Screening Instruments For Autism Spectrum Disorder Research Articles

Validation and determining an optimal cut-off score of the Infant Behavior Checklist for autism spectrum disorder.

Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID-19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut-off score. A total of 354 clinic-referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub-structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis. Among the 24 items, six failed to reach significance to differentiate ASD from non-ASD cases. The Cronbach's alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non-ASD cases. With the chosen cut-off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively. The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut-off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.

Hvor nøyaktig identifiserer screeninginstrumentet Social Communication Questionnaire autismespekterforstyrrelser i BUP?

Background: The accuracy of the Norwegian Social Communication Questionnaire (SCQ) in identifying autism spectrum disorder (ASD) within child psychiatry is not known. Method: We investigated the accuracy of SCQ in identifying clinically diagnosed ASD and ASD classified by the Developmental, Dimensional and Diagnostic Interview (3Di) and the Autism Diagnostic Observation Schedule (ADOS-2). Results: The SCQ cut-off of 15 showed low sensitivity (Se) for correct classification of clinically diagnosed ASD (Se = 38%) and ADOS-2 classified ASD (Se = 30%) with 78% and 76% specificity (SP), respectively. For 3Di classified ASD, Se was somewhat higher (49%) and had good specificity (86%), with the best positive predictive value (.73). Conclusions/Implications: The SCQ showed low accuracy in identifying a clinical ASD diagnosis in child psychiatry. However, children with SCQ scores at or above threshold had a high risk of also being categorised with ASD according to the 3Di. We recommend that future studies include more detailed information about the basis for the final diagnostic conclusions. Furthermore, SCQ's characteristics should be evaluated in samples of children within a broad range of ASD that includes individuals with delayed development. Investigation of the suitability of other screening instruments for ASD for diagnostic work in child psychiatric clinics is also needed. Keywords: Autism Diagnostic Observation Schedule (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3Di), sensitivity; specificity, Social Communication Questionnaire (SCQ)

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

Examining the correlation between symptoms of obsessive compulsive disorder and autism spectrum disorder in a community-based sample of adults

We examined the association between obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) symptoms among a community-based sample of adults (n = 217) that completed an OCD and ASD screening instrument. Approximately 39% of the sample that met the ASD screener cutoff criteria also met the screener cutoff criteria for OCD. The correlation between overall OCD symptoms (i.e., obsessions and compulsions) and ASD symptoms was small but statistically significant for the entire sample of participants. Similarly, obsession and compulsion subscales showed almost identical results for correlation with ASD symptoms (i.e., small but statistically significant) for the entire sample. These results suggest that levels of compulsions and obsessions are equally correlated with ASD symptoms, and neither elevated compulsions nor obsessions differentially predicted the severity of ASD symptoms in a community-based sample of adults. However, when the analysis was restricted to only the participants that met screening criteria cutoff score for ASD, statistically significant results occurred with only elevated compulsions accurately predicting severity of ASD symptoms. These results suggest that compulsive behavior appears to be a good candidate for targeting intervention resources for individuals with characteristics of ASD given the mounting data suggesting that compulsions are more common than obsessions.

Fine Motor Skills and Unsystematic Spatial Binding in the Common Region Test: Under-Inclusivity in Autism Spectrum Disorder and Over-Inclusivity in Attention-Deficit Hyperactivity Disorder

Introduction: The Common Region Test (CRT) is useful for predicting children’s visual memory as individual object-place binding predicted better object memory while objects-region coding predicted better place memory. Aim: To test children with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) with regards to spatial binding in the CRT. Methods: 19 children with ASD and 20 children with ADHD were gender-matched with 39 typically developing children by chronological age and with another 39 children by verbal mental age as control groups (N = 117) and tested with the CRT and Bender Gestalt test. Results: Children with ASD and ADHD showed more unsystematic coding than typically developing children. This was due to lower fine motor skills, and in children with ADHD also because of reduced verbal naming. Almost all children with ASD presented the less mature under-inclusive Type I unsystematic coding which included object-place binding, while children with ADHD showed the over-inclusive Type II unsystematic coding that was overriding the Gestalt-like properties of proximity and similarity. Conclusions: It was demonstrated that the CRT is a useful screening instrument for ASD and ADHD that shows that their spatial categorization varies in their unsystematic visuo-spatial classification due to fine motor skill deficiencies.

