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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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Terner M, Israel-Yaacov S, Golan O. Sex differences in autism screening: An examination of the Childhood Autism Spectrum Test-Hebrew version. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235053. [PMID: 38465585 DOI: 10.1177/13623613241235053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LAY ABSTRACT Autism is a neurodevelopmental condition, characterized by social communication alterations and restricted, repetitive behaviors. Typically diagnosed in early childhood, screening and diagnosis at a later age can be challenging, particularly in girls who exhibit a wider range of behaviors and characteristics. Our study set out to examine the effectiveness of the Hebrew translation of the Childhood Autism Spectrum Test, a parent report questionnaire, in identifying these diverse characteristics of autism within an Israeli sample of boys and girls. We examined parent reports on 403 (211 autistic, 192 non-autistic) children, aged 4-12 years. Results revealed the Childhood Autism Spectrum Test-Hebrew version was a valuable tool in differentiating between autistic and typically developing children, correctly identifying 93% of children with autism and 82% of typically developing children. In addition, specific items of the Childhood Autism Spectrum Test-Hebrew version were particularly useful in differentiating between autistic and non-autistic boys and autistic and non-autistic girls. Using these items, in addition to the overall score of the questionnaire, increased the correct identification of children as autistic or typically developing, especially in girls. The Childhood Autism Spectrum Test-Hebrew version test results corresponded well with the Autism Diagnostic Interview-Revised, which relies on parental input, but not with the clinician-administered Autism Diagnostic Observation Schedule-2. Our findings highlight the potential benefits of gender-specific tools to better support correct identification of autism in boys and in girls. More research is recommended to further explore these gender differences and to validate our findings with a larger, diverse group.
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Affiliation(s)
| | | | - Ofer Golan
- Bar-Ilan University, Israel
- OTI - The Israeli Autism Association, Israel
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Yang S, Han D, Zhou H, Yang C, Zhang K, Chen S, Yang R, Cao X, Grodberg D, Zhao X, Kang C. Validity and Cutoff Score of the Autism Mental Status Exam for an Autism Spectrum Disorder Diagnosis in Chinese Children. J Autism Dev Disord 2023; 53:4822-4829. [PMID: 36087158 DOI: 10.1007/s10803-022-05730-9] [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] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
The Autism Mental Status exam (AMSE) has demonstrated excellent sensitivity and specificity in Western high-risk population with suspected autism spectrum disorder (ASD). This study aimed to evaluate the psychometric properties of the AMSE in a sample of high-risk Chinese children, and to determine the optimal cutoff score of the Chinese version of the AMSE in supporting ASD diagnosis. 66 young children aged from 2 to 11 years with suspected ASD were enrolled in the present study. A diagnosis of ASD or non-ASD was determined by a Best Estimate Diagnosis protocol according to the DSM-5 criteria. Receiver operating characteristic (ROC) curve analysis was conducted to assess the validity of the AMSE and search for the most effective cutoff score. The ROC curve analysis yields the area under the ROC curve of 0.98 which represents excellent diagnostic accuracy. Findings indicate the optimal cutoff score of the Chinese version of the AMSE was estimated as 6, producing the highest sensitivity of 98% and a specificity of 87%. Preliminary findings of the study suggest the AMSE has promising psychometric properties as an assessment tool for identifying ASD symptoms and supporting diagnostic decision-making in high-risk Chinese children population.
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Affiliation(s)
- Shuran Yang
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Dong Han
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Huizhi Zhou
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Chen Yang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Kun Zhang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Shi Chen
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Runxu Yang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Xia Cao
- Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - David Grodberg
- Yale University Child Study Center, New Haven, CT, 06511, USA
| | - Xudong Zhao
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
| | - Chuanyuan Kang
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China.
