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Levick S, Staples AD, Warschausky S, Huth-Bocks A, Taylor HG, Gidley Larson JC, Peterson C, Lukomski A, Lajiness-O'Neill R. [Formula: see text] Caregiver-reported infant motor and imitation skills predict M-CHAT-R/F. Child Neuropsychol 2024; 30:1035-1053. [PMID: 38275156 PMCID: PMC11272902 DOI: 10.1080/09297049.2024.2304378] [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] [Received: 05/10/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024]
Abstract
Altered motor and social-communicative abilities in infancy have been linked to later ASD diagnosis. Most diagnostic instruments for ASD cannot be utilized until 12 months, and the average child is diagnosed substantially later. Imitation combines motor and social-communicative skills and is commonly atypical in infants at risk for ASD. However, few measures have been developed to assess infant imitation clinically. One barrier to the diagnostic age gap of ASD is accessibility of screening and diagnostic services. Utilization of caregiver report to reliably screen for ASD mitigates such barriers and could aid in earlier detection. The present study developed and validated a caregiver-report measure of infant imitation at 4, 6, and 9 months and explored the relationship between caregiver-reported imitation and motor abilities with later ASD risk. Participants (N = 571) were caregivers of term and preterm infants recruited as part of a large multi-site study of PediaTrac™, a web-based tool for monitoring and tracking infant development. Caregivers completed online surveys and established questionnaires on a schedule corresponding to well-child visits from birth to 18 months, including the M-CHAT-R/F at 18 months. Distinct imitation factors were derived from PediaTrac at 4, 6, and 9 months via factor analysis. The results supported validity of the imitation factors via associations with measures of infant communication (CSBS; ASQ). Imitation and motor skills at 9 months predicted 18-month ASD risk over and above gestational age. Implications for assessment of infant imitation, detecting ASD risk in the first year, and contributing to access to care are discussed.
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Affiliation(s)
- Samantha Levick
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Angela D Staples
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Seth Warschausky
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alissa Huth-Bocks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Pediatrics, The Ohio State University, Columbus, OH, USA
| | | | - Catherine Peterson
- Pediatric Psychology and Neuropsychology, Atrium Health Levine Children's Rea Village Pediatrics, Charlotte, NC, USA
| | | | - Renée Lajiness-O'Neill
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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2
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Parikh C, Ozonoff S. Brief Report: Single and Repeat Screening with the Modified Checklist for Autism in Toddlers-Revised in Young Children at Higher Likelihood for Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06138-9. [PMID: 37906321 PMCID: PMC11058106 DOI: 10.1007/s10803-023-06138-9] [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: 09/08/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare the utility of single versus repeated autism screening in a sample at higher likelihood (HL) for ASD, following both screen positives and all screen negatives to diagnostic outcome. METHODS Using a prospective infant sibling design, the current study followed 135 toddlers at HL for ASD and conducted diagnostic evaluations on the full sample at 18, 24, and 36 months. The psychometric properties of the M-CHAT-R using both concurrent and predictive diagnostic evaluations were compared in a group screened once (at 18 months only, n = 60) or twice (at both 18 and 24 months, n = 75). The study also examined consistency in reporting of ASD symptoms across the M-CHAT-R and a developmental concerns interview, comparing the HL group to a group with lower likelihood (LL) for ASD (n = 88). RESULTS Sensitivity and specificity of the M-CHAT-R were high (75 - 95%), consistent with previous research. Positive predictive value (43 - 76%) was higher in this HL group than in previous community samples. Repeat screening improved sensitivity with little cost to specificity. At both 18 and 24 months, HL parents were more consistent in their reporting on the M-CHAT-R and a concerns interview than LL parents. CONCLUSION The M-CHAT-R has strong psychometric properties when used with groups at HL for ASD, suggesting that scores over the screening cutoff of 3 should lead to prompt diagnostic evaluation referrals in children with older siblings on the spectrum.