Do early-life eating habits predict later autistic traits? Results from a population-based study

Eating problems are common among children with Autism Spectrum Disorder (ASD), but it is unknown to what extent infant eating behavior is associated with later autistic traits. As eating behavior is currently not included in ASD screening instruments, it is important to evaluate whether infant eating behavior predicts later autistic traits and might therefore be used to enhance the early detection of ASD. We investigated the association of breastfeeding and eating behavior during infancy with later autistic traits in the population-based Generation R cohort. We included 3546 mother-child dyads with maternal reports on feeding and eating at age two months and autistic traits at six years. Eating behavior was assessed with seven items on specific eating habits and the Social Responsiveness Scale was used to evaluate autistic traits. Covariates included child sex, and maternal psychopathology and autistic traits. Linear regression analyses showed that being formula fed at two months was associated with a higher autistic trait score at six years (adjusted B = 0.07; 95% CI: 0.00–0.14). Children who were drinking only small quantities (adjusted B = 0.17, 95% CI: 0.04–0.30) and were hungry/not satisfied (adjusted B = 0.23, 95% CI: 0.08–0.39) at age two months also had a higher autistic traits score at age six years. We found no interactions with sex or breastfeeding. This study shows that eating behavior during infancy is related with autistic traits in childhood. Although the associations were fairly small, these findings suggest that early-life eating problems might be relevant for early detection of ASD and a potential addition to ASD-specific screening instruments.

Experience with the Rapid Interactive Test for Autism in Toddlers in an Autism Spectrum Disorder Diagnostic Clinic.

To examine the psychometric properties of the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) in an autism spectrum disorder (ASD) clinic for children aged 18 to 36 months. The RITA-T (level 2 screening instrument) was integrated into an ASD screening and diagnostic process for evaluating children aged 18 to 36 months who were referred to a pediatric tertiary care center. Scoring of the RITA-T to differentiate ASD from non-ASD developmental concerns was evaluated. Screening instrument measurements included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). From a total of 239 participants aged 18 to 36 months (males = 78% and females = 22%), 201 (84%) were diagnosed with ASD (4:1 male-to-female ratio). An ASD diagnosis was significantly associated with RITA-T scores, with ASD patients scoring higher than non-ASD patients [F (1,235) = 170, mean difference: males 9.21, mean difference: females 12.4, p < 0.001]. The RITA-T score was not statistically correlated with age or sex. The optimal cutoff score of ≥14 was determined from a receiver operator curve analysis (area under the curve = 0.953). In the study group, with a cutoff score of ≥14, the RITA-T showed a sensitivity of 0.97, specificity of 0.71, PPV of 0.95, NPV of 0.79, LR+ of 3.33, and LR- of 0.05. The RITA-T, as a level 2 screening instrument for ASD, exhibits discriminative psychometric properties similar to previously published results. When integrated into an ASD screening and diagnostic process for families for whom concerns about ASD have been raised with their children aged 18 to 36 months, the RITA-T helps to predict a best-estimate clinical diagnosis of ASD.

Visual scanning preferences in low birth weight preterm infants.

Few studies have used eye tracking as a screening tool for autism spectrum disorder (ASD) in preterm infants. To evaluate fixation time on social and non-social figures and percentage of preterm babies who gazed at the images. This was a cross-sectional study of 31 preterm infants born weighing ≤ 2,000 g in which eye gaze was evaluated at 6 months of corrected age. Six boards with social and non-social figures were projected on a computer screen, successively, evaluating time and percentage of preterm babies who gazed at each board. The Modified Checklist for Autism in Toddlers (M-CHAT) was answered at 18 months of corrected age. Preterm infants showed longer visual fixation time on social figures compared with non-social images, regardless of the position of the social figure on the board. Similar percentages of preterm infants gazed either at social or non-social figures, at social figures with a direct or an indirect look, and at the eyes or mouth of the social figures. No preterm infant screened positive on the M-CHAT. At 6 months of corrected age, preterm infants show the ability to gaze in an eye-tracking test, with preference for social figures, suggesting that this tool could be useful as another screening instrument for ASD.

Ethnic Disparities in Autism Spectrum Disorder Screening and Referral: Implications for Pediatric Practice.

