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Husebye ESN, Romanowska J, Bjørke-Monsen AL, Gilhus NE, Selmer K, Gervin K, Riedel B, Bjørk MH. Does maternal genetic liability to folate deficiency influence the risk of antiseizure medication-associated language impairment and autistic traits in children of women with epilepsy? Am J Clin Nutr 2023:S0002-9165(23)63922-X. [PMID: 37217097 PMCID: PMC10375495 DOI: 10.1016/j.ajcnut.2023.05.023] [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: 01/26/2023] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Prenatal exposure to antiseizure medication (ASM) may lead to low plasma folate concentrations and is associated with impaired neurodevelopment. OBJECTIVE To examine whether maternal genetic liability to folate deficiency interacts with ASM-associated risk of language impairment and autistic traits in children of women with epilepsy. METHODS We included children of women with and without epilepsy and with available genetic data enrolled in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Information on ASM use, folic acid supplement use and dose, dietary folate intake, child autistic traits, and child language impairment was obtained from parent-reported questionnaires. Using logistic regression, we examined the interaction between prenatal ASM exposure and maternal genetic liability to folate deficiency expressed as polygenic risk score (PRS) of low folate concentrations or maternal rs1801133 genotype (CC or CT/TT) on risk of language impairment or autistic traits. RESULTS We included 96 children of women with ASM-treated epilepsy, 131 children of women with ASM-untreated epilepsy, and 37,249 children of women without epilepsy. The PRS of low folate concentrations or the maternal rs1801133 genotype did not interact with the ASM-associated risk of language impairment or autistic traits in ASM-exposed children of women with epilepsy compared to ASM-unexposed children aged 1.5-8 years. ASM-exposed children had increased risk of adverse neurodevelopment regardless of maternal rs1801133 genotype (adjusted odds ratio (aOR) for language impairment age 8 years was 2.88 (95% confidence interval (CI) 1.00-8.26) if CC and aOR 2.88 (CI 1.10-7.53) if CT/TT genotypes). In children of women without epilepsy aged 3 years, those with maternal rs1801133 CT/TT compared to CC genotype had increased risk of language impairment (aOR 1.18, CI 1.05-1.34). CONCLUSIONS In this cohort of pregnant women reporting widespread use of folic acid supplements, maternal genetic liability to folate deficiency did not significantly influence the ASM-associated risk of impaired neurodevelopment.
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Affiliation(s)
| | - Julia Romanowska
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anne-Lise Bjørke-Monsen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kaja Selmer
- National Center for Epilepsy, Oslo University Hospital, Oslo; Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo
| | - Kristina Gervin
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo; Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo
| | - Bettina Riedel
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway
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A Parental-Report Questionnaire for Language Abilities and Pragmatics in Children and Adolescents with Autism Spectrum Disorders. Brain Sci 2023; 13:brainsci13020196. [PMID: 36831739 PMCID: PMC9953798 DOI: 10.3390/brainsci13020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to test and validate a parental-report questionnaire, which assesses language abilities and pragmatics, in children with Autism Spectrum Disorders (ASD). We report two experiments: The first served as the initial test and the second sought to provide the first assessment of convergent validity. In total, we recruited 230 parents, where approximately two-thirds had a child with ASD. Results of factor analyses showed a consistent factor structure within each subscale, and the internal consistency was excellent for both sub-scales (Cronbach's alpha >0.90). Convergent validity was assessed by correlating the results of the questionnaire with two sub-scales of the Autism Quotient questionnaire. The correlations were all greater than 0.60. The final version of the questionnaire (following exclusion of problematic items) contains 30 items (12 for language abilities and 18 for pragmatics). We conclude that the questionnaire is a concise and practical instrument for use in a variety of contexts for assessing language functioning and communication in children with ASD.
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Liu SY, Wang X, Chen Q, Chen JJ, Jin CK, Zhan XL, Guo CH, Li XH, Lin LZ, Jing J. The validity and reliability of the simplified Chinese version of the Social Communication Questionnaire. Autism Res 2022; 15:1732-1741. [PMID: 35403828 DOI: 10.1002/aur.2726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/28/2022] [Accepted: 04/03/2022] [Indexed: 12/27/2022]
Abstract
This study aims to validate the simplified Chinese version of the Social Communication Questionnaire (SCQ) in children aged 2-12 years from both general and clinical populations. We recruited 819 Chinese children in this study, including 505 typically developing (TD) children, 202 children with autism spectrum disorder (ASD) and 112 children with non-ASD neurodevelopmental disorders. All the children's parents completed the simplified Chinese version of the SCQ and all children with ASD were additionally assessed for intelligence and the Childhood Autism Rating Scale to confirm their diagnosis. We have developed a 40-item, 4-factor structure of SCQ with two domains (social communication and social interaction; and restricted, repetitive, and stereotyped patterns of behavior), which showed adequate goodness of fit (comparative fit index [CFI] = 0.96, Tucker-Lewis index [TLI] = 0.95, standardized root mean squared residual [SRMR] = 0.07, root mean square error of approximation [RMSEA] = 0.05), with good internal consistency (Cronbach's alpha = 0.92). We have provided different cut-offs to distinguish ASD cases from TD children (11 for children under 4 years [sensitivity: 0.96, specificity: 0.95], 12 for children 4 years and above [sensitivity: 0.93, specificity: 0.98]) or children with other neurodevelopmental disorders (14 [sensitivity: 0.85, specificity: 0.88]). Through this large sample validation, we confirmed that the simplified Chinese version of the SCQ could be used for children aged 2-12 years with relatively good psychometric properties. LAY SUMMARY: We aimed to develop the simplified Chinese version of the Social Communication Questionnaire (SCQ) for Chinese children aged 2-12 years as a screening tool to identified potential risk of autism spectrum disorder (ASD). We have developed a 40-item, 4-factor structure of SCQ with two domains, which showed adequate goodness of fit and good psychometric properties. We also provided different cut-offs to identify ASD cases in general or clinical populations.
