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Huda E, Hawker P, Cibralic S, John JR, Hussain A, Diaz AM, Eapen V. Screening tools for autism in culturally and linguistically diverse paediatric populations: a systematic review. BMC Pediatr 2024; 24:610. [PMID: 39342198 PMCID: PMC11437884 DOI: 10.1186/s12887-024-05067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 09/09/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) has varying prevalence rates worldwide, often higher in culturally diverse populations. Cultural differences can affect autism symptom recognition. Language barriers and differing healthcare attitudes may delay diagnosis and intervention. Most autism screening tools were developed in Western, predominantly Caucasian populations, and their appropriateness in culturally and linguistically diverse (CALD) contexts remains uncertain. There is a lack of comprehensive data on the accuracy of these tools in identifying autism in culturally and linguistically diverse groups. Consequently, it is unclear whether current screening tools are culturally sensitive and appropriate. METHODS A research protocol was registered in PROSPERO (CRD42022367308). A comprehensive search of literature published from inception to October 2022 was conducted using the following databases: PubMed, Medline Complete, Scopus, PsychInfo and CINAHL Complete. The articles were screened using pre-determined inclusion and exclusion criteria. Data extracted included participant demographics, screening tool psychometric properties (validity, reliability, accuracy) and acceptability. A narrative synthesis approach was used. RESULTS From the initial retrieval of 2310 citations, 51 articles were included for analysis. The studies were conducted in 32 different countries with screening tools in the following languages: Chinese, Spanish, Korean, Turkish, Arabic, Kurdish, Persian, Serbian, Italian, French, Sinhala, Taiwanese, Finnish, Northern Soho, Albanian, German, Japanese, Vietnamese, Farsi, Greek and English. There was no data on acceptability of the screening tools in CALD populations. Validity, reliability, and accuracy ranged from poor to excellent with consistently high performance by screening tools devised within the populations they are intended for. CONCLUSIONS The review evaluated autism screening tools in culturally diverse populations, with a focus on validity, reliability, and acceptability. It highlighted variations in the effectiveness of these tools across different cultures, with high performance by tools devised specifically for the intended population, emphasizing the need for culturally sensitive screening tools. Further research is needed to improve culturally specific, reliable autism screening tools for equitable assessment and intervention in diverse communities.
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Affiliation(s)
- Elmee Huda
- Department of General Paediatrics, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, 4101, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, School of Medicine, University of New South Wales, Sydney, NSW, 1466, Australia
| | - Sara Cibralic
- Discipline of Psychiatry and Mental Health, School of Medicine, University of New South Wales, Sydney, NSW, 1466, Australia
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - James Rufus John
- Discipline of Psychiatry and Mental Health, School of Medicine, University of New South Wales, Sydney, NSW, 1466, Australia
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - Aniqa Hussain
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - Antonio Mendoza Diaz
- Discipline of Psychiatry and Mental Health, School of Medicine, University of New South Wales, Sydney, NSW, 1466, Australia
- Tasmanian Centre for Mental Health Service Innovation, Tasmanian Health Service, Hobart, TAS, 7000, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Medicine, University of New South Wales, Sydney, NSW, 1466, Australia.
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, Sydney, Australia.
- ICAMHS, L1 MHC,, Liverpool Hospital, Elizabeth Street, Sydney, NSW, 2170, Australia.
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Hegemann L, Bugge Askeland R, Barbo Valand S, Øyen AS, Schjølberg S, Bal VH, Bishop SL, Stoltenberg C, von Soest T, Hannigan LJ, Havdahl A. Measuring autism-associated traits in the general population: Factor structure and measurement invariance across sex and diagnosis status of the Social Communication Questionnaire. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2105-2119. [PMID: 38159069 PMCID: PMC11360277 DOI: 10.1177/13623613231219306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
LAY ABSTRACT Using questionnaires in research relies on the expectation that they measure the same things across different groups of individuals. If this is not true, then interpretations of results can be misleading when researchers compare responses across different groups of individuals or use in it a group that differs from that in which the questionnaire was developed. For the questionnaire we investigated, the Social Communication Questionnaire (SCQ), we found that parents of boys and girls responded to questionnaire items in largely the same way but that the SCQ measured traits and behaviors slightly differently depending on whether the children had autism. Based on these results, we concluded that researchers using this questionnaire should carefully consider these differences when deciding how to interpret findings. SCQ scores as a reflection of "autism-associated traits" in samples that are mostly or entirely made up of individuals without an autism diagnosis may be misleading and we encourage a more precise interpretation of scores as a broader indication of social-communicative and behavioral traits.