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Ehteshami S, Mirzakhani Araghi N, Pashmdarfard M. Psychometric properties of Autism Spectrum Disorders Screening Assessment Tools: Systematic Review. Med J Islam Repub Iran 2023; 37:117. [PMID: 38145177 PMCID: PMC10744142 DOI: 10.47176/mjiri.37.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 12/26/2023] Open
Abstract
Background Due to the prevalence of autism spectrum disorder (ASD), these children must be screened as soon as possible and receive the necessary and appropriate treatment. The purpose of this study was to examine all the ASD screening tools and examine their psychometric properties in available languages. Methods This was a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to review the articles published between 2000 and 2023 and were published in PubMed, EMBASE, ProQuest, and Scopus databases. English keywords were as follows: autism spectrum disorders (ASD), screening/screen, tools, psychometric properties, validity, reliability, translations, pervasive developmental disorders (PDD), and children. The COnsensus -based Standards for the selection of health Measurement Instruments (COSMIN) checklist were used to investigate the psychometric properties of the studies. Results Among the 476 primary studies, 35 ASD screening tools (132 articles related to the psychometric properties of 35 ASD screening tools in different languages) were identified based on our criteria, and their psychometric properties were examined. Various tools, including performance-based, direct observation, interactive play, and parent and teacher reports tools, were included in the list of tools. Conclusion Considering that each of these tools has advantages and limitations, they need to be selected and used according to the goals of the researchers and the therapists. Another important point is that many of these tools still need more extensive studies in relation to their psychometric properties.
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Affiliation(s)
- Sahar Ehteshami
- Student Research Committee, Department of Occupational Therapy, School of
Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Mirzakhani Araghi
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Marzieh Pashmdarfard
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
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Ribeiro TC, Farhat LC, Casella EB, Graeff-Martins AS, Baron-Cohen S, Allison C, Polanczyk GV. Brazilian Portuguese Childhood Autism Spectrum Test: an investigation of the factor structure of autistic traits in school-aged children from Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:650-654. [PMID: 35724422 PMCID: PMC9851759 DOI: 10.47626/1516-4446-2022-2688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE There is limited evidence about the cross-cultural validity of autistic symptoms in school-aged children in Brazil. We used data from a large school survey to evaluate the factor structure of autism symptoms in community-dwelling children and adolescents. METHODS We translated the Childhood Autism Spectrum Test to Brazilian Portuguese and performed factor analyses to investigate the factor structure of parent-reported autistic symptoms in a large sample (n=8,571) of children/adolescents from a school survey in the metropolitan area of São Paulo. RESULTS Autistic symptoms were best conceptualized under a correlated-factors model with two factors: one predominantly characterized by social-communication symptoms and the other by symptoms of inflexible/restricted language, behaviors, and interests. CONCLUSIONS These findings provide evidence that the structure of autistic symptoms in Brazil is similar to that described in other countries, indicating the cross-cultural validity of autism in Brazil.
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Affiliation(s)
- Tatiane Cristina Ribeiro
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Luis C. Farhat
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Erasmo B. Casella
- Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Soledade Graeff-Martins
- Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Guilherme V. Polanczyk
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil,Correspondence: Guilherme V. Polanczyk, Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Departamento de Psiquiatria, Rua Dr. Ovídio Pires de Campos, 785, 1° andar, ala Sul, sala 8, CEP 05403-903, São Paulo, SP, Brazil. E-mail:
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Lizé M, Monfort C, Rouget F, Limon G, Durand G, Tillaut H, Chevrier C. Prenatal exposure to organophosphate pesticides and autism spectrum disorders in 11-year-old children in the French PELAGIE cohort. ENVIRONMENTAL RESEARCH 2022; 212:113348. [PMID: 35500857 DOI: 10.1016/j.envres.2022.113348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Organophosphate (OP) pesticides act by inhibiting acetylcholinesterase activity at synaptic junctions and have already been linked with deleterious effects on neurodevelopment, including autism spectrum disorders (ASD). OBJECTIVES To investigate the association of prenatal exposure to OP pesticides with traits related to ASD in 11-year-old children. METHODS The "Childhood Autism Spectrum Test" (CAST) parent questionnaire was used to screen for autistic traits in 792 children from the French PELAGIE cohort. Prenatal maternal urine samples were collected <19 weeks of gestation in which metabolites of organophosphate insecticides were assessed for 185 of them. Negative binomial regression models were performed to explore the association between the CAST score and 8 groups of urine components, adjusted for potential ASD risk factors. RESULTS In these urine samples, dialkylphosphates (DAP) were detected most often (>80%), terbufos and its metabolites least often (<10%). No association with ASD was found for DAP, terbufos or its metabolites. Incidence rate ratios (IRRs) increased with maternal urinary diazinon concentrations, from 1.11 (95% CI: 0.87-1.42) to 1.17 (95% CI: 0.94-1.46). Higher CAST scores were statistically significantly associated with the maternal urine samples in which chlorpyrifos or two of its metabolites (chlorpyrifos-oxon and 3,5,6-trichloro-2-pyridinol) were detected. The IRR for exposure to chlorpyrifos or chlorpyrifos-oxon was 1.27 (95%CI: 1.05-1.52) among all children, and 1.39 (95%CI: 1.07-1.82) among boys. CONCLUSION These findings suggest an increase in autistic traits among 11-year-old children in association with prenatal maternal exposure to chlorpyrifos and possibly diazinon. These associations were previously suspected in the literature, in particular for chlorpyrifos. Further work establishing the causal mechanisms behind these risk association is needed.