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Affiliation(s)
- Si-Yu Liu
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin Wang
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiang Chen
- Department of Child Psychological Health, Zhuhai Women and Children's Hospital, Zhuhai, Guangdong, China
| | - Jia-Jie Chen
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cheng-Kai Jin
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Ling Zhan
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cui-Hua Guo
- Child Health Care Institute, Dongguan Children's Hospital, Dongguan, Guangdong, China
| | - Xiu-Hong Li
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jin Jing
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Hofer J, Tillmann J, Salzmann J, Bölte S, Fellinger J, Holzinger D. Screening for autism spectrum disorder in deaf adults with intellectual disability: Feasibility and accuracy of two autism screening instruments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104167. [PMID: 34998116 DOI: 10.1016/j.ridd.2021.104167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is a lack of autism screening instruments for deaf or hard of hearing (DHH) adults with intellectual disability. AIMS This study examined the diagnostic validity of the Pervasive Developmental Disorder in Mental Retardation Scale and the Diagnostic Behavioral Assessment for autism spectrum disorder - Revised in this rare population. METHODS AND PARTICIPANTS 56 DHH adults with intellectual disability living in three specialized therapeutic communities were examined, 9 of whom met criteria for autism. OUTCOMES AND RESULTS With minimal adaptions regarding item interpretation, both tools showed good diagnostic and high convergent validity. Items probing for difficulties in reciprocal social interaction and restricted interests were discriminant between individuals with and without autism. CONCLUSION These data suggest that both autism screening tools are feasible and psychometrically sound when used with appropriate adaptations for DHH adults with intellectual disability.
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Affiliation(s)
- J Hofer
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria; Institute of Neurology of Language and Senses, Hospital of St. John of God, Linz, Austria; Department of Pediatrics I, Medical University of Innsbruck, Austria
| | - J Tillmann
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria
| | - J Salzmann
- Institute of Neurology of Language and Senses, Hospital of St. John of God, Linz, Austria
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institute & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - J Fellinger
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria; Institute of Neurology of Language and Senses, Hospital of St. John of God, Linz, Austria; Division of Social Psychiatry, University Clinic for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - D Holzinger
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria; Institute of Neurology of Language and Senses, Hospital of St. John of God, Linz, Austria; Institute of Linguistics, University of Graz, Graz, Austria.
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Husebye ESN, Wendel AWK, Gilhus NE, Riedel B, Bjørk MH. Plasma unmetabolized folic acid in pregnancy and risk of autistic traits and language impairment in antiseizure medication-exposed children of women with epilepsy. Am J Clin Nutr 2022; 115:1432-1440. [PMID: 34994378 PMCID: PMC9071448 DOI: 10.1093/ajcn/nqab436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fetal exposure to unmetabolized folic acid (UMFA) during pregnancy may be associated with adverse neurodevelopment. Antiseizure medication (ASM) may interact with folate metabolism. Women with epilepsy using ASM are often recommended high-dose folic acid supplement use during pregnancy. OBJECTIVES The aim was to determine the association between UMFA concentrations in pregnant women with epilepsy using ASM and risk of autistic traits or language impairment in their children aged 1.5-8 y. METHODS We included children of women with epilepsy using ASM and with plasma UMFA measurement enrolled in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Data on ASM use, folic acid supplement use, autistic traits, and language impairment were obtained from parent-reported questionnaires during pregnancy and when the child was 1.5, 3, 5, and 8 y old. Plasma UMFA concentrations were measured during gestational weeks 17-19. RESULTS A total of 227 ASM-exposed children of 203 women with epilepsy were included. Response rates at ages 1.5, 3, 5, and 8 y were 67% (n = 151), 54% (n = 122), 36% (n = 82), and 37% (n = 85), respectively. For 208 (94%) children, the mother reported intake of folic acid supplement. There was no association between UMFA concentrations and autistic traits score in the adjusted multiple regression analyses at age 3 y (unstandardized B: -0.01; 95% CI: -0.03, 0.004) or 8 y (unstandardized B: 0.01; 95% CI: -0.02, 0.03). Children exposed to UMFA had no increased risk of autistic traits at age 3 y [adjusted OR (aOR): 0.98; 95% CI: 0.2, 4.2] or 8 y (aOR: 0.1; 95% CI: 0.01, 1.4) compared with unexposed children. We found no association between UMFA concentrations and language impairment in children aged 1.5-8 y. CONCLUSIONS Our findings do not support any adverse neurodevelopmental effects of UMFA exposure in utero in children of women with epilepsy using ASM.
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Affiliation(s)
| | | | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen,
Bergen, Norway,Department of Neurology, Haukeland University Hospital,
Bergen, Norway
| | - Bettina Riedel
- Department of Medical Biochemistry and Pharmacology, Haukeland University
Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen,
Bergen, Norway
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen,
Bergen, Norway,Department of Neurology, Haukeland University Hospital,
Bergen, Norway
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Ganesh K, Umapathy S, Thanaraj Krishnan P. Deep learning techniques for automated detection of autism spectrum disorder based on thermal imaging. Proc Inst Mech Eng H 2021; 235:1113-1127. [PMID: 34105405 DOI: 10.1177/09544119211024778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with autism spectrum disorder have impairments in emotional processing which leads to the inability in recognizing facial expressions. Since emotion is a vital criterion for having fine socialisation, it is incredibly important for the autistic children to recognise emotions. In our study, we have chosen the facial skin temperature as a biomarker to measure emotions. To assess the facial skin temperature, the thermal imaging modality has been used in this study, since it has been recognised as a promising technique to evaluate emotional responses. The aim of this study was the following: (1) to compare the facial skin temperature of autistic and non-autistic children by using thermal imaging across various emotions; (2) to classify the thermal images obtained from the study using the customised convolutional neural network compared with the ResNet 50 network. Fifty autistic and fifty non-autistic participants were included for the study. Thermal imaging was used to obtain the temperature of specific facial regions such as the eyes, cheek, forehead and nose while we evoked emotions (Happiness, anger and sadness) in children using an audio-visual stimulus. Among the emotions considered, the emotion anger had the highest temperature difference between the autistic and non-autistic participants in the region's eyes (1.9%), cheek (2.38%) and nose (12.6%). The accuracy obtained by classifying the thermal images of the autistic and non-autistic children using Customised Neural Network and ResNet 50 Network was 96% and 90% respectively. This computer aided diagnostic tool can be a predictable and a steadfast method in the diagnosis of the autistic individuals.