Autism spectrum disorder (ASD) screening completion rates are often low despite their validity and influence on earlier intervention and positive treatment outcomes. This study sought to examine the use of one ASD screening tool, the Modified Checklist for Autism in Toddlers-Revised (MCHAT-R), in a racially and ethnically diverse urban pediatric clinic to review potential disparities within screening rates and referral practices. A retrospective chart review was conducted for children (N = 999) within the ages of 17 to 34 months seen for a well-child appointment at one of 3 pediatric clinics: a general pediatric clinic, resident pediatric clinic, and Hispanic pediatric clinic. MCHAT-R screening completion rates were low for all clinics. There were no significant differences in MCHAT-R screening completion based on ethnicity; however, the percentage of children screening positive on the MCHAT-R was significantly higher for Hispanic versus non-Hispanic children. Referral practices were highly variable across positive screenings, and few children received the appropriate combination of referrals. Ethnic disparities in ASD positive screening rates and inconsistent referrals represent a critical issue in current pediatric practice. There is a great need for the development of more culturally sensitive ASD screening instruments. Additionally, to help increase ASD screening rate and accuracy, as well as consistency in referrals, greater emphasis is needed on professional training, parental education, and technology use within pediatric clinics.

The Feasibility and Validity of Autism Spectrum Disorder Screening Instrument: Behavior Development Screening for Toddlers (BeDevel)-A Pilot Study.

Although early screening is critical for individuals with autism spectrum disorder (ASD) in order to receive early intervention and improve function later in life, screening is often delayed. Limitations of existing screening instruments, and the need for a culturally appropriate early screening tool in Korean children, led us to develop Behavior Development Screening for Toddlers (BeDevel). The BeDevel assessment consists of two parts: BeDevel-Interview, a structured interview measure for parents/primary caregivers; and BeDevel-Play, a play-based semi-structured observational measure in children. To examine the feasibility and validity of BeDevel, 155 children (N = 75 ASD, N = 55 typical development, N = 25 developmentally delayed) aged 18-42 months (M = 31.54 months, SD = 7.60) were examined through parent-reported screening questionnaires, BeDevel, and standard diagnostic assessments. When BeDevel items were analyzed using Cohen's kappa statistics, most items in BeDevel-Interview and all items in BeDevel-Play were reasonably consistent with diagnoses. We identified primary items, which were significantly interacted with actual diagnosis in the chi-squared test (P < 0.05, range = 0.000-0.032). Using cutoff numbers of items determined using the receiver operating characteristics curve, BeDevel showed satisfactory levels of sensitivity (83.33%-100%), specificity (81.25%-100%), positive predictive values (80.65%-100%), and negative predictive values (83.87%-100%), as well as high internal consistency (Cronbach's α = 0.866-959). The agreement between BeDevel and most other screening/diagnostic instruments was moderate (k = 0.419-1.000). These results suggest that BeDevel can be a useful instrument for early screening of ASD. Autism Res 2019, 12: 1112-1128. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Although early screening is critical for individuals with autism spectrum disorder (ASD) in order to receive early intervention and improve function later in life, screening is often delayed. Limitations of existing screening instruments and the need for a culturally appropriate early screening tool in Korean children led us to develop Behavior Development Screening for Toddlers (BeDevel). The BeDevel assessment consists of two parts: BeDevel-Interview, a structured interview measure for parents/primary caregivers; and BeDevel-Play, a play-based, semi-structured observational measure in children. In order to test the feasibility and validity of BeDevel, we analyzed preliminary data of total 155 children aged 18-42 months, examined through parent-reported screening questionnaires, BeDevel, and standard diagnostic assessments. When individual items were analyzed, responses of all BeDevel-Interview items and of most BeDevel-Play items well matched actual diagnoses, and we identified primary items, which were particularly useful in differentiating between the ASD group and the non-ASD group. With the optimal screening criteria determined, the BeDevel was able to identify individuals with a diagnosis of ASD and those without it, all at satisfactory levels. Lastly, BeDevel items were closely related as a set, and the BeDevel screening results were reasonably consistent with the results of most other screening/diagnostic instruments. These results suggest that BeDevel can be a useful instrument for early screening of ASD.

Sensitivity and specificity of early screening for autism.