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Affiliation(s)
- Mathilde Lizé
- Université Rennes 1, CHU Rennes, Irset (institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000, Rennes, France.
| | - Christine Monfort
- Université Rennes 1, CHU Rennes, Irset (institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000, Rennes, France.
| | - Florence Rouget
- CHU Rennes, Université Rennes 1, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France.
| | - Gwendolina Limon
- LABOCEA (Laboratoire public Conseil, Expertise et Analyse in Brittany), F-29280, Plouzané, France.
| | - Gaël Durand
- LABOCEA (Laboratoire public Conseil, Expertise et Analyse in Brittany), F-29280, Plouzané, France.
| | - Hélène Tillaut
- Université Rennes 1, Inserm, EHESP, Irset (institut de Recherche en santé, environnement et travail), UMR_S 1085, F-35000, Rennes, France.
| | - Cécile Chevrier
- Université Rennes 1, Inserm, EHESP, Irset (institut de Recherche en santé, environnement et travail), UMR_S 1085, F-35000, Rennes, France.
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Yang HX, Zhou HY, Li Y, Cui YH, Xiang Y, Yuan RM, Lui SSY, Chan RCK. Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention deficit/hyperactivity disorder. Autism Res 2022; 15:729-739. [PMID: 35088528 DOI: 10.1002/aur.2679] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
Interoception refers to the awareness of internal physiological state. Several previous studies reported that people with autism spectrum disorders (ASD) and adults with attention-deficit/hyperactivity disorder (ADHD) have diverse patterns of interoception, but the extent of literature is limited and inconsistent. This study aimed to investigate the interoceptive accuracy (IA) in children with ASD, children with comorbid ASD and ADHD, and typically developing (TD) children with high and low levels of autistic traits. We administered the eye-tracking interoceptive accuracy task (EIAT) to 30 children with ASD, 20 children with comorbid ASD and ADHD, and 63 TD controls with high and low levels of autistic traits. Parent-report scales concerning ASD and ADHD symptoms were collected. ASD children with and without comorbid ADHD both exhibited lower IA than TD children. Reduced IA was also found in TD children with high-autistic traits relative to those with low-autistic traits. IA was negatively correlated with autistic and ADHD symptoms. Atypical cardiac interoception could be found in children with ASD. Difficulties in sensing and comprehending internal bodily signals in childhood may be related to both ASD and ADHD symptoms.
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Affiliation(s)
- Han-Xue Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ying Li
- Psychiatry Department, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Yong-Hua Cui
- Psychiatry Department, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Yang Xiang
- Research Center for Mental Health Education, Beijing Institute of Education Shijingshan Branch, Beijing, China
| | - Rong-Man Yuan
- Primary School of Jingyuan, Jingyuan School, Beijing, China
| | - Simon S Y Lui
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Liang SHY, Lee YC, Kelsen BA, Chen VCH. Health-related quality of life in mothers of children with attention deficit hyperactivity disorder in Taiwan: The roles of child, parent, and family characteristics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 113:103944. [PMID: 33836402 DOI: 10.1016/j.ridd.2021.103944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND No study has examined how child and maternal psychopathological difficulties and family factors contribute to the health-related quality of life (HRQOL) of mothers of children with attention deficit hyperactivity (ADHD). AIMS To investigate the impact of children's diagnosis of ADHD, children's and maternal psychopathology and significant sociodemographic variables of the children, parents and family on HRQOL of mothers of children with ADHD and those of children with typical development (TD) in Taiwan. METHODS AND PROCEDURES Children with ADHD (n = 257) and children with typical development (n = 324) and their mothers were recruited from a psychiatric clinic of a medical center and 10 elementary schools and four high schools in northern Taiwan. Maternal HRQOL was assessed with the World Health Organization Quality of Life - BREF, while the other factors were screened using the Chinese version of the Childhood Autism Spectrum Test for autistic traits, the Swanson, Nolan, and Pelham, version IV scale for ADHD symptoms, the Child Behavior Checklist for behavioral and emotional problems, The Center for Epidemiologic Studies Depression Scale for maternal depression and interpersonal problems, the Adult ADHD Self-report Scale for maternal ADHD symptoms, and the Family APGAR for family support. OUTCOMES AND RESULTS Mothers of children with ADHD had significantly worse HRQOL in all four domains compared with those of children with typical development. Multiple regressions found that factors consistently related to the HRQOL of mothers of children with ADHD and those of children with TD were maternal depression and perceived family support after controlling for several familial, parental and child variables. HRQOL of mothers of children with ADHD and those of children with TD was more closely related to her own and family factors rather than mother- or teacher-rated ADHD symptoms, clinical diagnosis of ADHD or psychopathology of the child. CONCLUSIONS AND IMPLICATIONS Screening for maternal HRQOL, depressive symptoms and family support systems and mental health services for mothers of children with ADHD are warranted based on these findings.