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Affiliation(s)
- Kavya Ganesh
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Snekhalatha Umapathy
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Palani Thanaraj Krishnan
- Department of Electronics and Instrumentation Engineering, St. Joseph's College of Engineering, Anna University, Chennai, Tamil Nadu, India
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Finkelman MD, Wei T, Lowe SR. Computer-Based Testing to Shorten the Social Communication Questionnaire (SCQ): a Proof- of-Principle Study of the Lifetime and Current Forms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kennedy-Williams P, Care H, Dalton L, Horton J, Kearney A, Rooney N, Hotton M, Pinckston M, Huggons E, Culshaw L, Kilcoyne S, Johnson D, Wilkie AOM, Wall S. Neurodevelopmental, Cognitive, and Psychosocial Outcomes for Individuals With Pathogenic Variants in the TCF12 Gene and Associated Craniosynostosis. J Craniofac Surg 2021; 32:1263-1268. [PMID: 33904513 DOI: 10.1097/scs.0000000000007535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Heterozygous mutations in the TCF12 gene were discovered in 2013 as a cause of craniosynostosis (CS). However, limited information regarding the behavioral phenotypic profile is available. Here the authors provide the first detailed study of the neurodevelopmental, cognitive, and psychosocial outcomes for patients with a pathogenic TCF12 variant and associated CS.A clinical casenote audit was conducted at the 4 UK highly specialized craniofacial centers. A total of 35 patients aged 18 months to 10 years with an identified TCF12 pathogenic variant and CS (bicoronal CS = 45.7%, unicoronal CS = 40.0%, multisuture = 14.3%) were included. Standardized screening and/or assessment of full-scale intelligence quotient, social communication, development, behavior, and self-concept were conducted.In the majority of cases, outcomes were consistent with age-related expectations. About 75% of patients demonstrated no delay across any early developmental domain, while 84.6% demonstrated full-scale intelligence quotient scores within 1 standard deviation of the population mean. Significant behavioral difficulties were demonstrated by parent reporters in 26.3% to 42.1% of cases (dependent upon domain). Clinically elevated social communication profiles were present in (41.7%) of parent-reported cases. Levels of self-concept (at age 10) were consistent with age-related normative data.Most patients with a TCF12 pathogenic variant had a mild behavioral and cognitive phenotype, although they may be at a slightly increased risk of social communication difficulties and psychosocial issues. Although not measured statistically, there were no clear associations between surgical history and cognitive, behavioral, or psychosocial outcomes. This paper highlights the need for robust integrated developmental assessment of all CS patients, particularly those with an identified syndrome.
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Affiliation(s)
| | - Helen Care
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Louise Dalton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Jo Horton
- Birmingham Children's Hospital Craniofacial Unit, Birmingham Women's and Children's Hospital, Birmingham
| | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Natasha Rooney
- Great Ormond Street Hospital for Children Craniofacial Unit, Great Ormond Street NHS Foundation Trust, London, United Kingdom
| | - Matthew Hotton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Molly Pinckston
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Esme Huggons
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Laura Culshaw
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Sarah Kilcoyne
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Andrew O M Wilkie
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
- MRC Weatherall Institute of Molecular Medicine, Oxford
| | - Steven Wall
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
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Use of Machine Learning to Investigate the Quantitative Checklist for Autism in Toddlers (Q-CHAT) towards Early Autism Screening. Diagnostics (Basel) 2021; 11:diagnostics11030574. [PMID: 33810146 PMCID: PMC8004748 DOI: 10.3390/diagnostics11030574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/13/2023] Open
Abstract
In the past two decades, several screening instruments were developed to detect toddlers who may be autistic both in clinical and unselected samples. Among others, the Quantitative CHecklist for Autism in Toddlers (Q-CHAT) is a quantitative and normally distributed measure of autistic traits that demonstrates good psychometric properties in different settings and cultures. Recently, machine learning (ML) has been applied to behavioral science to improve the classification performance of autism screening and diagnostic tools, but mainly in children, adolescents, and adults. In this study, we used ML to investigate the accuracy and reliability of the Q-CHAT in discriminating young autistic children from those without. Five different ML algorithms (random forest (RF), naïve Bayes (NB), support vector machine (SVM), logistic regression (LR), and K-nearest neighbors (KNN)) were applied to investigate the complete set of Q-CHAT items. Our results showed that ML achieved an overall accuracy of 90%, and the SVM was the most effective, being able to classify autism with 95% accuracy. Furthermore, using the SVM–recursive feature elimination (RFE) approach, we selected a subset of 14 items ensuring 91% accuracy, while 83% accuracy was obtained from the 3 best discriminating items in common to ours and the previously reported Q-CHAT-10. This evidence confirms the high performance and cross-cultural validity of the Q-CHAT, and supports the application of ML to create shorter and faster versions of the instrument, maintaining high classification accuracy, to be used as a quick, easy, and high-performance tool in primary-care settings.
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Arinda A, Nakasujja N, Odokonyero R. Prevalence of autism spectrum disorder symptoms in a paediatric neurology clinic at a tertiary hospital in Uganda. S Afr J Psychiatr 2021; 27:1548. [PMID: 33604074 PMCID: PMC7876953 DOI: 10.4102/sajpsychiatry.v27i0.1548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background Children with neurological disorders are more likely to present with autism spectrum disorder (ASD) symptoms and get an ASD diagnosis. Despite the large burden of childhood neurological disorders in Uganda, there is limited information on ASD amongst children with neurological disorders in Uganda. Aim The aim of this study was to determine the prevalence and factors associated with ASD symptoms amongst children attending the paediatric neurology clinic. Setting The study was conducted at the paediatric neurology clinic of Mulago National Referral Hospital in Uganda. Methods This was a cross-sectional study of 318 children aged 2–9 years. After obtaining consent, a socio-demographic questionnaire and the Social Communication Questionnaire were administered to the caregivers of the children. Additional questions were administered to assess the prenatal, birth and postnatal characteristics of the children. Sample characteristics were described using frequencies and means. Bivariate analysis was carried out using chi-square test and Fisher’s exact test. Multiple logistic regression models were used to assess which factors were independently associated with ASD symptoms. Results The mean age of the children was 5 years and 58.2% were males. The prevalence of significant ASD symptoms was found to be 45%. Factors negatively associated with significant ASD symptoms were female sex (odds ratio [OR] 0.48 [95% CI 0.24, 0.98]) and ability to speak (OR 0.09 [95% CI 0.04, 0.2]). The history of delayed developmental milestones was positively associated with significant ASD symptoms (OR 3.3 [95% CI 1.59, 6.84]). Conclusion The prevalence of ASD symptoms is high in children with neurological disorders. Children, especially those with delayed developmental milestones, should routinely be screened for ASD.