Early identification and diagnosis is beneficial for children with autism spectrum disorder (ASD). Universal early screening is recommended by many experts, but disputed because evidence is limited, and sensitivity and specificity in general populations are largely unknown. To estimate the sensitivity and specificity of early population-based screening for ASDs. The study was based on the Norwegian Mother and Child Cohort Study. The 36-month cohort questionnaire included the Social Communication Questionnaire (SCQ), a 40-item screening instrument for ASD. A total of 58 520 mothers (58%) responded to the questionnaire. By the end of follow-up on 31 December 2015, 385 (0.7%) individuals with ASD had been identified among the responders' children. The distributions of SCQ scores in those with ASD and other children had large degrees of overlap. With the cut-off of 15 recommended in the SCQ manual, screening sensitivity was 20% (95% CI 16-24) for ASD overall. For children with ASD who had not developed phrase speech at 36 months, sensitivity was 46% (95% CI 35-57%), whereas it was 13% (95% CI 9-17) for children with ASD with phrase speech. Screening specificity was 99% (95% CI 99-99). With the currently recommended cut-off of 11, sensitivity increased to 42% for ASD overall (95% CI 37-47), 69% (95% CI 58-79) for ASD without phrase speech and 34% (95% CI 29-40) for ASD with phrase speech. Specificity was then reduced to 89% (95% CI 89-90). Early ASD screening with a parent checklist had low sensitivity. It identified mainly individuals with ASD with significant developmental delay and captured very few children with ASD with cognitive skills in the normal range. Increasing sensitivity was not possible without severely compromising specificity. C.L. receives royalty for the Social Communication Questionnaire, which she has co-authored.

Developing an eye-tracking algorithm as a potential tool for early diagnosis of autism spectrum disorder in children.

BackgroundAutism spectrum disorder (ASD) currently affects nearly 1 in 160 children worldwide. In over two-thirds of evaluations, no validated diagnostics are used and gold standard diagnostic tools are used in less than 5% of evaluations. Currently, the diagnosis of ASD requires lengthy and expensive tests, in addition to clinical confirmation. Therefore, fast, cheap, portable, and easy-to-administer screening instruments for ASD are required. Several studies have shown that children with ASD have a lower preference for social scenes compared with children without ASD. Based on this, eye-tracking and measurement of gaze preference for social scenes has been used as a screening tool for ASD. Currently available eye-tracking software requires intensive calibration, training, or holding of the head to prevent interference with gaze recognition limiting its use in children with ASD.MethodsIn this study, we designed a simple eye-tracking algorithm that does not require calibration or head holding, as a platform for future validation of a cost-effective ASD potential screening instrument. This system operates on a portable and inexpensive tablet to measure gaze preference of children for social compared to abstract scenes. A child watches a one-minute stimulus video composed of a social scene projected on the left side and an abstract scene projected on the right side of the tablet’s screen. We designed five stimulus videos by changing the social/abstract scenes. Every child observed all the five videos in random order. We developed an eye-tracking algorithm that calculates the child’s gaze preference for the social and abstract scenes, estimated as the percentage of the accumulated time that the child observes the left or right side of the screen, respectively. Twenty-three children without a prior history of ASD and 8 children with a clinical diagnosis of ASD were evaluated. The recorded video of the child´s eye movement was analyzed both manually by an observer and automatically by our algorithm.ResultsThis study demonstrates that the algorithm correctly differentiates visual preference for either the left or right side of the screen (social or abstract scenes), identifies distractions, and maintains high accuracy compared to the manual classification. The error of the algorithm was 1.52%, when compared to the gold standard of manual observation.DiscussionThis tablet-based gaze preference/eye-tracking algorithm can estimate gaze preference in both children with ASD and without ASD to a high degree of accuracy, without the need for calibration, training, or restraint of the children. This system can be utilized in low-resource settings as a portable and cost-effective potential screening tool for ASD.

Analysis of early symptoms of autism spectrum disorder children based on three-minute videos