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Affiliation(s)
- Sophie Hsin-Yi Liang
- Section of Department of Child and Adolescent Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taiwan; Department of Psychiatry, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Chen Lee
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan.
| | | | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Sun X, Allison C, Wei L, Matthews FE, Auyeung B, Wu YY, Griffiths S, Zhang J, Baron-Cohen S, Brayne C. Autism prevalence in China is comparable to Western prevalence. Mol Autism 2019; 10:7. [PMID: 30858963 PMCID: PMC6394100 DOI: 10.1186/s13229-018-0246-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Autism prevalence in the West is approximately 1% of school age children. Autism prevalence in China has been reported to be lower than in the West. This is likely due to at least two reasons: (1) most studies in China only included the special school population, overlooking the mainstream school population; and (2) most studies in China have not used contemporary screening and diagnostic methods. To address this, we tested total autism prevalence (mainstream and special schools) in Jilin City, and mainstream school autism prevalence in Jiamusi and Shenzhen cities. Methods The study included a three-step process: (1) screening; (2) clinical assessment of 'screen positives' plus controls; and (3) research diagnostic assessment of those meeting clinical threshold for concerns at step 2. Prevalence estimates per 10,000 children aged 6-10 years old were weighted for study design using diagnostic criteria applied at the research assessment stage. Results In Jilin City, 77 cases of autism were identified from a total population of 7258, equating to a prevalence of 108 per 10,000 (95% confidence interval (CI) 89, 130). In Shenzhen City: 21,420 children were screened and 35 cases of autism were identified, resulting in a mainstream prevalence of 42 per 10,000 (95% CI 20-89). In Jiamusi City, 16,358 children were screened, with 10 autism cases being identified, with a mainstream prevalence of 19 per 10,000 (95% CI 10-38). Conclusions Results from Jilin City, where both mainstream and special school data were available, revealed a similar prevalence of autism in China to the West, at around 1%. Results from Shenzhen and Jiamusi cities, where only mainstream data were available, prevalence is also in line with Western estimates. In all three cities, new cases of autism were identified by the study in mainstream schools, reflecting current under-diagnosis. Non-significant variation across different cities is seen indicating the need to explore potential variation of autism across diverse Chinese regions with large sample sizes to achieve a fully robust national picture.