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Affiliation(s)
- Anita Arinda
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Raymond Odokonyero
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Wright B, Konstantopoulou K, Sohal K, Kelly B, Morgan G, Hulin C, Mansoor S, Mon-Williams M. Systematic approach to school-based assessments for autism spectrum disorders to reduce inequalities: a feasibility study in 10 primary schools. BMJ Open 2021; 11:e041960. [PMID: 33455935 PMCID: PMC7813406 DOI: 10.1136/bmjopen-2020-041960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This was a pilot study to explore whether the Early Years Foundation Stage Profile (EYFSP) carried out by UK teachers within the 'reception' year, combined with the Social Communication Questionnaire (SCQ), can lead to early identification of children with autism spectrum disorders (ASD) and early access to intervention and can reduce inequity in access to assessment and intervention. DESIGN Pragmatic prospective cohort. SETTING Ten primary schools from the SHINE project in Bradford. PARTICIPANTS 587 pupils from 10 schools who transitioned from reception to year 1 in July 2017 and had the EYFSP completed were included in the final study. INTERVENTIONS The assessment involved a multidisciplinary team of three staff who completed Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule Version 2, classroom observations with an ASD checklist, a teacher-based ASD questionnaire and a final consensus meeting. PRIMARY OUTCOME MEASURE National Institute for Health and Care Excellence guideline-compliant clinical diagnosis of ASD. SECONDARY OUTCOME MEASURES Age of diagnosis, demographic data and feasibility parameters. RESULTS Children with low scores on the EYFSP were more likely to score above the SCQ threshold of 12, indicating potential autism (50% compared with 19% of children with high scores on the EYFSP (p<0.001)). All children scoring above the SCQ threshold received a full autism assessment; children who scored low on the EYFSP were more likely to be diagnosed with autism (and other developmental issues) compared with those who did not. CONCLUSIONS We identified nine new children with a diagnosis of ASD, all from ethnic minorities, suggesting that this process may be addressing the inequalities in early diagnosis found in previous studies. All children who scored above the SCQ threshold required support (ie, had a neurodevelopmental disorder), indicating the EYFSP questionnaire captured 'at-risk' children.
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Affiliation(s)
- Barry Wright
- Hull York medical School and Department of Health Sciences, University of York, York, UK
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Kuldeep Sohal
- Born in Bradford Research Team, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Brian Kelly
- Born in Bradford Research Team, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Geoff Morgan
- Educational Psychology Team, City of Bradford, Metropolitan District Council, Bradford, UK
| | - Cathy Hulin
- Born in Bradford Research Team, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Sara Mansoor
- Child and Adolescent Psychiatry, Bradford District Care NHS Foundation Trust, Saltaire, Bradford, UK
| | - Mark Mon-Williams
- Born in Bradford Research Team, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- Department of Psychology, University of Leeds, Leeds, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, West Yorkshire, UK
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Lærerskoleveien, Norway
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12
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Poppi K, Jones J, Botting N. Childhood autism in the UK and Greece: a cross-national study of progress in different intervention contexts. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 65:162-174. [PMID: 34141337 PMCID: PMC8115582 DOI: 10.1080/20473869.2018.1511254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aim: This is a cross-national study with the aim to explore the development of children with autism over time in the UK and Greece. The focus of the study was to investigate the differences in language and social skills between children with autism across the two countries who were receiving different types of treatment: speech and language therapy, psychoanalytic/psychodynamic psychotherapy, and occupational therapy. Study design: A cross-national longitudinal design with a mixed (between-subjects and within-subjects) design. Participants: A sample of 40 children in total. In the UK, 20 children with autism who had received psychotherapy (n = 10) and speech and language therapy (n = 10) were recruited and monitored post-therapy twice over a two-year period. In Greece, 20 children with autism who received occupational therapy (n = 10) and speech and language therapy (n = 10) were recruited and monitored post-therapy twice over a two-year period. Results: All children changed significantly over time on all aspects of measurement, demonstrating that children with autism are developing in a very similar way across the two countries. With respect to the effect of the therapy context on the development of children with autism, it was found that there were no differences across intervention contexts at the start of the study, and there were mainly nonsignificant interactions in the rate of change across the differing types of intervention. However, further analysis showed some important differences: speech and language therapy participants presented more widespread change on language scores across the measures; psychotherapy participants showed significant greater increase in imagination and decrease in stereotypical behavior; and occupational therapy participants presented significant reduction of stereotypical behavior. Conclusions: This study can help professionals who work with children with autism further their understanding of the disorder and how it manifests through time in order to provide appropriate services based on each child's needs. Keywords: Childhood autism, speech and language therapy, psychotherapy, occupational therapy, UK, Greece.
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Affiliation(s)
- Kristi Poppi
- Language and Communication Science, City University of London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Nicola Botting
- Language and Communication Science, City University of London, London, UK
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13
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Marlow M, Servili C, Tomlinson M. A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children: recommendations for use in low- and middle-income countries. Autism Res 2019; 12:176-199. [DOI: 10.1002/aur.2033] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marguerite Marlow
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
| | - Chiara Servili
- Department of Mental Health and Substance Abuse; World Health Organization; Geneva Switzerland
| | - Mark Tomlinson
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
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14
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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: 14] [Impact Index Per Article: 2.8] [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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15
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Chojnicka I, Pisula E. Cross-Cultural Validation of the Polish Version of the ADI-R, Including New Algorithms for Toddlers and Young Preschoolers. Child Psychiatry Hum Dev 2019; 50:591-604. [PMID: 30661145 PMCID: PMC6589143 DOI: 10.1007/s10578-018-00865-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Autism Diagnostic Interview-Revised (ADI-R) is one of the most widely used standardized diagnostic instruments for autism spectrum disorder (ASD). This article presents findings from the validation of the Polish version of the Autism Diagnostic Interview-Revised (ADI-R-PL), including new algorithms for toddlers and preschoolers. The validation group consisted of 125 participants: 65 with Autism Spectrum Disorder (ASD group) and 60 in the control group, including individuals with non-ASD disorders and typical development. The normalization group consisted of 178 participants, including 118 with ASD. The ADI-R-PL was found to have good psychometric properties. Confirmatory factor analysis supported both a bifactor structure and three-factor model. The study has generated preliminary information about the psychometric properties of the new algorithms for toddlers and young preschoolers. To the best of our knowledge, this paper is the first to propose new cutoffs in three ADI-R domains for a non-English-speaking population.