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Affiliation(s)
- Laura Hegemann
- Department of Psychology, University of Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Norway
- Norwegian Institute of Public Health, Norway
| | | | - Stian Barbo Valand
- Department of Psychology, University of Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Norway
- Norwegian Institute of Public Health, Norway
| | - Anne-Siri Øyen
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Norway
| | | | - Vanessa H Bal
- Graduate School of Applied and Professional Psychology, Rutgers University, USA
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, USA
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Norway
- Department of Global Public health and Primary Care, University of Bergen, Norway
| | | | - Laurie J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Norway
- Norwegian Institute of Public Health, Norway
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, UK
| | - Alexandra Havdahl
- Department of Psychology, University of Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Norway
- Norwegian Institute of Public Health, Norway
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Kipkemoi P, Savage JE, Gona J, Rimba K, Kombe M, Mwangi P, Kipkoech C, Posthuma D, Newton CRJC, Abubakar A. Evaluation of the Psychometric Properties of the Social Communication Questionnaire in Rural Kenya. J Autism Dev Disord 2024:10.1007/s10803-024-06380-9. [PMID: 38816602 PMCID: PMC7616653 DOI: 10.1007/s10803-024-06380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
Children can be reliably diagnosed with autism as early as 3 years of age, and early interventions are initiated. There is often a significant gap between the age of onset of symptoms (2-3 years) and diagnosis (8-10 years) in Africa. We conducted a study to validate the Social Communication Questionnaire (SCQ) as a screening instrument in a rural setting in Kenya. The study was conducted along the Kenyan Coast. Study participants included 172 children with a neurodevelopmental disorder (NDD) diagnosis (84 of which were autism) and 112 controls. Internal consistency was evaluated through the use of Cronbach's alpha, confirmatory factor analysis (CFA) with maximum likelihood procedure to assess the conceptual model for the SCQ. Additionally, the sensitivity and specificity of cut-off scores using ROC analysis and item difficulties and discrimination quality using an IRT framework were also assessed. Factor analysis revealed an adequate fitting model for the three-factor DSM-IV-TR (root mean squared error of approximation (RMSEA) = 0.050; Comparative Fit Index (CFI) = 0.974; Tucker-Lewis Index (TLI) = 0.973) and two-factor DSM-5 factor structure (RMSEA = 0.050; CFI = 0.972; TLI = 0.974). The reliability coefficient alphas for the whole group for all items (Cronbach's α = 0.90) and all three domains (Cronbach's α = 0.68-0.84) were acceptable to excellent. The recommended cut-off score of 15 yielded 72% sensitivity and 100% specificity in the ASD group compared to the typically developing group. We provide early evidence of the adequate factor structure and good internal consistency of the SCQ. We also note that the recommended cut-off yielded sufficient predictive validity.
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Affiliation(s)
- Patricia Kipkemoi
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya.
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Jeanne E Savage
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joseph Gona
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Kenneth Rimba
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Martha Kombe
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Paul Mwangi
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Collins Kipkoech
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Danielle Posthuma
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Child and Adolescent Psychology and Psychiatry, Complex Trait Genetics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Charles R J C Newton
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, P.O. BOX, Kilifi, 195-80108, Kenya
- Institute for Human Development, Aga Khan University, P.O. BOX, Nairobi, 30270-00100, Kenya
| | - Amina Abubakar
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, P.O. BOX, Kilifi, 195-80108, Kenya
- Institute for Human Development, Aga Khan University, P.O. BOX, Nairobi, 30270-00100, Kenya
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Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges in social interaction and communication and the presence of restricted interests and repetitive behaviors. The importance of early detection of ASD and subsequent early intervention is well documented. Efforts have been made over the years to clarify ASD diagnostic criteria and develop predictive, accurate screening tools and evidence-based, standardized diagnostic instruments to aid in the identification of ASD. In this article, we review the most recent changes in ASD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, summarize evidence-based instruments for ASD screening and diagnostic evaluations as well as the assessment of co-occurring conditions in ASD, the impact of COVID-19 on ASD assessment, and directions for future research in the field of ASD assessment.
