to two years.