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Affiliation(s)
- Izabela Chojnicka
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
| | - Ewa Pisula
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
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16
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Lo YC, Chen YJ, Hsu YC, Chien YL, Gau SSF, Tseng WYI. Altered frontal aslant tracts as a heritable neural basis of social communication deficits in autism spectrum disorder: A sibling study using tract-based automatic analysis. Autism Res 2018; 12:225-238. [PMID: 30548800 DOI: 10.1002/aur.2044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/12/2018] [Accepted: 10/21/2018] [Indexed: 01/08/2023]
Abstract
Investigating social behaviors and brain structural alterations in unaffected siblings of individuals with autism spectrum disorder (ASD) may help identify intermediate phenotypes of social communication deficits in ASD. This study hypothesized that such intermediate phenotypes could be identified in white matter tracts of the social communication model that exhibited reduced tract integrity and associations with social communication deficits. Boys with ASD (N = 30), unaffected male siblings (N = 27), and typically developing (TD) boys (N = 30) underwent clinical evaluation and MRI scanning. Group differences in generalized fractional anisotropy (GFA) values, a white matter integrity index derived from diffusion MRI data, and the relationships of GFA with the Social Responsiveness Scale (SRS) scores and the Child Behavior Checklist (CBCL/4-18) scores were investigated. Significant differences were found in the GFA values of the frontal aslant tract (FAT) among the three groups, with the decreasing order of GFA from TD to siblings to ASD. The GFA values of the FAT were associated with the social communication scores (on the SRS) in the sibling group, and those of the superior longitudinal fasciculus III were associated with the social problems scores (on the CBCL/4-18) in the boys with ASD. Due to the altered tract integrity and association with social communication deficits in the unaffected siblings of individuals with ASD, the FAT might be a heritable neural basis for social communication deficits of ASD. Autism Res 2019, 12: 225-238 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorder (ASD) is a group of highly heritable disorders with social communication deficits as one of the core symptoms. This study aimed to identify a neural trait of social communication deficits in individuals with ASD. We investigated brain structural alterations and their associations with social communication scores in unaffected siblings of individuals with ASD. The siblings' frontal aslant tract was found to be impaired, and this tract showed a significant association with the social communication scores. Our findings support that the frontal aslant tract might be a potential neural trait of social communication deficits in ASD.
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Affiliation(s)
- Yu-Chun Lo
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Research Center of Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Chin Hsu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
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17
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Randall M, Egberts KJ, Samtani A, Scholten RJPM, Hooft L, Livingstone N, Sterling‐Levis K, Woolfenden S, Williams K. Diagnostic tests for autism spectrum disorder (ASD) in preschool children. Cochrane Database Syst Rev 2018; 7:CD009044. [PMID: 30075057 PMCID: PMC6513463 DOI: 10.1002/14651858.cd009044.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a behaviourally diagnosed condition. It is defined by impairments in social communication or the presence of restricted or repetitive behaviours, or both. Diagnosis is made according to existing classification systems. In recent years, especially following publication of the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5; APA 2013), children are given the diagnosis of ASD, rather than subclassifications of the spectrum such as autistic disorder, Asperger syndrome, or pervasive developmental disorder - not otherwise specified. Tests to diagnose ASD have been developed using parent or carer interview, child observation, or a combination of both. OBJECTIVES Primary objectives1. To identify which diagnostic tools, including updated versions, most accurately diagnose ASD in preschool children when compared with multi-disciplinary team clinical judgement.2. To identify how the best of the interview tools compare with CARS, then how CARS compares with ADOS.a. Which ASD diagnostic tool - among ADOS, ADI-R, CARS, DISCO, GARS, and 3di - has the best diagnostic test accuracy?b. Is the diagnostic test accuracy of any one test sufficient for that test to be suitable as a sole assessment tool for preschool children?c. Is there any combination of tests that, if offered in sequence, would provide suitable diagnostic test accuracy and enhance test efficiency?d. If data are available, does the combination of an interview tool with a structured observation test have better diagnostic test accuracy (i.e. fewer false-positives and fewer false-negatives) than either test alone?As only one interview tool was identified, we modified the first three aims to a single aim (Differences between protocol and review): This Review evaluated diagnostic tests in terms of sensitivity and specificity. Specificity is the most important factor for diagnosis; however, both sensitivity and specificity are of interest in this Review because there is an inherent trade-off between these two factors.Secondary objectives1. To determine whether any diagnostic test has greater diagnostic test accuracy for age-specific subgroups within the preschool age range. SEARCH METHODS In July 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 10 other databases, and the reference lists of all included publications. SELECTION CRITERIA Publications had to: 1. report diagnostic test accuracy for any of the following six included diagnostic tools: Autism Diagnostic Interview - Revised (ADI-R), Gilliam Autism Rating Scale (GARS), Diagnostic Interview for Social and Communication Disorder (DISCO), Developmental, Dimensional, and Diagnostic Interview (3di), Autism Diagnostic Observation Schedule - Generic (ADOS), and Childhood Autism Rating Scale (CARS); 2. include children of preschool age (under six years of age) suspected of having an ASD; and 3. have a multi-disciplinary assessment, or similar, as the reference standard.Eligible studies included cohort, cross-sectional, randomised test accuracy, and case-control studies. The target condition was ASD. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies for inclusion and extracted data using standardised forms. A third review author settled disagreements. We assessed methodological quality using the QUADAS-2 instrument (Quality Assessment of Studies of Diagnostic Accuracy - Revised). We conducted separate univariate random-effects logistical regressions for sensitivity and specificity for CARS and ADI-R. We conducted meta-analyses of pairs of sensitivity and specificity using bivariate random-effects methods for ADOS. MAIN RESULTS In this Review, we included 21 sets of analyses reporting different tools or cohorts of children from 13 publications, many with high risk of bias or potential conflicts of interest or a combination of both. Overall, the prevalence of ASD for children in the included analyses was 74%.For versions and modules of ADOS, there were 12 analyses with 1625 children. Sensitivity of ADOS ranged from 0.76 to 0.98, and specificity ranged from 0.20 to 1.00. The summary sensitivity was 0.94 (95% confidence interval (CI) 0.89 to 0.97), and the summary specificity was 0.80 (95% CI 0.68 to 0.88).For CARS, there were four analyses with 641 children. Sensitivity of CARS ranged from 0.66 to 0.89, and specificity ranged from 0.21 to 1.00. The summary sensitivity for CARS was 0.80 (95% CI 0.61 to 0.91), and the summary specificity was 0.88 (95% CI 0.64 to 0.96).For ADI-R, there were five analyses with 634 children. Sensitivity for ADI-R ranged from 0.19 to 0.75, and specificity ranged from 0.63 to 1.00. The summary sensitivity for the ADI-R was 0.52 (95% CI 0.32 to 0.71), and the summary specificity was 0.84 (95% CI 0.61 to 0.95).Studies that compared tests were few and too small to allow clear conclusions.In two studies that included analyses for both ADI-R and ADOS, tests scored similarly for sensitivity, but ADOS scored higher for specificity. In two studies that included analyses for ADI-R, ADOS, and CARS, ADOS had the highest sensitivity and CARS the highest specificity.In one study that explored individual and additive sensitivity and specificity of ADOS and ADI-R, combining the two tests did not increase the sensitivity nor the specificity of ADOS used alone.Performance for all tests was lower when we excluded studies at high risk of bias. AUTHORS' CONCLUSIONS We observed substantial variation in sensitivity and specificity of all tests, which was likely attributable to methodological differences and variations in the clinical characteristics of populations recruited.When we compared summary statistics for ADOS, CARS, and ADI-R, we found that ADOS was most sensitive. All tools performed similarly for specificity. In lower prevalence populations, the risk of falsely identifying children who do not have ASD would be higher.Now available are new versions of tools that require diagnostic test accuracy assessment, ideally in clinically relevant situations, with methods at low risk of bias and in children of varying abilities.
