Tool For Autism Spectrum Disorder Research Articles

Psychometric properties of the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ) in a sample of Italian psychiatric outpatients

BackgroundThe present study aimed to examine the reliability and validity of the Italian version of the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), a screening tool for autism spectrum disorder (ASD) among psychiatric outpatients. MethodsWe recruited 340 subjects via an outpatient psychiatric service in Italy. Forty-eight had a diagnosis of ASD, confirmed after a comprehensive clinical assessment and the administration of the Autism Diagnostic Observation Schedule-2 (ADOS-2). The remaining 292 participants had other diagnoses, confirmed after a careful psychiatric evaluation and the administration of the Structured Clinical Interview for DSM-5 (SCID-5). The ASDASQ was administered to contact clinicians of each subject. ResultsThe ASDASQ showed outstanding accuracy (AUC = 0.96) in discriminating between ASD and non-ASD patients, with good sensitivity (0.85) and specificity (0.92). Agreement with clinical diagnosis was substantial (k = 0.68). Internal consistency of the tool was good (Cronbach’s alpha = 0.82), while intra- (ICC = 0.97) and inter-rater reliability (ICC = 0.92) were excellent. We found also a moderate correlation between ASDASQ and ADOS-2 scores in the ASD sample (r = 0.56). ConclusionOur findings suggest that the ASDASQ, in the Italian adaptation, may be considered a quick, simple, and effective tool to screen for ASD among psychiatric outpatients. Further studies are needed to evaluate its utility in other clinical settings.

Digital Behavioral Phenotyping Detects Atypical Pattern of Facial Expression in Toddlers with Autism.

Commonly used screening tools for autism spectrum disorder (ASD) generally rely on subjective caregiver questionnaires. While behavioral observation is more objective, it is also expensive, time-consuming, and requires significant expertise to perform. As such, there remains a critical need to develop feasible, scalable, and reliable tools that can characterize ASD risk behaviors. This study assessed the utility of a tablet-based behavioral assessment for eliciting and detecting one type of risk behavior, namely, patterns of facial expression, in 104 toddlers (ASD N = 22) and evaluated whether such patterns differentiated toddlers with and without ASD. The assessment consisted of the child sitting on his/her caregiver's lap and watching brief movies shown on a smart tablet while the embedded camera recorded the child's facial expressions. Computer vision analysis (CVA) automatically detected and tracked facial landmarks, which were used to estimate head position and facial expressions (Positive, Neutral, All Other). Using CVA, specific points throughout the movies were identified that reliably differentiate between children with and without ASD based on their patterns of facial movement and expressions (area under the curves for individual movies ranging from 0.62 to 0.73). During these instances, children with ASD more frequently displayed Neutral expressions compared to children without ASD, who had more All Other expressions. The frequency of All Other expressions was driven by non-ASD children more often displaying raised eyebrows and an open mouth, characteristic of engagement/interest. Preliminary results suggest computational coding of facial movements and expressions via a tablet-based assessment can detect differences in affective expression, one of the early, core features of ASD. LAY SUMMARY: This study tested the use of a tablet in the behavioral assessment of young children with autism. Children watched a series of developmentally appropriate movies and their facial expressions were recorded using the camera embedded in the tablet. Results suggest that computational assessments of facial expressions may be useful in early detection of symptoms of autism.

Fourier Transform Infrared Spectroscopy Based Complementary Diagnosis Tool for Autism Spectrum Disorder in Children and Adolescents.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that begins early in life and continues lifelong with strong personal and societal implications. It affects about 1%–2% of the children population in the world. The absence of auxiliary methods that can complement the clinical evaluation of ASD increases the probability of false identification of the disorder, especially in the case of very young children. In this study, analytical models for auxiliary diagnosis of ASD in children and adolescents, based on the analysis of patients’ blood serum ATR-FTIR (Attenuated Total Reflectance-Fourier Transform Infrared) spectra, were developed. The models use chemometrics (either Principal Component Analysis (PCA) or Partial Least Squares Discriminant Analysis (PLS-DA)) methods, with the infrared spectra being the X-predictor variables. The two developed models exhibit excellent classification performance for samples of ASD individuals vs. healthy controls. Interestingly, the simplest, unsupervised PCA-based model results to have a global performance identical to the more demanding, supervised (PLS-DA)-based model. The developed PCA-based model thus appears as the more economical alternative one for use in the clinical environment. Hierarchical clustering analysis performed on the full set of samples was also successful in discriminating the two groups.

Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review.

Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). We systematically reviewed evidence for universal screening of children for ASD in PC. We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. Potential limitations include publication bias, selective reporting within studies, and a constrained search. ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4.

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.

Factor Structure of the Social Communication Questionnaire in Preschool Aged Autistic Children

The Social Communication Questionnaire (SCQ) is a common screening tool for autism spectrum disorder. Given its wide use, as well as recent changes to diagnostic criteria for autism, there is a need to evaluate whether the SCQ maps onto the social communication and interaction, and repetitive behaviour and restricted interests domains specified in the revised criteria in DSM-5. Participants included 294 preschool aged autistic children. Confirmatory factor analysis was implemented to evaluate the factor structure of the SCQ. None of the models evaluated provided an adequate fit to the data. However, the best fitting model mapped onto the previous DSM-IV diagnostic criteria for autism. The SCQ does not align with the new DSM-5 domains. More research is needed to evaluate the factor structure of the SCQ in different populations of autistic children in order to determine its current validity as a screening tool.

Accuracy of the Childhood Autism Rating Scale: a systematic review and meta-analysis.

To assess the accuracy of the Childhood Autism Rating Scale (CARS) through systematic review and meta-analysis. Studies that provided quantitative values for the reliability and validity for all versions of CARS were searched through MEDLINE, CINAHL, PsycINFO, Embase, and OpenDissertations. A total of 24 studies with 4433 participants were included in our analysis. Meta-analysis showed that the summary Cronbach's alpha regarding a team of physicians and psychologists or others subgroup, derived from six studies (952 participants), was considered to be acceptable at 0.90 (95% confidence interval, 0.87-0.92) with moderate heterogeneity. Analysis of two 'low risk of bias' studies on the criterion validity for CARS with a cut-off of 30 and DSM-IV resulted in sensitivity of 0.86 and 0.71 and specificity of 0.79 and 0.75. Through the results of the current systematic review and meta-analysis, the internal consistency can be considered to be acceptable for a team of physicians and psychologists or others subgroup. In terms of the criterion validity, the sensitivity was thought to be acceptable although the specificity was not, suggesting that CARS should be used along with other confirmatory tools. The Childhood Autism Rating Scale can be considered as a supplementary diagnostic tool for autism spectrum disorder.

Brief Report: An Evaluation of the Social Communication Questionnaire as a Screening Tool for Autism Spectrum Disorder in Young People Referred to Child & Adolescent Mental Health Services.

The SCQ is a widely used screening measure for the assessment of autism spectrum disorder (ASD). However, its sensitivity and specificity when used with older children in the context of community Child & Adolescent Mental Health services is unclear. Seventy-seven (Mean age = 12.8years) young people with suspected ASD were screened using parent- and teacher-reported SCQ's before completing a comprehensive diagnostic assessment. Of the 77 young people included, 44 (57%) met criteria for an ASD diagnosis. Our results indicated that regardless of informant, SCQ scores did not significantly predict the outcome of the diagnostic assessment. Based on the published cut-off score for the SCQ, Receiver Operating Characteristic curve analyses revealed a lower than expected sensitivity and specificity. This suggests that the SCQ is not an effective screening tool when used in the context of community Child & Adolescent Mental Health services.

Development and validation of DSM-5 based diagnostic tool for children with Autism Spectrum Disorder.

