Checklist For Autism Research Articles

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.

Are There Bidirectional Influences Between Screen Time Exposure and Social Behavioral Traits in Young Children?

Screen time in early childhood has been associated with children's prosocial and behavioral skills; however, the directionality of this relationship is unclear. We aimed to determine the direction of the relationship between screen time, social skills, and nonsocial behavioral traits in young children. This was a population-based, prospective cohort study with data across 5 time points. We examined the reciprocal relationships between caregiver-reported children's screen time at 12, 18, 24, 36, and 54 months and social behaviors collected using the Infant-Toddler Social-Emotional Assessment at 12 months; the Quantitative Checklist for Autism at 18, 24, and 36 months; and the Social Responsiveness Scale at 54 months. Cross-lagged path models were used for analysis. A multiple imputation data set and complete data from 229 participants were included in the analyses. Screen time at 12, 18, and 36 months predicted nonsocial behavioral traits at 54 months. Cross-lagged path models showed a clear direction from increased screen time at earlier time points to both poorer social skills and atypical behaviors at later time points (Akaike information criterion 18936.55, Bayesian information criterion 19210.73, root mean square error of approximation 0.037, and comparative fit index 0.943). Social skills or behavioral traits at a younger age did not predict later screen time at any of the time points. Screen time in early childhood has lagged influences on social skills and nonsocial behaviors; the reverse relationship is not found. Close monitoring of social behaviors may be warranted in the setting of excessive screen time during early childhood.

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.

Integrating a New Online Platform in Primary Care for Early Detection, Referral, and Intervention in Autism Spectrum Disorder: The First Italian Pivotal Project.

Autism spectrum disorder (ASD) is a heterogeneous condition characterized by deficits in social communication and a repetitive pattern of behavior, with recent Italian prevalence estimates of 1 in 77. Although the core behavioral features of ASD appear to emerge within the first two years of life, clinical diagnosis is often not received before the third birthday. The American Academy of Pediatrics (AAP) has recommended that primary care physicians routinely screen for ASD at the 18- and 24-month visits. In Italy, the Guidelines of the Italian National Institute for Health (ISS) recommend the Checklist for Autism in Toddlers (CHAT) as a screening tool for ASD, which compares parent responses with a semistructured observation by a healthcare provider. In the Italian National Health System, pediatricians have regular visits with all children; however, there is wide variability in following screening guidelines, and some barriers have been detected. For these reasons, other studies have highlighted the advantages of using telemedicine with the potential for enhancing ASD screening practices. The current study is an examination of the implementation of the first Italian online web-based screening tool (Web Italian Network for Autism Spectrum DisorderWIN4ASD), an innovative web app for pediatricians. We present the data obtained from the screening activity through the platform by a small group of pediatricians. The results of this study show that the implemented web-based platform appears to be an effective, efficient, and sustainable way to integrate screening services into primary care.

Rare diseases – rare outcomes: Assessing communication abilities for the developmental and epileptic encephalopathies

ObjectiveDevelopmental and epileptic encephalopathies (DEE) entail moderate to profound communication and other impairments that are poorly measured by typical clinical outcomes assessments (COA). We examined the potential of alternative approaches, specifically, the use of raw scores and COAs outside of their intended age ranges. MethodsIn a cross-sectional survey, 120 parents of children with Dravet Syndrome, Lennox–Gastaut syndrome, KCNQ2-DEE, KCNB1-DEE, and SCN2A-DEE (ages 1–35 years) completed the Adaptive Behavior Assessment System-3 for ages 0–5 years, modified checklist for autism (mCHAT), communication and social behavior scales (CSBS), communication matrix (CM), and several parent-reported classifiers of communication. Adaptive Behavior Assessment System communication and social raw scores were the primary and adjunctive outcomes. Floor and ceiling effects, dispersion and convergence with related measures were assessed with appropriate parametric and nonparametric statistical techniques. ResultsMedian chronological age (CA) was 8.7 years (Interquartile range (IQR): 5.3–13.5). Adaptive Behavior Assessment Systemcommunication and social age equivalents were 12.5 months (IQR 7.5–28) and 16.5 months (IQR 9–31). Most raw scores corresponded to standardized scores indicating performance <3 standard deviations below the general population mean. Adaptive Behavior Assessment System raw scores demonstrated minimal floor and ceiling effects (<1–2.5%). In linear regression models, scores correlated with age under 6 years (communication, p = 0.001; social, p = 0.003) but significantly flattened out thereafter. Scores varied substantially by DEE group (both p < 0.001) and decreased with higher convulsive seizure frequency (communication, p = 0.01, social, p = 0.02). There was good convergence with mCHAT, CSBS, and CM scores (all r > 0.8). SignificanceRaw scores and out-of-range COAs may provide measures that are sensitive at the very limited levels of functioning typical of profoundly impaired, older patients with DEEs. To ensure that targeted trial outcomes are responsive to meaningful change, development of these approaches will be essential to clinical trial readiness for novel therapies for rare DEEs.