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Affiliation(s)
- Melinda Randall
- The Royal Children's HospitalDepartment of Occupational Therapy50 Flemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of PaediatricsParkvilleAustralia
| | | | - Aarti Samtani
- UNSW SydneyUNSW MedicineHigh StreetKensingtonNew South WalesAustralia2052
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtCochrane NetherlandsRoom Str. 6.126P.O. Box 85500UtrechtNetherlands3508 GA
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtCochrane NetherlandsRoom Str. 6.126P.O. Box 85500UtrechtNetherlands3508 GA
| | - Nuala Livingstone
- CochraneEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Katy Sterling‐Levis
- University of New South Wales & Sydney Children's HospitalSchool of Women's and Children's HealthRandwickNSWAustralia
| | - Susan Woolfenden
- Sydney Children's Hospital NetworkHigh StreetRandwickNSWAustralia2031
- UNSW SydneySchool of Women's & Children's Health, UNSW MedicineHigh StreetKensingtonNew South WalesAustralia2052
| | - Katrina Williams
- The University of MelbourneDepartment of PaediatricsParkvilleAustralia
- The Royal Children's HospitalDepartment of Neurodevelopment and Disability50 Flemington RdParkvilleVictoriaAustralia3052
- Murdoch Children's Research InstituteParkvilleAustralia
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18
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Moody EJ, Reyes N, Ledbetter C, Wiggins L, DiGuiseppi C, Alexander A, Jackson S, Lee LC, Levy SE, Rosenberg SA. Screening for Autism with the SRS and SCQ: Variations across Demographic, Developmental and Behavioral Factors in Preschool Children. J Autism Dev Disord 2018; 47:3550-3561. [PMID: 28856480 DOI: 10.1007/s10803-017-3255-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Social Communication Questionnaire (SCQ) and the Social Responsiveness Scales (SRS) are commonly used screeners for autism spectrum disorder (ASD). Data from the Study to Explore Early Development were used to examine variations in the performance of these instruments by child characteristics and family demographics. For both instruments, specificity decreased as maternal education and family income decreased. Specificity was decreased with lower developmental functioning and higher behavior problems. This suggests that the false positive rates of the SRS and the SCQ are associated with child characteristics and family demographic factors. There is a need for ASD screeners that perform well across socioeconomic and child characteristics. Clinicians should be mindful of differential performance of these instruments in various groups of children.
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Affiliation(s)
- Eric J Moody
- Departments of Psychiatry and Pediatrics, University of Colorado Anschutz Medical Campus, Mailstop C234, 13121 E 17th Ave, Aurora, CO, 80045, USA.
| | - Nuri Reyes
- Departments of Psychiatry and Pediatrics, University of Colorado Anschutz Medical Campus, Mailstop C234, 13121 E 17th Ave, Aurora, CO, 80045, USA
| | - Caroline Ledbetter
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amira Alexander
- Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support, Atlanta, GA, USA
| | - Shardel Jackson
- Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support, Atlanta, GA, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan E Levy
- University of Pennsylvania at The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steven A Rosenberg
- Departments of Psychiatry and Pediatrics, University of Colorado Anschutz Medical Campus, Mailstop C234, 13121 E 17th Ave, Aurora, CO, 80045, USA
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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: 44] [Impact Index Per Article: 6.3] [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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Boilson AM, Staines A, Ramirez A, Posada M, Sweeney MR. Operationalisation of the European Protocol for Autism Prevalence (EPAP) for Autism Spectrum Disorder Prevalence Measurement in Ireland. J Autism Dev Disord 2017; 46:3054-67. [PMID: 27364514 DOI: 10.1007/s10803-016-2837-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The European Autism Information System project highlighted the lack of systematic and reliable data relating to the prevalence of autism spectrum disorders in Europe. A protocol for the study of ASD prevalence at European level was developed to facilitate a common format for screening and diagnosing children across the EU. This is the first study to operationalise and screen national school children for ASDs using this protocol. National school children 6-11 years (N = 7951) were screened males 54 % (N = 4268) females 46 % (N = 3683). Screening children for ASD implementing the EAIS protocol using the Social Communication Questionnaire (Rutter et al. in Social Communication Questionnaire (SCQ). Western Psychological Services, Los Angeles, ) as a first level screening instrument in a non-clinical setting of Irish national schools was demonstrated.
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Affiliation(s)
- A M Boilson
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland, UK
| | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland, UK
| | - A Ramirez
- The Hope Project, Scarriff, Ogonnelloe, Co. Clare, Ireland, UK
| | - M Posada
- Instituto de Salud Carlos III, Instituto de Investigación de Enfermedades Raras (IIER), Melchor Fernández Almagro 5, 28029, Madrid, Spain
| | - M R Sweeney
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland, UK.