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Affiliation(s)
- Xiang Sun
- Cambridge Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
- Department of Psychology, The Chinese University of Hong Kong, 3rd Floor, Sino Building, Shatin, NT Hong Kong
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
| | - Liping Wei
- Centre for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871 People’s Republic of China
- National Institute of Biological Sciences, Beijing, China
| | - Fiona E. Matthews
- Institute of Health and Society, Newcastle University, Newcastle, NE4 5PL UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, EH8 9JZ UK
| | - Yu Yu Wu
- YuNing Psychiatry Clinic, YuNing Growing With You Mental Health Centre, Taipei, Taiwan
| | - Sian Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT Hong Kong
| | - Jie Zhang
- Centre for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871 People’s Republic of China
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
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Zhou H, Li C, Luo X, Wu L, Huang Y, Zhang L, Zou X, Xu X, Jiang YH, Yan W, Wang Y. Cross-Cultural Revision and Psychometric Properties of the Chinese Version of the Autism Spectrum Rating Scale (2-5 Years). Front Neurol 2018; 9:460. [PMID: 30013502 PMCID: PMC6036302 DOI: 10.3389/fneur.2018.00460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
Background: No sufficient biomarkers are available for early identification of autism in the general population. Currently, the diagnosis of ASD depends on behavioral assessments. A useful screening tool can help to detect early autistic symptoms and provide children an early opportunity for ASD-related interventions. This research aimed to assess cross-cultural adaptation and psychometric properties of the autism spectrum rating scale (ASRS) under the Chinese cultural environment. Methods: Participants were recruited from 17 kindergartens and 5 special education schools across five cities (Shanghai, Guangzhou, Changsha, Chengdu, and Harbin) in China. A total of 2,181 kindergarten children and 207 ASD cases participated in this study. Mplus 7.03 was utilized to conduct exploratory factor analysis, followed by adaptive modifications to construct the revised Chinese version of the ASRS (RC_ASRS). Results: The result showed that 62 items comprised a two-factor structure; Factor 1 (social communication, SC) included 21 items, and Factor 2 (unusual behavior, UB) included 41 items. Cronbach's alpha ranged from 0.87 to 0.91 within the RC_ASRS. The total score and the SC and UB scores were significantly higher in ASD cases than in kindergarten samples (Cohen's d ranged from 0.82 to 2.72). The total RC_ASRS score showed an area under the curve (AUC) of 0.95 (95% CI: 0.93–0.97). With a total score cut-off ≥ 60, the RC_ASRS is an excellent tool to identify ASD cases from Chinese kindergarten children (sensitivity = 88.6%, specificity = 84.5%). Conclusions: The RC_ASRS has excellent psychometric properties and is a reliable, useful tool for early ASD screening among Chinese children.
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Affiliation(s)
- Hao Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China.,Guizhou Provincial People's Hospital, Medical College of Guizhou University, Guiyang, China
| | - Chunpei Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lijie Wu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Yi Huang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Zhang
- Department of Child Health, Chengdu Women and Children's Hospital, Chengdu, China
| | - Xiaobing Zou
- Child Development Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiu Xu
- Department of Child Health, Children's Hospital of Fudan University, Shanghai, China
| | - Yong-Hui Jiang
- Division of Medical Genetics, Department of Pediatrics and Neurobiology, Duke University School of Medicine, Durham, NC, United States
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
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Zhou H, Zhang L, Luo X, Wu L, Zou X, Xia K, Wang Y, Xu X, Ge X, Jiang YH, Fombonne E, Yan W, Wang Y. Modifying the Autism Spectrum Rating Scale (6-18 years) to a Chinese Context: An Exploratory Factor Analysis. Neurosci Bull 2017; 33:175-182. [PMID: 28238114 PMCID: PMC5360853 DOI: 10.1007/s12264-017-0104-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/22/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to explore the psychometric properties of the Chinese version of the autism spectrum rating scale (ASRS). We recruited 1,625 community-based children and 211 autism spectrum disorder (ASD) cases from 4 sites, and the parents of all participants completed the Chinese version of the ASRS. A robust weighted least squares means and variance adjusted estimator was used for exploratory factor analysis. The 3-factor structure included 59 items suitable for the current sample. The item reliability for the modified Chinese version of the ASRS (MC-ASRS) was excellent. Moreover, with 60 as the cut-off point, receiver operating characteristic analysis showed that the MC-ASRS had excellent discriminate validity, comparable to that of the unmodified Chinese version (UC-ASRS), with area under the curve values of 0.952 (95% CI: 0.936-0.967) and 0.948 (95% CI: 0.930-0.965), respectively. Meanwhile, the confirm factor analysis revealed that MC-ASRS had a better construct validity than UC-ASRS based on the above factor solution in another children sample. In conclusion, the MC-ASRS shows better efficacy in epidemiological screening for ASD in Chinese children.
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Affiliation(s)
- Hao Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, 201102, China
- Pediatric Department of Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Lili Zhang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Lijie Wu
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Xiaobing Zou
- Child Development Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510000, China
| | - Kun Xia
- State Key Laboratory of Medical Genetics, Changsha, 400078, China
| | - Yimin Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiaoling Ge
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yong-Hui Jiang
- Division of Medical Genetics, Department of Pediatrics and Neurobiology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Eric Fombonne
- Institute on Development and Disability, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, 201102, China.