The synergistic interaction between urbanicity and maternal education affecting childcare pressure related to autism spectrum disorder in two national birth cohort studies.

To gain a holistic approach for parental help-seeking behavior and ASD diagnosis, this study aimed to use two national birth cohort study datasets to investigate the pathway relationship between personal and social/environmental factors, including maternal perceived childcare pressure, maternal level of education, urbanization at age 3, and the chance of receiving a autism spectrum disorder (ASD) diagnosis at when children are aged 5.5years (2.5years later). The 2003 Taiwan Birth Cohort Pilot Study (TBCS-p; N = 1618) and 2005 Taiwan Birth Cohort Study (TBCS; N = 19,183) datasets were used. The TBCS-p and TBCS both showed similar prevalence of ASD (0.3-0.4%). Children with ASD characteristics, as measured using the Modified Checklist of Autism in Toddlers, had 8.27-18.20times increased likelihood of receiving ASD diagnosis [TBCS confidence interval (CF) of 5.32-12.86; TBCS-p CF of 2.03-163.46]. Pathway analysis showed that, although having a mother with higher education or who lived in a city decreased the chance for ASD diagnosis, the interactive effect of a maternal higher level of education and living in a city led to an increased likelihood for ASD diagnosis. Additionally, mothers who perceived a higher level of childcare pressure were also more likely to seek medical assistance and diagnosis. Access to healthcare (living in the city), maternal level of awareness (level of education), and perceived childcare pressure are all factors that influence help-seeking behavior and diagnosis. Therefore, medical professionals should pay special attention to the developmental condition of children in underserved backgrounds and rural areas to prevent delayed diagnosis.

Application of Telemedicine for Preliminary Screening of Autism Spectrum Disorder.

ObjectivePreliminary screening for autism spectrum disorder (ASD) is mainly performed offline in China. This method is time consuming, labor intensive, inefficient and costly. These complications limit its routine implementation in some hospitals and child health institutions, especially community health service centers. Thus, the present study explored the clinical applicability of an online screening system for ASD detection based on telemedicine technology.MethodsThe online screening system designed based on the WeChat platform and section A of the Chinese-validated version of the checklist for autism in toddlers (CHAT-23-A) and combined with an independent Research and Development (R&D) program. The sensitivity and specificity were 0.92 and 0.90, respectively, and the area under the receiver operating characteristic curve (AUC) values for all 23 items and 7 key items were 0.934 and 0.91, respectively.ResultsThe online screening system based on telemedicine technology was not limited by time, space, region, or medical resources and showed high sensitivity, specificity, and diagnostic efficiency for ASD.ConclusionThe online screening system based on telemedicine technology is suitable for large-scale population ASD screening in childcare institutions.

Cultural adaptation and Northern Sotho translation of the Modified Checklist for Autism in Toddlers

Background: In recent reviews of autism spectrum disorder screening tools, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/FTM) has been recommended for use in lower middle-income countries to promote earlier identification.Aim: The study aim was to culturally adapt and translate the M-CHAT-R/FTM into Northern Sotho, a South African language.Setting: An expert panel was purposively selected for the review and focus group discussion that was conducted within an academic context.Method: The source translation (English) was reviewed by bilingual Northern Sotho-English speech-language therapists who made recommendations for cultural adaptation. A double translation method was used, followed by a multidisciplinary expert panel discussion and a self-completed questionnaire.Results: Holistic review of test, additional remarks and grammar and phrasing were identified as the most prominent themes of the panel discussion, emphasising the equivalence of the target translation.Conclusion: A South African culturally adapted English version of the M-CHAT-R/FTM is now available along with the preliminary Northern Sotho version of the M-CHAT-R/FTM. The two versions can now be confirmed by gathering empirical evidence of reliability and validity.

Autism screening at 18\xa0months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners

BackgroundAutism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.MethodsThis is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old.Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.ResultsWhile the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10.LimitationsMany parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages.ConclusionsLimitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age.