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Affiliation(s)
- Chandni Parikh
- Department of Psychiatry & Behavioral Sciences, MIND Institute, University of California-Davis, Davis, CA, USA.
| | - Sally Ozonoff
- Department of Psychiatry & Behavioral Sciences, MIND Institute, University of California-Davis, Davis, CA, USA
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3
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Do Autism-Specific and General Developmental Screens Have Complementary Clinical Value? J Autism Dev Disord 2022:10.1007/s10803-022-05541-y. [PMID: 35579791 PMCID: PMC10214166 DOI: 10.1007/s10803-022-05541-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18 months, reinforcing the need for recurrent screening as autism emerges in early development.
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4
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Schjølberg S, Shic F, Volkmar FR, Nordahl-Hansen A, Stenberg N, Torske T, Larsen K, Riley K, Sukhodolsky DG, Leckman JF, Chawarska K, Øien RA. What are we optimizing for in autism screening? Examination of algorithmic changes in the M-CHAT. Autism Res 2022; 15:296-304. [PMID: 34837355 PMCID: PMC8821132 DOI: 10.1002/aur.2643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
The present study objectives were to examine the performance of the new M-CHAT-R algorithm to the original M-CHAT algorithm. The main purpose was to examine if the algorithmic changes increase identification of children later diagnosed with ASD, and to examine if there is a trade-off when changing algorithms. We included 54,463 screened cases from the Norwegian Mother and Child Cohort Study. Children were screened using the 23 items of the M-CHAT at 18 months. Further, the performance of the M-CHAT-R algorithm was compared to the M-CHAT algorithm on the 23-items. In total, 337 individuals were later diagnosed with ASD. Using M-CHAT-R algorithm decreased the number of correctly identified ASD children by 12 compared to M-CHAT, with no children with ASD screening negative on the M-CHAT criteria subsequently screening positive utilizing the M-CHAT-R algorithm. A nonparametric McNemar's test determined a statistically significant difference in identifying ASD utilizing the M-CHAT-R algorithm. The present study examined the application of 20-item MCHAT-R scoring criterion to the 23-item MCHAT. We found that this resulted in decreased sensitivity and increased specificity for identifying children with ASD, which is a trade-off that needs further investigation in terms of cost-effectiveness. However, further research is needed to optimize screening for ASD in the early developmental period to increase identification of false negatives.
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Affiliation(s)
- Synnve Schjølberg
- a: Norwegian Institute of Public Health, University of Washington School of Medicine
| | - Frederick Shic
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | - Fred R. Volkmar
- c: Yale Child Study Center, The Arctic University of Norway,d: Southern Connecticut University, The Arctic University of Norway
| | | | - Nina Stenberg
- f: Oslo University Hospital, The Arctic University of Norway
| | - Tonje Torske
- g: Vestre Viken Hospital:, The Arctic University of Norway
| | | | - Katherine Riley
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | | | | | | | - Roald A. Øien
- c: Yale Child Study Center, The Arctic University of Norway,h: UiT – The Arctic University of Norway,Corresponding author tel: +4793099994, PB 6070, 9037 Tromsoe, Norway
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5
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Sturner R, Howard B, Bergmann P, Attar S, Stewart-Artz L, Bet K, Allison C, Baron-Cohen S. Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners. Mol Autism 2022; 13:2. [PMID: 34980240 PMCID: PMC8722322 DOI: 10.1186/s13229-021-00480-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.
Methods This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.