Objective To explore the difference in early symptoms between 2-3 years old autism spectrum disorder (ASD) children and healthy children through video analysis, in order to provide evidence for the identification and screening of ASD children. Methods The study involved 25 cases of ASD children who were admitted to Children Development and Behavior Center, the Third Affiliated Hospital, Sun Yat-Sen University, and confirmed with diagnosis standards of Diagnosis and Statistical Manual of Medical Disorder 5th edition (DSM-5) and 21 healthy children recruited in community.Three-minute videos of children in standard procedure were collected.After that, all the videos were scored on 5 items by 2 professional evaluators, unaware of diagnostic status.Comparison analysis of video scores between ASD and the healthy controls was made, and the sensitivity and specificity of video analysis were evaluated. Results Response to roll-call score was higher in ASD children [2(2) scores]than that of the healthy children [0(0) scores], response to audible object score was higher in ASD children [0(1) scores] than that of the healthy children [0(0) scores], social smiling score was higher in ASD children [1(1) scores] than that of the healthy children [0(1) scores], and total score was higher in ASD children [4(2) scores] than that of the healthy children [2(0) scores], and the differences were statistically significant(Z=2.272, P=0.000; Z=0.976, P=0.010; Z=1.763, P=0.001; Z=2.355, P=0.000). But, no difference was found in speech and finger pointing (all P>0.05). The consistency between three-minute video analysis and standard diagnosis was 0.652(P=0.000), with 80.0% of sensitivity and 85.7% of specificity. Conclusions The ASD children perform worse than the healthy children in response to roll-call, response to audible object and social smiling.Three-minute standard video analysis can help to detect the early symptoms of ASD children.This result also demonstrates the potential of video-based analysis used as a ASD screening instrument in 2-3 years old children. Key words: Early symptom; Autism spectrum disorder; Video analysis

Screening for autism spectrum disorder in low- and middle-income countries: A systematic review.

This review contributes to the growing body of global autism spectrum disorder literature by examining the use of screening instruments in low- and middle-income countries with respect to study design and methodology, instrument adaptation and performance, and collaboration with community stakeholders in research. A systematic review was conducted to understand the use of autism spectrum disorder screening instruments in low- and middle-income countries from studies published between 1992 and 2015. This review found that 18 different autism spectrum disorder screeners have been used in low- and middle-income settings with wide ranges of sensitivities and specificities. The significant variation in study design, screening methodology, and population characteristics limits the ability of this review to make robust recommendations about optimal screening tool selection. Clinical-based screening for autism spectrum disorder was the most widely reported method. However, community-based screening was shown to be an effective method for identifying autism spectrum disorder in communities with limited clinical resources. Only a few studies included in this review reported cultural adaptation of screening tools and collaboration with local stakeholders. Establishing guidelines for the reporting of cultural adaptation and community collaboration procedures as well as screening instrument psychometrics and screening methodology will enable the field to develop best practices for autism spectrum disorder screening in low-resource settings.

Investigating the validation of the Chinese Mandarin version of the Social Responsiveness Scale in a Mainland China child population

BackgroundResearchers from several different countries have found the Social Responsiveness Scale (SRS) to have good psychometric properties. However, to our knowledge, no studies on this subject have been reported in Mainland China. In this study, we investigated the psychometric properties of the Chinese Mandarin version of the SRS when used in Mainland China.MethodsThe reliability and validity of the parent-report SRS in a sample of 749 children of 4- to 14-year-olds: 411 typically developing and 338 clinical participants (202 with autism spectrum disorder (ASD)) were examined.ResultsInternal consistency for total scale (0.871–0.922), test–retest reliability (0.81–0.94), and convergent validity with the Autism Behavior Checklist (ABC) (0.302–0.647) were satisfactory. The SRS total score discriminated between the ASD and other developmental disorders. Receiver operating characteristic (ROC) analyses revealed that the SRS was predicted to accurately classify 69.2–97.2% of youth ASD. Exploratory factor analysis (EFA) supported a single-factor solution for the ASD subsample. Confirmatory factor analysis (CFA) did not confirm the theoretical construct of five factors model with inadequate fit in the ASD subsample.ConclusionsOverall, our findings supported the reliability and validity of the parent-report SRS as one ASD screening instrument. In addition, we also suggest that the use of separate cut-offs for screening purposes (optimizing sensitivity) vs. clinical confirmation (optimizing specificity) should be considered.

Combining parent and clinician ratings of behavioural indicators of autism spectrum disorder improves diagnostic classification

ABSTRACTReliance on a single informant method in the evaluation of autism spectrum disorder (ASD) can increase misclassification. Yet, current ASD screening instruments predominately rely on a single informant approach. This study combined scores from two ASD screening instruments, the clinician-administered Autistic Behavioural Indicators Instrument (ABII) and its Parent Questionnaire (ABII-PQ) equivalent, to examine whether a combination score improved ASD classification in a sample of children with ASD (n = 51, Mchild age = 3.6 years, SD = 1.01, range = 2–6 years). Results showed the ABII and ABII-PQ were significantly associated, r = .62, p = .01, and did not differ significantly on final correct ASD classification. However, final agreement on ASD classification between instruments was poor, κ = .19, p = .184. One method of combining scores from the ABII and ABII-PQ significantly improved classification, correctly classifying 100% of children with ASD. Results show combining scores from parent- and clinician-rated screening instruments could improve ASD classification.