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Zhou H, Zhang L, Wu L, Zou X, Luo X, Xia K, Wang Y, Xu X, Ge X, Sun C, Deng H, Fombonne E, Jiang YH, Yan W, Wang Y. Validity and reliability analysis of the Chinese parent version of the Autism Spectrum Rating Scale (6-18 years). Psychiatry Res 2015; 230:255-61. [PMID: 26384573 DOI: 10.1016/j.psychres.2015.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 12/23/2022]
Abstract
This study aimed to investigate the validity and reliability of the Chinese parent version of the Autism Spectrum Rating Scale (ASRS, 6-18 years) for a general sample of Chinese children. The study involved assessing 1625 community-based subjects aged 6-12 years from four sites (Shanghai, Guangzhou, Changsha, and Harbin city) in China and 211 clinic-based participants aged 6-18 with a confirmed diagnosis of autism spectrum disorders (ASDs). The internal consistency (Cronbach's alpha) ranged from 0.585 to 0.929, and the test-retest reliability (interclass correlations) ranged from 0.542 to 0.749, indicating no significant difference between the two tests at an interval of 2-4 weeks. The construct validity was relatively excellent, and the concurrent validity with the Social Responsiveness Scale (SRS) (Pearson correlations) was 0.732 between the two total scores. Receiver operating characteristics (ROC) analyses showed excellent and comparable discriminant validity of the ASRS with respect to the SRS, with an area under the curve (AUC) of 0.9507 (95% CI: 0.93-0.97) versus 0.9703 (95% CI: 0.96-0.98), respectively. Our data suggested a cutoff ≥60 for the Chinese version of the ASRS, with good accuracy in screening autism symptoms (sensitivity=94.2%, specificity=77%). The Chinese parent version of the ASRS is therefore a reliable and valid tool for screening autistic symptoms in Chinese children in general.
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Affiliation(s)
- Hao Zhou
- No. 399, Wanyuan Road, Minhang District, Division of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Lili Zhang
- No. 399, Wanyuan Road, Minhang District, Division of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Lijie Wu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Xiaobing Zou
- Child Development Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Kun Xia
- State Key Laboratory of Medical Genetics, Changsha, China
| | - Yimin Wang
- No. 399, Wanyuan Road, Minhang District, Division of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoling Ge
- Children's Hospital of Fudan University, Shanghai, China
| | - Caihong Sun
- School of Public Health, Harbin Medical University, Harbin, China
| | - Hongzhu Deng
- Child Development Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Eric Fombonne
- Oregon Health & Science University, Portland, OR, USA
| | - Yong-Hui Jiang
- Division of Medical Genetics, Department of Pediatrics and Neurobiology, Duke University School of Medicine, USA
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.
| | - Yi Wang
- No. 399, Wanyuan Road, Minhang District, Division of Neurology, Children's Hospital of Fudan University, Shanghai, China.
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Sun X, Allison C, Auyeung B, Baron-Cohen S, Brayne C. Parental concerns, socioeconomic status, and the risk of autism spectrum conditions in a population-based study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3678-88. [PMID: 25262013 DOI: 10.1016/j.ridd.2014.07.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 05/02/2023]
Abstract
A total number of 11,635 screening packs were distributed to 5-10 year-old children in 136 schools in Cambridgeshire to investigate the associations between levels of parental concern (none/minor/strong), socioeconomic status and the risk of having Autism Spectrum Conditions (ASC). The variables for investigating associations and possible confounders were extracted for analysis, including parental concern question score, SES, age of the child, sex, maternal age at birth, paternal age at birth, mother's age of leaving education, father's age of leaving education, birth order and the number of children in the family. The SES, age of the child, sex and mother's age at leaving education were associated with parental concern. Parents with higher SES reported higher levels of concern (Chi-square = 11.8; p = 0.02). However, a higher SES was not associated with the risk of having ASC (p = 0.50). After adjusting for potential confounders, the odds of children meeting ASC criteria whose parents had reported strong parental concern were 8.5 times (odds ratio: 8.5; 95%CI: 4.5, 16.2; p < 0.001) the odds of children having ASC whose parents reported minor concern. No child met ASC criteria where parents expressed no concerns. Parents with higher social class express more concerns than those from lower social classes. However, the concerns reported by parents in higher SES did not appear to be specific for ASC as there was no relationship between ASC and SES.
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Affiliation(s)
- Xiang Sun
- Cambridge Institute of Public Health, Cambridge University School of Medicine, Forvie Site, University of Cambridge, CB2 0SR, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; The Jockey Club School of Public Health and Primary Care, Shatin, NT, Hong Kong.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK; Department of Psychology, University of Edinburgh, EH8 9JZ, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 2AH, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Cambridge University School of Medicine, Forvie Site, University of Cambridge, CB2 0SR, UK
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