Results While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Limitations Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Conclusions Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00480-4.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA. .,Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Paul Bergmann
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,Foresight Logic, Inc., St. Paul, MN, USA
| | - Shana Attar
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,University of Washington, Seattle, WA, USA
| | - Lydia Stewart-Artz
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA
| | - Kerry Bet
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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6
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Meng Y, Xu D, Zhang W, Meng W, Lan X, Wang X, Li M, Zhang X, Zhao Y, Yang H, Zhang R, Zhen Z. Effect of Early Swimming on the Behavior and Striatal Transcriptome of the Shank3 Knockout Rat Model of Autism. Neuropsychiatr Dis Treat 2022; 18:681-694. [PMID: 35387206 PMCID: PMC8979754 DOI: 10.2147/ndt.s357338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a developmental disorder characterized by social behavior deficits and stereotyped behaviors in childhood that lacks satisfactory medical intervention. Early swimming intervention is a noninvasive method combining enriched environment and exercise, which has been proven to improve brain development in young children and to treat neurodevelopmental diseases. METHODS In this study, we tested the autism-like behavior of rats with deletions in exons 11-21 of the Shank3 gene and evaluated the effect of early swimming intervention (from postnatal day 8 to 60) on the behavior of this animal model of autism. In addition, the transcriptomes of the striatal tissues of wild-type, Shank3 knockout and Shank3 knockout swimming groups rats were analyzed. RESULTS Shank3 knockout rats exhibit core symptoms of autism, and early swimming improved the social and stereotyped behaviors in this autism rat model. Transcriptomics results revealed that compared to the wild-type group, 291 differentially expressed genes (DEGs) were identified in the striatum of the Shank3 knockout group. Compared to Shank3 knockout group, 534 DEGs were identified in the striatum of Shank3 knockout swimming group. The DEGs annotated by Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway shows that the impacts of Shank3 deletion were primarily reflected in synaptic structure, development, morphology, receptor function and signaling, and swimming primarily changed the terms related to the synapses in the striatum of Shank3 knockout rats, including the morphology, structure, composition, development and regulation of synapses. CONCLUSION Early swimming intervention can ameliorate behavioral abnormalities caused by Shank3 knockout, by a mechanism that may involve the process of striatal synaptic development and should be further investigated.
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Affiliation(s)
- Yunchen Meng
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Dan Xu
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Weinan Zhang
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Wenshu Meng
- College of Life Sciences, Beijing Normal University, Beijing, People's Republic of China
| | - Xingyu Lan
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, People's Republic of China
| | - Xiaoxi Wang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, People's Republic of China
| | - Mingjuan Li
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, People's Republic of China
| | - Xiaoyan Zhang
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Yu Zhao
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Haodong Yang
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
| | - Rong Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, People's Republic of China.,Neuroscience Research Institute, Peking University, Beijing, People's Republic of China.,Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, People's Republic of China.,Autism Research Center of Peking University Health Science Center, Beijing, People's Republic of China
| | - Zhiping Zhen
- College of P.E and Sports, Beijing Normal University, Beijing, People's Republic of China
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7
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Wieckowski AT, Thomas RP, Chen CMA, Zitter A, Fein DA, Barton ML, Adamson LB, Robins DL. Effect of Brief Training to Identify Autism Spectrum Disorder During Toddler Well-Child Care Visits. J Dev Behav Pediatr 2021; 42:666-671. [PMID: 34618724 PMCID: PMC8497937 DOI: 10.1097/dbp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of a brief Enhanced training using the information-motivation-behavior (IMB) change model on improving providers' surveillance rates and accuracy of autism spectrum disorder (ASD) detection. METHOD Toddlers (n = 5,672) were screened for ASD during their pediatric well-child visits. Pediatric providers (n = 120) were randomized to receive Enhanced (incorporating components of the IMB model) or Control training. Providers indicated whether they had an ASD concern at each well-child visit. Toddlers who were positive on any screener and/or whose provider indicated ASD concern were invited for a diagnostic evaluation. Differences in provider-indicated ASD concerns before and after training were evaluated using log-linear analyses. RESULTS The Enhanced training did not have a significant effect on provider-endorsed ASD concerns (p = 0.615) or accuracy of endorsing concerns (p = 0.619). Providers in the Control training showed a significant reduction in indicating whether or not they had concerns after the training (from 71.9% to 64.3%), which did not occur in the Enhanced group. The Enhanced training led to more frequent endorsements of language (χ2 = 8.772, p = 0.003) and restricted and repetitive behavior (χ2 = 7.918, p = 0.005) concerns for children seen after training. CONCLUSION Provider training had limited impact on ASD surveillance, indicating the importance of using formal screening instruments that rely on parent report during well-child visits to complement developmental surveillance. Future research should examine whether providers who indicate specific concerns are more likely to accurately refer children for ASD evaluations.