Indonesian Modified Checklist for Autism in Toddler, Revised with Follow-Up (M-CHAT-R/F) for Autism Screening in Children at Sanglah General Hospital, Bali-Indonesia

Background: Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired reciprocal social interaction and communication, and by a restricted, repetitive or stereotyped behavior. Early detection of autism is recommended on all toddlers from the ages of 9 months because of increasing in prevalence. The Modified Checklist for Autism (M-CHAT) in Toddlers, a Revised with Follow-Up (M-CHAT-R/F) is a 2-stage parent-report screening tool to assess a risk for ASD and it demonstrates an improvement compared to the original M-CHAT. It is translated to Indonesian language by Soetjiningsih and colleagues, and it needs to be validated. Methods: This is a diagnostic accuracy study conducted at Sanglah Hospital, Bali, conducted from March 2015 to December 2016. We included children 18-48 months in this study. The parents of the outpatient children in the growth and development clinic of Sanglah Hospital were asked to fill out the Indonesian M-CHAT-R/F form. In the same visit, the Autism Spectrum Disorder (ASD) assessment according to the DSM-5 as a gold standard was done by the researchers, without knowing the M-CHAT -R/F result. The assessment comparison based on M-CHAT-R/F and DSM-5 was analyzed to obtain the AUC intersection on ROC curve that gives the best sensitivity and specificity. Results: We found 10.71% of our outpatient was diagnosed with autism according to DSM 5, when they are 18-24 months old. The Indonesian version of M-CHAT-R/F as an ASD screening tool has 88.9% in sensitivity and 94.6% in specificity. Conclusion: Our results suggest that the Indonesian translation of the M-CHAT-R/F is an effective screening instrument for ASD, particularly when a two-step screening process is used.

Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL.

Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy.

Early screening for autism spectrum disorder in Serbia: A pilot study of screening instruments for parents and child care workers

Introduction: Early diagnosis of autism spectrum disorder (ASD) can lead to early interventions, which may improve developmental and academic outcomes in children with ASD. Early screening is thus of significant importance. Aims: This study had two aims. First, it was aimed to translate into Serbian five screening instruments for ASD: Modified Checklist for Autism in Toddlers - Revised, (M-CHATR), Quantitative Checklist for Autism in Toddlers (Q-CHAT), Infant-Toddler Checklist (ITC), and Early Screening Autistic Traits Questionnaire (ESAT) for parents and the Checklist for Early Signs of Developmental Disorders (CESDD) for child care workers. Second, it was aimed to test the feasibility of the included data from parents and child care workers in early ASD screening. Methods: The translation and cultural adaptation process included standardized forward and backward translation with pilot testing. For screening within a childcare setting, one day-care center was selected. Data from at least one parent and a child care worker were collected for 47 children aged 28.94 months on average (SD = 8.39). Results: The face and content validity of each version of the instruments is satisfactory. The correlations among the scores showed that the ESET, M-CHAT-R, Q-CHAT, and ITC evaluate slightly different aspects of ASD. The M-CHAT covers similar aspects to the CESDD. Eight (17%) children were positively screened for ASD with at least one instrument. All positively screened with the ESAT, QCHAT, or ITC were also positive with the CESDD, while not all positively screened with M-CHAT-R were detected with the CESDD. All five instruments were able to detect the child with confirmed ASD in the final stage - clinical assessment. Conclusions: All five screening instruments are targeting ASD symptoms at early stage of life in our population. It is feasible to include reports from parents and child care workers in early ASD screening and there is an added value of combining data from the two.

Screening for autism spectrum disorders in 12-month-old high-risk siblings by parental report.

This study examines whether parental report of social-communicative and repetitive behaviors at 12 months can be helpful in identifying autism spectrum disorder (ASD) in younger siblings of children with ASD [high-risk (HR)-siblings]. Parents of HR-siblings and infants without a family history of ASD completed the First Year Inventory at 12 months. Developmental outcomes were based on 24- or 36-month assessments. HR-siblings later diagnosed with ASD showed greater impairments in social communication than those with other developmental outcomes based on parental and clinician ratings. Parental report of decline in play and communication and impaired vocal imitation correctly classified a majority of ASD cases with high specificity. These preliminary findings have important implications for the development of early screening instruments for ASD in HR-siblings.