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21
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Lo YC, Chen YJ, Hsu YC, Tseng WYI, Gau SSF. Reduced tract integrity of the model for social communication is a neural substrate of social communication deficits in autism spectrum disorder. J Child Psychol Psychiatry 2017; 58:576-585. [PMID: 27677901 DOI: 10.1111/jcpp.12641] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder with social communication deficits as one of the core symptoms. Recently, a five-level model for the social communication has been proposed in which white matter tracts corresponding to each level of the model are identified. Given that the model for social communication subserves social language functions, we hypothesized that the tract integrity of the model for social communication may be reduced in ASD, and the reduction may be related to social communication deficits. METHODS Sixty-two right-handed boys with ASD and 55 typically developing (TD) boys received clinical evaluations, intelligence tests, the Social Communication Questionnaire (SCQ), and MRI scans. Generalized fractional anisotropy (GFA) was measured by diffusion spectrum imaging to indicate the microstructural integrity of the tracts for each level of the social communication model. Group difference in the tract integrity and its relationship with the SCQ subscales of social communication and social interaction were investigated. RESULTS We found that the GFA values of the superior longitudinal fasciculus III (SLF III, level 1) and the frontal aslant tracts (FAT, level 2) were decreased in ASD compared to TD. Moreover, the GFA values of the SLF III and the FAT were associated with the social interaction subscale in ASD. CONCLUSIONS The tract integrity of the model for social communication is reduced in ASD, and the reduction is associated with impaired social interaction. Our results support that reduced tract integrity of the model for social communication might be a neural substrate of social communication deficits in ASD.
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Affiliation(s)
- Yu-Chun Lo
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Chin Hsu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Derks O, Heinrich M, Brooks W, Sterkenburg P, McCarthy J, Underwood L, Sappok T. The Social Communication Questionnaire for adults with intellectual disability: SCQ-AID. Autism Res 2017; 10:1481-1490. [DOI: 10.1002/aur.1795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 03/20/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Olivia Derks
- Department of Clinical Child and Family Studies; Vrije Universiteit; Amsterdam The Netherlands
| | - Manuel Heinrich
- Department for Psychiatry, Psychotherapy and Psychosomatics; Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79; Berlin 10365 Germany
- Department of Education and Psychology, Division of Clinical Psychological Intervention; Freie Universität Berlin; Germany
| | - Whitney Brooks
- TEACCH Autism Program; University of North Carolina; Chapel Hill NC
| | - Paula Sterkenburg
- Department of Clinical Child and Family Studies; Vrije Universiteit; Amsterdam The Netherlands
| | - Jane McCarthy
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry; Psychology and Neuroscience, King's College London; London United Kingdom
| | - Lisa Underwood
- Forensic and Neurodevelopmental Sciences; Institute of Psychiatry, Psychology and Neuroscience, King's College London; London United Kingdom
- School of Population Health, University of Auckland; Auckland New Zealand
| | - Tanja Sappok
- Department for Psychiatry, Psychotherapy and Psychosomatics; Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79; Berlin 10365 Germany
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Abstract
The Mobile Autism Risk Assessment (MARA) is a new, electronically administered, 7-question autism spectrum disorder (ASD) screen to triage those at highest risk for ASD. Children 16 months–17 years (N = 222) were screened during their first visit in a developmental-behavioral pediatric clinic. MARA scores were compared to diagnosis from the clinical encounter. Participant median age was 5.8 years, 76.1 % were male, and most participants had an intelligence/developmental quotient score >85; 69 of the participants (31 %) received a clinical diagnosis of ASD. The sensitivity of the MARA in detecting ASD was 89.9 % [95 % CI = 82.7–97]; the specificity was 79.7 % [95 % CI = 73.4–86.1]. In a high-risk clinical setting, the MARA shows promise as a screen to distinguish ASD from other developmental/behavioral disorders.
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Tsai PC, Harrington RA, Lung FW, Lee LC. Disparity in report of autism-related behaviors by social demographic characteristics: Findings from a community-based study in Taiwan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:540-551. [PMID: 27899712 DOI: 10.1177/1362361316677024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Social Communication Questionnaire is one of the most commonly used screening tools for autism spectrum disorder. The Social Communication Questionnaire is a caregiver-reported questionnaire with 40 items based on questions from the Autism Diagnostic Interview-Revised. This study collected Social Communication Questionnaire data from a community-based, multi-stage case identification design epidemiologic study in one socioeconomically disadvantaged county in Taiwan. The Social Communication Questionnaire was distributed to 3034 school children, aged 6-8 years. Item prevalence results indicate males were reported to have more autism-related behaviors than females (higher prevalence on most items), in the whole study sample as well as in children meeting Social Communication Questionnaire clinical cut-offs (⩾15). Children whose biological fathers completed the Social Communication Questionnaire were reported to have more behavioral issues than children whose biological mothers were the respondent. Lower respondent education levels were associated with reports of clinically concerning autism-related behaviors. However, males were not at higher risk of meeting Social Communication Questionnaire clinical cut-offs than females in this study population. Findings from this study help to better understand reporting patterns on children's autism-related behaviors potentially due to social demographic characteristics and child sex, which may lead to improved identification of these behaviors.
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Affiliation(s)
| | | | | | - Li-Ching Lee
- 1 Johns Hopkins Bloomberg School of Public Health, USA
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Cross-Cultural Validity of the Social Communication Questionnaire for Adults with Intellectual Developmental Disorder. J Autism Dev Disord 2016; 47:393-404. [DOI: 10.1007/s10803-016-2967-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Öner P, Öner Ö, Çöp E, Munir KM. [Reliability and Validity of the Turkish Version of the Social Communication Scale.]. ACTA ACUST UNITED AC 2016; 22:43-50. [PMID: 25580078 DOI: 10.5455/bcp.20111212091514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Reliability and validity of the turkish version of the social communication scale. OBJECTIVE The aim of this study was to evaluate the reliability and validity of the Turkish version of the Social Communication Scale (SCQ). METHOD Throughout 2010-2011, we evaluated children who were between 18-60 months of age in the outpatient clinic who were diagnosed as having autism (n=49) or pervasive developmental disorder not otherwise specified (n=18) according to the DMS-IV criteria. The control group consisted of 51children with developmental delay (25 mental retardation, 26 speech delay) and 71 children with typical development in the same age group. We used a one way analysis of variance and post-hoc Tukey HSD test to compare the SCQ scores of the groups. For the reliability and validity analysis the Cronbach alpha, item-total score correlations and test-retest correlations were used. Principal components analysis and varimax rotation were used to find the factor solutions. Receiver Operator Characteristic (ROC) curves were utilised to detect cut-off scores, sensitivity, specificity, and negative and positive predictive values. RESULTS The analysis yielded 3 factors named Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest. The Cronbach alpha value of the total score was 0.88. The test-retest correlation was high (r=0.90, p<0.01). The SCQ Total, Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were significantly different among the groups. The SCQ Total, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were highest in the autism spectrum disorders group. The SCQ Language and Stereotypic Behaviors/Restricted Areas of Interest scores were not significantly different between the developmental delay and the typical development groups. ROC analysis indicated that the SCQ Total and Reciprocal Social Interaction scores differentiated very well between the autism spectrum and control group (area under the curve 0.89 and 0.91) while the Stereotypic Behaviors/Restricted Areas of Interest score differentiated less (0.72). Using a cut-off score of 14.5 for the SCQ Total score, sensivity was 0.84, specificity was 0.81, positive predictive value was 0.82 and negative predictive value was 0.83. Using a cut-off score of 7.5 for the SCQ Reciprocal Social Interaction score, sensivity, specifity, positive predictive value and negative predictive value were 0.91, 0.82, 0.83, 0.90, respectively. CONCLUSION The results indicated that in children younger than 60 months of age the SCQ Total score can differentiate subjects with autism spectrum disorders from children with developmental delay and typically developing controls; however, the Reciprocal Social Interactions score was more sensitive and specific. On the other hand, the negative and positive predictive values indicated that there was a fair percentage of false negatives and positives. Our results showed that, particularly in younger children, the Reciprocal Social Interaction items were more specific and were more helpful for differentiation of the children with autism spectrum disorders. The availability of the SCQ as a shorter and more practical form of the Autism Diagnostic Interview, revised in Turkish, is important as both a research and clinical tool.