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Affiliation(s)
| | - Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Chi-Ming A. Chen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Deborah A. Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Marianne L. Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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8
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Wetherby AM, Guthrie W, Hooker JL, Delehanty A, Day TN, Woods J, Pierce K, Manwaring SS, Thurm A, Ozonoff S, Petkova E, Lord C. The Early Screening for Autism and Communication Disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2112-2123. [PMID: 33962531 PMCID: PMC8418999 DOI: 10.1177/13623613211012526] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT There is a critical need for accurate screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. However, there are few screeners designed for children 18-24 months. Developing screeners that pick up on the signs of autism spectrum disorder in very young children has proved even more challenging. In this study, we examined a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children between 12 and 36 months of age. Field-testing was done in five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was tested in three age groups: 12-17, 18-23, and 24-36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Analyses examined all 46 items and identified 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Cutoffs were established for each age group with good sensitivity and specificity. Results provide preliminary support for the accuracy of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12-36 months with elevated risk of communication delay or autism spectrum disorder.
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9
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Abstract
This article describes the current understanding of the identification, classification, and diagnosis of autism spectrum disorder (ASD) as it relates to the practice of primary care providers. In addition, the most updated information regarding risk factors, as well as effective treatment strategies are provided. Although primary care providers are not typically the experts in ASD treatment, they constitute a critical component of the care team responsible for early identification and intervention initiation for patients with ASD.
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Affiliation(s)
- Ashley Iles
- 215 Central Avenue Suite 100, Louisville, KY 40208, USA.
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10
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2020 International Neuroethics Society Annual Meeting Top Abstracts. AJOB Neurosci 2021; 15:1-23. [PMID: 34060979 DOI: 10.1080/21507740.2021.1917726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Stenberg N, Schjølberg S, Shic F, Volkmar F, Øyen AS, Bresnahan M, Svendsen BK, von Tetzchner S, Thronæs NT, Macari S, Cicchetti DV, Chawarska K, Suren P, Øien RA. Functional Outcomes of Children Identified Early in the Developmental Period as at Risk for ASD Utilizing the The Norwegian Mother, Father and Child Cohort Study (MoBa). J Autism Dev Disord 2021; 51:922-932. [PMID: 32424708 PMCID: PMC7954713 DOI: 10.1007/s10803-020-04539-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Early identification of autism spectrum disorder (ASD) is regarded as crucial for swift access to early intervention and, subsequently, better outcomes later in life. However, current instruments miss large proportions of children who later go on to be diagnosed with ASD, raising a question of what these instruments measure. The present study utilized data from the Norwegian Mother, Father, and Child Cohort Study and the Autism Birth Cohort study to explore the subsequent developmental and diagnostic characteristics of children raising developmental concern on the six-critical discriminative item criterion of the M-CHAT (DFA6) at 18 months of age (N = 834). The DFA6 identified 28.8% of children diagnosed with ASD (N = 163), but 4.4% with language disorder (N = 188) and 81.3% with intellectual disability (N = 32) without ASD. Scoring in the «at-risk» range was associated with lower IQ, impaired functional language, and greater severity of autism symptoms whether children had ASD or not.