Diagnostic and Statistical Manual of mental disorder-IV (DSM-IV) TR based INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an established instrument for the diagnosis of ASD in Indian subcontinent and low-middle income countries (LMIC). The introduction of DSM-5 necessitated revision of existing INDT-ASD tool to incorporate the DSM-5 related changes. This study was undertaken to develop and validate the DSM-5 based All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool. The modifications were done using Delphi method and included: (a) rearrangement of questions from the previous tool; and (b) addition of new questions on sensory symptoms. The modified tool was validated against DSM-5 diagnostic criteria. In addition, receiver operating characteristic (ROC) curves were used to determine the cut-off for total score as compared to Childhood Autism Rating Scale (CARS) score to grade the severity of ASD. Two-hundred-twenty-five children (159 boys, median age = 47months) were enrolled. The modified tool demonstrated sensitivity of 98.4% and specificity of 91.7% to diagnose ASD. A score ≥14 on the tool was suggestive of severe ASD (CARS>36.5) with a sensitivity and specificity of 80% and 80.7% respectively [Area under the curve = 0.89]. AIIMS-Modified-INDT-ASD Tool is a simple and structured instrument based on DSM-5 criteria which can facilitate diagnosis of ASD with acceptable diagnostic accuracy.

Validation of the Arabic version of the Social Communication Questionnaire.

Validated screening and diagnostic tools for autism spectrum disorder for use in Arabic-speaking individuals are scarce. This study validated the Arabic version of the Social Communication Questionnaire. The total study sample included 206 children with autism spectrum disorder and 206 typically developing children (73.8% male; mean age: 8.5 (standard deviation = 2.6) years). The mean Social Communication Questionnaire total score was significantly higher in autism spectrum disorder children than in typically developing children (p < 0.0001). Scores on the three Social Communication Questionnaire subscales also differed significantly between the groups (p < 0.001). Of the 39 items, 37 were endorsed significantly more often in the autism spectrum disorder group. The total Social Communication Questionnaire score did not vary by age or gender. Internal consistency was excellent (alpha = 0.92). In the receiver operating characteristic analysis, the area under the curve for the total score showed excellent discrimination between autism spectrum disorder and typically developing children (area under the curve = 0.95; 95% confidence interval: 0.93–0.97). The areas under the curve for the scale subscores were 0.923 (95% confidence interval: 0.898–0.949) for the social interaction score, 0.872 (95% confidence interval: 0.838–0.905) for the communication score, and 0.856 (95% confidence interval: 0.819–0.893) for the repetitive behaviors score. The findings support the use of the Arabic Social Communication Questionnaire to successfully differentiate children with clinically diagnosed autism spectrum disorder using the established cutoff value for the English version.

Diagnostic Accuracy of International Epidemiology Network (INCLEN) Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) in Comparison with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)

To compare the diagnostic accuracy of INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) against Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) for the diagnosis of Autism Spectrum Disorder (ASD). 118 children aged 2-9 years with symptoms suggestive of ASD were assessed by INDT-ASD and DSM-V by trained personnel. ASD diagnosis by INDT-ASD was compared against the expert's DSM-5 diagnosis. INDT-ASD had a sensitivity and specificity of 100% and 75%, respectively against DSM-5 for the diagnosis of ASD; specificity for Autistic Disorder was 87%. The INDT-ASD has a good sensitivity and specificity against DSM-5, and can continue to be used for the diagnosis of ASD even after the adoption of DSM-5 criteria.

Gut Microbial Dysbiosis in Indian Children with Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a term associated with a group of neurodevelopmental disorders. The etiology of ASD is not yet completely understood; however, a disorder in the gut-brain axis is emerging as a prominent factor leading to autism. To identify the taxonomic composition and markers associated with ASD, we compared the fecal microbiota of 30 ASD children diagnosed using Childhood Autism Rating Scale (CARS) score, DSM-5 approved AIIMS-modified INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD), and Indian Scale for Assessment of Autism (ISAA) tool, with family-matched 24 healthy children from Indian population using next-generation sequencing (NGS) of 16S rRNA gene amplicon. Our study showed prominent dysbiosis in the gut microbiome of ASD children, with higher relative abundances of families Lactobacillaceae, Bifidobacteraceae, and Veillonellaceae, whereas the gut microbiome of healthy children was dominated by the family Prevotellaceae. Comparative meta-analysis with a publicly available dataset from the US population consisting of 20 ASD and 20 healthy control samples from children of similar age, revealed a significantly high abundance of genus Lactobacillus in ASD children from both the populations. The results reveal the microbial dysbiosis and an association of selected Lactobacillus species with the gut microbiome of ASD children.