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Affiliation(s)
- Yue Yu
- University of California, Davis, Sacramento, USA
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Reis RDC, Souza INB, Dias MCR, Mendes CMDM, Almeida KJ. Association of Parental Support with Reduced Stereotypy in Children with Autism Spectrum Disorder: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1667. [PMID: 37763786 PMCID: PMC10534513 DOI: 10.3390/medicina59091667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: To analyze the influence of parental presence and use of risperidone on social interaction and apathy among patients with Autism Spectrum Disorder (ASD). Materials and Methods: Cross-sectional study in a reference center for patients with ASD in a city in northeastern Brazil. The research was carried out using a sociodemographic questionnaire, the Dimensional Apathy Scale, and the Social Communication Questionnaire (SCQ) with the domains of social interaction, language, stereotypy, and communication. The referred questionnaire was answered by the parents or guardians of the children with ASD according to the DSM V criteria. Data were analyzed via independent t-test using the SPSS software version 20. Results: Interviews were conducted with 51 parents/guardians of autistic children with a mean age of 8.8 years (±2.95) and a predominance of males, 34 (66.7%). Of this total, 49 (96.1%) of the children attended school; 40 (78.4%) children were on medication, of which 38 (74.5%) were on risperidone. Those children on risperidone had a higher score on the SCQ scale (p = 0.049) and on the domain of stereotyped behaviors (p = 0.033), which indicated greater impairment. Another statistically relevant variable was the presence of married parents, whereby children who did not have the presence of married parents had a higher average of stereotyped behaviors compared to those who had married parents. Conclusions: The results showed differences in the means of social interactions for children on risperidone, especially regarding stereotyped behaviors. However, it is not possible to state whether this difference was due to the use of risperidone or whether they used risperidone precisely because of these behaviors. Also important was that children who had the presence of married parents showed fewer stereotyped behaviors. There was no difference in apathetic behavior between children.
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Affiliation(s)
- Renandro de Carvalho Reis
- Department of Medicine, University Center UNINOVAFAPI, Teresina 64073-505, Brazil
- Department of Medicine, University Center IDOMED/UniFacid, Teresina 64073-505, Brazil
- Pharmaceutical Sciences Graduation Program, Federal University of Piauí, Teresina 64049-550, Brazil
| | | | | | | | - Kelson James Almeida
- Department of Medicine, University Center IDOMED/UniFacid, Teresina 64073-505, Brazil
- Pharmaceutical Sciences Graduation Program, Federal University of Piauí, Teresina 64049-550, Brazil
- Department of Neurology, Federal University of Piauí, Teresina 64049-550, Brazil
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Araújo M, Jorge JC, do Carmo Santos M, Vilhena E, Oliveira P, Freitas PP. Screening for Autism Spectrum Disorders - Validation of the Portuguese Version of the Social Communication Questionnaire. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01535-8. [PMID: 37079183 DOI: 10.1007/s10578-023-01535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
There are no assessment and screening tools for Autism Spectrum Disorders (ASD) validated for the Portuguese population. The Social Communication Questionnaire (SCQ) is an useful screening tool of ASD diagnosis. The main objectives of our study were to produce a Portuguese version of the SCQ (SCQ-PF), study its internal consistency, sensitivity and specificity in order to evaluate its validity as a screening instrument for ASD. We also wanted to study the impact of intellectual disability and verbal impairment and other mental disorders on SCQ-PF psychometric properties. The study included 211 children and adolescents, aged 4-17, divided in three groups: ASD Group (n = 96), Other Mental Disorders Group (OMD) (n = 63) and No Mental Disorders (NMD) Group (n = 52). Parents or other primary caregiver provided information on the SCQ items. The SCQ-PF score was significantly higher in the ASD group than in the other groups (p < 0.001). As to internal consistency, Cronbach's alpha was 87%. ASD subjects were distinguished from subjects without ASD (OMD and NMD Groups) and the area under the curve (AUC) was 0.897 (95% Confidence Interval: 0.852-0.943), for a cutoff of 14, which yielded the highest AUC, with values of sensitivity and specificity 0.76 and 0.93, respectively. These findings show that SCQ- PF with a cutoff of 14 is an acceptable and useful screening tool for ASD in the Portuguese population.
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Affiliation(s)
- Manuela Araújo
- Departamento de Psiquiatria da Infância e Adolescência - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Calejo Jorge
- Departamento de Psiquiatria da Infância e Adolescência - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria do Carmo Santos
- Departamento de Psiquiatria da Infância e Adolescência - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Estela Vilhena
- 2Ai - School of Technology, IPCA, Barcelos, Portugal
- LASI - Associate Laboratory of Intelligent Systems, Guimarães, Portugal
| | - Pedro Oliveira
- Instituto Ciências Biomédicas Abel Salazar-Universidade do Porto, Porto, Portugal
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Paula Pinto Freitas
- 2Ai - School of Technology, IPCA, Barcelos, Portugal.
- Center for Health Technology and Services Research (CINTESIS.ICBAS), Rua de Jorge Viterbo Ferreira, 228, Porto, 4050-313, Portugal.
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