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Affiliation(s)
| | | | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Fred Volkmar
- School of Medicine, Child Study Center, Yale University, New Haven, USA
| | - Anne-Siri Øyen
- Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway
| | | | | | | | - Nina Torheim Thronæs
- Department of Education, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway
| | - Suzanne Macari
- School of Medicine, Child Study Center, Yale University, New Haven, USA
| | | | | | - Pål Suren
- Norwegian Institute of Public Health, Oslo, Norway
| | - Roald A Øien
- Department of Education, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway.
- School of Medicine, Child Study Center, Yale University, New Haven, USA.
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12
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Øien RA, Vivanti G, Robins DL. Editorial S.I: Early Identification in Autism Spectrum Disorders: The Present and Future, and Advances in Early Identification. J Autism Dev Disord 2021; 51:763-768. [PMID: 33483912 PMCID: PMC7954717 DOI: 10.1007/s10803-020-04860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
Early identification of autism spectrum disorder (ASD) is considered by most scholars and clinicians to be a feasible and useful step for improving the wellbeing of individuals on the autism spectrum and their families. Arguments supporting early detection efforts include the benefit of earlier access to services providing autism-specific evidence-based interventions (Vivanti et al., Journal of Autism and Developmental Disorders, 46(7), 2441-2449, 2016; Zwaigenbaum et al., Pediatrics, 136(Suppl), S10-S40, 2015), and its potential to mitigate or even prevent the challenges associated with ASD symptoms, reduce care costs, and improve the quality of life and productivity of individuals with ASD (Constantino et al., Pediatrics, 146(3), e20193629, 2020; Jacobson et al., Behavioral Interventions, 13(4), 201-226, 1998; Jacobson and Mulick, Journal of Autism and Developmental Disorders, 30(6), 585-593, 2000). Nevertheless, controversies and challenges in this field exist.
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Affiliation(s)
- Roald A Øien
- Child Study Center, Yale University School of Medicine, New Haven, CT, 06520, USA.
- Department of Education, UiT-The Arctic University of Norway, Tromsø, Norway.
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13
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Allison C, Matthews FE, Ruta L, Pasco G, Soufer R, Brayne C, Charman T, Baron-Cohen S. Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism. BMJ Paediatr Open 2021; 5:e000700. [PMID: 34131593 PMCID: PMC8166626 DOI: 10.1136/bmjpo-2020-000700] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/22/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This is a prospective population screening study for autism in toddlers aged 18-30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4. DESIGN Observational study. SETTING Luton, Bedfordshire and Cambridgeshire in the UK. PARTICIPANTS 13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18-30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4. INTERVENTIONS A stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT. MAIN OUTCOME MEASURES Consensus diagnostic outcome at phase 1 and phase 2. RESULTS At phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2. CONCLUSIONS The Q-CHAT can be used at 18-30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4-5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.
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Affiliation(s)
- Carrie Allison
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Liliana Ruta
- Institute for Biomedical Research and Innovation (IRIB) - National Research Council of Italy (CNR), Messina, Italy
| | - Greg Pasco
- Dept of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Renee Soufer
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Tony Charman
- Dept of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Baron-Cohen
- Psychiatry Department, Autism Research Centre, University of Cambridge, Cambridge, UK
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14
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Wang X, Ding R, Song Y, Wang J, Zhang C, Han S, Han J, Zhang R. Transcutaneous Electrical Acupoint Stimulation in Early Life Changes Synaptic Plasticity and Improves Symptoms in a Valproic Acid-Induced Rat Model of Autism. Neural Plast 2020; 2020:8832694. [PMID: 33456456 PMCID: PMC7787794 DOI: 10.1155/2020/8832694] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/12/2020] [Indexed: 01/30/2023] Open
Abstract
Autism spectrum disorder (ASD) is a developmental disorder characterized by social behavior deficit in childhood without satisfactory medical intervention. Transcutaneous electrical acupoint stimulation (TEAS) is a noninvasive technique derived from acupuncture and has been shown to have similar therapeutic effects in many diseases. Valproic acid- (VPA-) induced ASD is a known model of ASD in rats. The therapeutic efficacy of TEAS was evaluated in the VPA model of ASD in the present study. The offspring of a VPA-treated rat received TEAS in the early life stage followed by a series of examinations conducted in their adolescence. The results show that following TEAS treatment in early life, the social and cognitive ability in adolescence of the offspring of a VPA rat were significantly improved. In addition, the abnormal pain threshold was significantly corrected. Additional studies demonstrated that the dendritic spine density of the primary sensory cortex was decreased with Golgi staining. Results of the transcriptomic study showed that expression of some transcription factors such as the neurotrophic factor were downregulated in the hypothalamus of the VPA model of ASD. The reduced gene expression was reversed following TEAS. These results suggest that TEAS in the early life stage may mitigate disorders of social and recognition ability and normalize the pain threshold of the ASD rat model. The mechanism involved may be related to improvement of synaptic plasticity.