Culturally adapted pictorial screening tool for autism spectrum disorder: A new approach.

AIMTo assess the performance of a newly designed, culturally adapted screening tool for autism spectrum disorder (ASD).METHODSItems for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD. Each item in text was paired with a photograph that illustrated the written content, which was in the 2 main local languages. The final product had 21 items and was named the pictorial autism assessment schedule (PAAS). Performance of PAAS was tested on a clinical sample of 18-48 mo old children, diagnosis naïve, presenting with developmental deficits. Mothers completed PAAS checklist. Based on clinical diagnosis, which was taken as the gold standard, children were later grouped into ASD (Group 1) and non-ASD developmental disorders (Group 2). Mothers of a control sample of typically developing children also completed PAAS (Group 3).RESULTSA total of 105 children (Group 1-45, Group 2-30, Group 3-30) participated in the study. Mean age of Group 1 and Group 2 were 36 and 40 mo respectively. Majority were male in all 3 groups. Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%, specificity 60.7%, positive predictive value (PPV) 78.4%, negative predictive value (NPV) 77.2%, likelihood ratio (LR+) 2.26, and LR- 0.18. Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%, specificity 93.3%, PPV 95.2%, NPV 84.0%, LR+ 13.3 and LR- 0.12. The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder. A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSIONPAAS is an effective tool in screening for ASD. Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.

Disparity in report of autism-related behaviors by social demographic characteristics: Findings from a community-based study in Taiwan.

The Social Communication Questionnaire is one of the most commonly used screening tools for autism spectrum disorder. The Social Communication Questionnaire is a caregiver-reported questionnaire with 40 items based on questions from the Autism Diagnostic Interview-Revised. This study collected Social Communication Questionnaire data from a community-based, multi-stage case identification design epidemiologic study in one socioeconomically disadvantaged county in Taiwan. The Social Communication Questionnaire was distributed to 3034 school children, aged 6-8 years. Item prevalence results indicate males were reported to have more autism-related behaviors than females (higher prevalence on most items), in the whole study sample as well as in children meeting Social Communication Questionnaire clinical cut-offs (⩾15). Children whose biological fathers completed the Social Communication Questionnaire were reported to have more behavioral issues than children whose biological mothers were the respondent. Lower respondent education levels were associated with reports of clinically concerning autism-related behaviors. However, males were not at higher risk of meeting Social Communication Questionnaire clinical cut-offs than females in this study population. Findings from this study help to better understand reporting patterns on children's autism-related behaviors potentially due to social demographic characteristics and child sex, which may lead to improved identification of these behaviors.

INCLEN Diagnostic Tool for the assessment of Autism Spectrum Disorder: A new tool in the speech-language pathologist′s armoury

Objective: INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an indigenously developed tool for the assessment of Indian children with ASD. This tool has been developed by the INCLEN group in India, and it is used by mental health professionals and pediatricians. This work was to demonstrate its clinical utility for speech-language pathologists (SLPs) and sensitize them to this new tool. Materials and Methods: Forty children between 2 and 10 years of age, with the referral diagnosis of ASD and social communication disorder (SCD) from the Department of Child and Adolescent Psychiatry, were enrolled for the study. Diagnosis was reviewed and the Childhood Autism Rating Scale was administered on all children. The children were grouped as (i) children with ASD and (ii) children with SCD, i.e., no ASD. The INDT-ASD was then administered by an SLP, who was blind to group membership. Results: Thirty-nine out of forty children were correctly diagnosed by the INDT-ASD, showing high diagnostic accuracy of the tool. In addition to this, it is quick to administer, has very elaborate guidelines to observe different behaviors, a good scoring algorithm, and it is freely available in many regional languages. Conclusion: INDT-ASD is a simple and effective tool that can also be used regularly by SLPs and other professionals for the diagnosis of Indian children with ASD.

INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD): development and validation.