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Affiliation(s)
- Xiaoxi Wang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Rui Ding
- Department of Bioinformatics, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yayue Song
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Juan Wang
- Department of Bioinformatics, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Chen Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Songping Han
- Wuxi HANS Health Medical Technology Co., Ltd., Wuxi, China
| | - Jisheng Han
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Rong Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
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15
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Pasco G, Davies K, Ribeiro H, Tucker L, Allison C, Baron-Cohen S, Johnson MH, Charman T. Comparison of Parent Questionnaires, Examiner-Led Assessment and Parents' Concerns at 14 Months of Age as Indicators of Later Diagnosis of Autism. J Autism Dev Disord 2019; 51:804-813. [PMID: 31845131 PMCID: PMC7954743 DOI: 10.1007/s10803-019-04335-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents participating in a prospective longitudinal study of infants with older siblings with autism completed an autism screening questionnaire and were asked about any concerns relating to their child’s development, and children were administered an interactive assessment conducted by a researcher at 14 months. Scores on the parent questionnaire were highest for children later diagnosed with autism. Parental concerns and scores from the examiner-led assessment distinguished children with later developmental difficulties (both autism and other developmental atypicalities) from those who were developing typically. Children about whom parents expressed concern scored higher on both the questionnaire and the interactive assessment than those without concerns. There were no significant associations between total or individual item scores from the questionnaire and interactive assessment.
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Affiliation(s)
- Greg Pasco
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Kim Davies
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Helena Ribeiro
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Leslie Tucker
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tony Charman
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF, UK
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16
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Ip A, Dupuis A, Anagnostou E, Loh A, Dodds T, Munoz A, Smile S. General paediatric practice in autism spectrum disorder screening in Ontario, Canada: Opportunities for improvement. Paediatr Child Health 2019; 26:e33-e38. [PMID: 33542776 DOI: 10.1093/pch/pxz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Screening is important for early identification of children with autism spectrum disorder (ASD), potentially leading to earlier intervention. Research has identified some barriers to early identification of ASD, however, information about ASD screening in Canadian general paediatric practice is lacking. Objectives The aim of the study is to better understand ASD screening practice patterns by examining the use of ASD and general developmental screening tools by general paediatricians. Methods The research team conducted a cross-sectional survey of general paediatricians. Results Two-hundred and sixty-seven paediatricians responded and 132 were eligible for the study. Ninety-three per cent of the responders used a developmental screening tool. Eighty-five per cent of the responders used an ASD screening tool when there were concerns for ASD, and 15% never used one. The most commonly used ASD screening tool was the M-CHAT. Children suspected of having ASD were referred to specialists not only to confirm the diagnosis but also to facilitate access to resources. General paediatricians were keen to incorporate formal ASD screening tools in their practice but identified the need for clearer guidelines. Conclusion Previous studies have shown that children at risk of ASD continue to be missed through developmental surveillance and targeted screening. Paediatricians are interested in implementing an ASD screening tool and cite brevity and forms that can be completed by parents as factors that would support the use of a screening tool. Clearer guidelines and tools to support ASD screening and access to resources are needed.
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Affiliation(s)
- Angie Ip
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of British Columbia, Vancouver, British Columbia
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Evdokia Anagnostou
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
| | - Alvin Loh
- Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario.,Surrey Place Centre, Toronto, Ontario
| | - Tyler Dodds
- Bloorview Research Institute, Toronto, Ontario
| | | | - Sharon Smile
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
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17
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Ruta L, Chiarotti F, Arduino GM, Apicella F, Leonardi E, Maggio R, Carrozza C, Chericoni N, Costanzo V, Turco N, Tartarisco G, Gagliano A, Allison C, Baron Cohen S, Pioggia G, Muratori F. Validation of the Quantitative Checklist for Autism in Toddlers in an Italian Clinical Sample of Young Children With Autism and Other Developmental Disorders. Front Psychiatry 2019; 10:488. [PMID: 31427993 PMCID: PMC6690232 DOI: 10.3389/fpsyt.2019.00488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background: The Quantitative Checklist for Autism in Toddlers (Q-CHAT) is parent-report screening questionnaire for detecting threshold and sub-threshold autistic features in toddlers. The Q-CHAT is a dimensional measure normally distributed in the general population sample and is able to differentiate between a group of children with a diagnosis of autism and unselected toddlers. Objectives: We aim to investigate the psychometric properties, score distribution, and external validity of the Q-CHAT in an Italian clinical sample of young children with autism versus children with developmental delay and typically developing children. Method: N = 126 typically developing children (TD), n = 139 children with autism, and n = 50 children presenting developmental delay (DD) were administered the Q-CHAT. Standardized measures of cognitive functions, language, and behaviors were also obtained. Results: The Q-CHAT scores were normally distributed and demonstrated adequate internal consistency and good item to total score correlations. The mean Q-CHAT score in the autism group was significantly higher than those found in the DD sample and TD children. No difference on the mean Q-CHAT score between DD and TD children was found. The accuracy of the Q-CHAT to discriminate between autism and TD was very good. Two different cut-points (27 and 31, respectively) maximized sensitivity and specificity for autism versus TD and DD, respectively. Finally, higher Q-CHAT scores were correlated with lower language and social communication skills. Conclusions: In clinical settings, the Q-CHAT demonstrated good psychometric properties and external validity to discriminate autism children not just from children with typical development but also from children with developmental delay.
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Affiliation(s)
- Liliana Ruta
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy.,Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, National Institute of Health, Rome, Italy
| | | | - Fabio Apicella
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Elisa Leonardi
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | | | - Cristina Carrozza
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | - Natasha Chericoni
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Valeria Costanzo
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Nazarena Turco
- Centro Autismo e Sindrome di Asperger ASLCN1, Mondovì, Italy
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | | | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Simon Baron Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | - Filippo Muratori
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.,University of Pisa, Pisa, Italy
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18
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Øien RA, Schjølberg S, Volkmar FR, Shic F, Cicchetti DV, Nordahl-Hansen A, Stenberg N, Hornig M, Havdahl A, Øyen AS, Ventola P, Susser ES, Eisemann MR, Chawarska K. Clinical Features of Children With Autism Who Passed 18-Month Screening. Pediatrics 2018; 141:e20173596. [PMID: 29784756 DOI: 10.1542/peds.2017-3596] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.