To develop and validate INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). Diagnostic test evaluation by cross sectional design. Four tertiary pediatric neurology centers in Delhi and Thiruvanthapuram, India. Children aged 2-9 years were enrolled in the study. INDT-ASD and Childhood Autism Rating Scale (CARS) were administered in a randomly decided sequence by trained psychologist, followed by an expert evaluation by DSM-IV TR diagnostic criteria (gold standard). Psychometric parameters of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. 154 children (110 boys, mean age 64.2 mo) were enrolled. The overall diagnostic accuracy (AUC=0.97, 95% CI 0.93, 0.99; P<0.001) and validity (sensitivity 98%, specificity 95%, positive predictive value 91%, negative predictive value 99%) of INDT-ASD for Autism spectrum disorder were high, taking expert diagnosis using DSM-IV-TR as gold standard. The concordance rate between the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's k=0.89; 95% CI (0.82, 0.97); P=0.001]. The internal consistency of INDT-ASD was 0.96. The convergent validity with CARS (r = 0.73, P= 0.001) and divergent validity with Binet-Kamat Test of intelligence (r = -0.37; P=0.004) were significantly high. INDT-ASD has a 4-factor structure explaining 85.3% of the variance. INDT-ASD has high diagnostic accuracy, adequate content validity, good internal consistency high criterion validity and high to moderate convergent validity and 4-factor construct validity for diagnosis of Autistm spectrum disorder.

RAADS-14 Screen: validity of a screening tool for autism spectrum disorder in an adult psychiatric population

BackgroundAutism spectrum disorder (ASD) can be difficult to distinguish from other psychiatric disorders. The clinical assessment of ASD is lengthy, and has to be performed by a specialized clinician. Therefore, a screening instrument to aid in the identification of patients who may have undiagnosed ASD should be useful. The purpose of this study was to develop such a screening instrument.MethodsBased on the 80 item Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R), we developed a 14 item self-evaluation questionnaire, the RAADS-14 Screen. In total, 135 adults with ASD and 508 psychiatric controls completed the abridged version of the RAADS-R.ResultsThe RAADS-14 Screen score was significantly higher in the ASD group than in the control samples, with a median score of 32 for ASD, 15 for attention deficit hyperactivity disorder, and 11 for other psychiatric disorders (P < 0.001). A cut-off score of 14 or above reached a sensitivity of 97% and a specificity of 46 to 64%. A factor analysis identified three factors consistent with mentalizing deficits, social anxiety, and sensory reactivity relevant for the diagnosis of ASD. The psychometric properties of RAADS-14 Screen were shown to be satisfactory.ConclusionsThe results of this study indicate that RAADS-14 Screen is a promising measure in screening for ASD in adult psychiatric outpatients.

Autism Intervention Research Programs of the Maternal and Child Health Bureau

* Abbreviations: ASD — : autism spectrum disorder CAAI — : Combating Autism Act Initiative DBP — : Developmental Behavioral Pediatrics HRSA — : Health Resources and Services Administration MCH — : Maternal and Child Health MCHB — : Maternal and Child Health Bureau SDAS — : Secondary Data Analysis Studies Over the past 2 decades, autism has emerged as a major public health concern in the United States.1 Since 1995, the US Department of Health and Human Services has sharpened its focus on autism spectrum disorders (ASDs) through development of new initiatives that are aimed at increasing our understanding of autism, its causes, and potential treatments.2 However, families and young children with ASD and other related developmental disabilities continue to face many challenges in health care and educational service system access, ensuring optimal development through early intervention, a successful transition into adulthood, and fostering family well-being and positive family functioning in diverse racial and ethnic populations. To further address autism as a critical and growing public health concern, Congress enacted the Combating Autism Act of 20063 in December 2006, which authorized programs to combat autism through research, screening, intervention, and education. As stated in this legislation, the Secretary of Health and Human Services shall “establish and evaluate activities to: 1. provide information and education on autism spectrum disorder and other developmental disabilities to increase public awareness of developmental milestones; 2. promote research into the development and validation of reliable screening tools for autism spectrum disorder and other developmental disabilities and disseminate information regarding those screening tools; 3. promote early screening of individuals at higher risk for autism spectrum disorder and other developmental disabilities as early as practicable, given evidence-based screening techniques and interventions; 4. increase the number of individuals who are able to confirm or rule out a diagnosis of autism spectrum … Address correspondence to Hae Young Park, MPH, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, 18A-55, Rockville, MD 20857. E-mail: hpark{at}hrsa.gov