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Affiliation(s)
- Roald A Øien
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway;
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Synnve Schjølberg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fred R Volkmar
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Frederick Shic
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Domenic V Cicchetti
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Nina Stenberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mady Hornig
- Department of Epidemiology, and
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexandra Havdahl
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anne-Siri Øyen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway; and
| | - Pamela Ventola
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Ezra S Susser
- Department of Epidemiology, and
- New York State Psychiatric Institute, New York, New York
| | - Martin R Eisemann
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Katarzyna Chawarska
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
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19
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Marvin AR, Marvin DJ, Lipkin PH, Law JK. Analysis of Social Communication Questionnaire (SCQ) Screening for Children Less Than Age 4. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017; 4:137-144. [PMID: 29188169 PMCID: PMC5684265 DOI: 10.1007/s40474-017-0122-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
PURPOSE OF REVIEW The Social Communication Questionnaire (SCQ) is a screener for Autism spectrum disorder (ASD) validated for age 4.0 +. There is a clinical need for an ASD screener for children beyond the 30-month age limit of the M-CHAT-R/F. We evaluate the literature on the use of the SCQ in children < 4.0 years. RECENT FINDINGS Recent studies have used very large samples; included typically developing children, rather than just those with developmental disorders; compared the SCQ Lifetime and Current versions; and increased scrutiny of internal validity. SUMMARY The sensitivity-specificity balance in distinguishing between ASD and other developmental disorders is poor, which has led to development of abbreviated versions of the SCQ; however, sensitivity-specificity balance is better in a more general population. The SCQ Lifetime (not Current) version should be used. Future research relating should focus on further validation of the SCQ as a screener for children 30-48 months.
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Affiliation(s)
- Alison R. Marvin
- Department of Medical Informatics, Kennedy Krieger Institute, 3825 Greenspring Avenue, Baltimore, MD 21209 USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Daniel J. Marvin
- Department of Medical Informatics, Kennedy Krieger Institute, 3825 Greenspring Avenue, Baltimore, MD 21209 USA
| | - Paul H. Lipkin
- Department of Medical Informatics, Kennedy Krieger Institute, 3825 Greenspring Avenue, Baltimore, MD 21209 USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Department of Medical Informatics, Kennedy Krieger Institute, 733 N Broadway, Baltimore, MD 21205 USA
| | - J. Kiely Law
- Department of Medical Informatics, Kennedy Krieger Institute, 3825 Greenspring Avenue, Baltimore, MD 21209 USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Department of Medical Informatics, Kennedy Krieger Institute, 733 N Broadway, Baltimore, MD 21205 USA
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20
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Use of an Online Clinical Process Support System as an Aid to Identification and Management of Developmental and Mental Health Problems. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017; 4:108-117. [PMID: 29545988 DOI: 10.1007/s40474-017-0124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Recent findings Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening. An online clinical process support system (CHADIS) shows promise in addressing these issues. Summary Use of a comprehensive panel of online pre-visit screens; linked decision support to provide moment-of-care training; and post-visit activities and resources for patient-specific education, monitoring and care coordination is an efficient way to make the entire process of screening and follow up care feasible in primary care. CHADIS fulfills these requirements and provides Maintenance of Certification credit to physicians as well as added income for screening efforts.
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21
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Sturner R, Howard B, Bergmann P, Stewart L, Afarian TE. Comparison of Autism Screening in Younger and Older Toddlers. J Autism Dev Disord 2017; 47:3180-3188. [PMID: 28733850 PMCID: PMC5711534 DOI: 10.1007/s10803-017-3230-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the effect of age at completion of an autism screening test on item failure rates contrasting older (>20 months) with younger (<20 months) toddlers in a community primary care sample of 73,564 children. Items related to social development were categorized into one of three age sets per criteria from Inada et al. (Research in Autism Spectrum Disorders 4(4):605-611, 2010). Younger toddlers produced higher rates of item failure than older toddlers and items in both of the later acquired item sets had higher probability rates for failure than the earliest acquired item set (prior to 8 months). Use of the same items and the same scoring throughout the target age range for autism screening may not be the best strategy for identifying the youngest toddlers at risk for autism.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Bergmann
- Foresight Logic, Inc., Saint Paul, MN, USA
- PrairieCare Institute, Minneapolis, MN, USA
| | - Lydia Stewart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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