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Affiliation(s)
- Pınar Öner
- Dr. Sami Ulus Çocuk Hastanesi, Çocuk ve Ergen Psikiyatrisi Kliniği, SB Otizm Mükemmeliyet Merkezi, Ankara-Türkiye ; Fogarty International Center Mental Health and Developmental Disabilities Program, Children's Hospital, Boston, MA, USA
| | - Özgür Öner
- Dr. Sami Ulus Çocuk Hastanesi, Çocuk ve Ergen Psikiyatrisi Kliniği, SB Otizm Mükemmeliyet Merkezi, Ankara-Türkiye ; Fogarty International Center Mental Health and Developmental Disabilities Program, Children's Hospital, Boston, MA, USA
| | - Esra Çöp
- Dr. Sami Ulus Çocuk Hastanesi, Çocuk ve Ergen Psikiyatrisi Kliniği, SB Otizm Mükemmeliyet Merkezi, Ankara-Türkiye
| | - Kerim M Munir
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children's Hospital, Boston, MA, USA ; Children's Hospital, Boston; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Chesnut SR, Wei T, Barnard-Brak L, Richman DM. A meta-analysis of the social communication questionnaire: Screening for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:920-928. [PMID: 27503464 DOI: 10.1177/1362361316660065] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current meta-analysis examines the previous research on the utility of the Social Communication Questionnaire as a screening instrument for autism spectrum disorder. Previously published reports have highlighted the inconsistencies between Social Communication Questionnaire-screening results and formal autism spectrum disorder diagnoses. The variations in accuracy resulted in some researchers questioning the validity of the Social Communication Questionnaire. This study systematically examined the accuracy of the Social Communication Questionnaire as a function of the methodological decisions made by researchers screening for autism spectrum disorder over the last 15 years. Findings from this study suggest that the Social Communication Questionnaire is an acceptable screening instrument for autism spectrum disorder (area under the curve = 0.885). Variations in methodological decisions, however, greatly influenced the accuracy of the Social Communication Questionnaire in screening for autism spectrum disorder. Of these methodological variations, using the Current instead of the Lifetime version of the Social Communication Questionnaire resulted in the largest detrimental effect ( d = -3.898), followed by using the Social Communication Questionnaire with individuals younger than 4 years of age ( d = -2.924) and relying upon convenience samples ( d = -4.828 for clinical samples, -2.734 for convenience samples, and -1.422 for community samples). Directions for future research and implications for using the Social Communication Questionnaire to screen for autism spectrum disorder are discussed.
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Charman T, Baird G, Simonoff E, Chandler S, Davison-Jenkins A, Sharma A, O'Sullivan T, Pickles A. Testing two screening instruments for autism spectrum disorder in UK community child health services. Dev Med Child Neurol 2016; 58:369-75. [PMID: 26303216 DOI: 10.1111/dmcn.12874] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/01/2023]
Abstract
AIM The aim of this study was to test the accuracy of two screening instruments in UK Community health services: Modified Checklist for Autism in Toddlers (M-CHAT) and Social Communication Questionnaire (SCQ) for autism spectrum disorder (ASD). A two-stage screening and in-depth assessment procedure, combined with sampling stratification and statistical weighting, allowed the accuracy of the screens to be estimated in the entire population of referred children. METHOD The study included all referrals of children aged 18 to 48 months to community paediatric and speech and language therapy services in two London districts over a 12-month period between September 2004 and September 2005. Parents of 808 children were approached; screen data were obtained on 543 children (67.2%). A stratified subsample of 120 children received an in-depth assessment for ASD as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Community clinician judgement of likely ASD was available for 98 out of the 120 children. RESULTS The sensitivity and specificity were 64% (95% confidence intervals; range 51-80%) and 75% (63-85%) for the SCQ, and 82% (72-92%) and 50% (33-64%) for M-CHAT. There was no evidence that the area under the curve differed between the two screening instruments. There was also no evidence that clinician judgement of likely ASD differed from either of the screening tests. The screening tests did not perform well to confirm preliminary clinical judgement to refer (in series), nor as an alternative indicator for referral (in parallel). INTERPRETATION While screening tests may provide useful information, their accuracy is moderate. Screening information in isolation should not be used to make referral decisions regarding specialized ASD assessment.
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Affiliation(s)
- Tony Charman
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Gillian Baird
- Newcomen Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Emily Simonoff
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Susie Chandler
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Newcomen Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Ajay Sharma
- Sunshine House Community Services, Guy's and St. Thomas' NHS Trust, London, UK
| | - Tony O'Sullivan
- Kaleidoscope, Lewisham Centre for Children & Young People, Lewisham Healthcare, London, UK
| | - Andrew Pickles
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Hansen RL, Blum NJ, Gaham A, Shults J. Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study. Pediatrics 2016; 137 Suppl 2:S79-89. [PMID: 26908481 DOI: 10.1542/peds.2015-2851f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines. METHODS A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site. RESULTS A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%-100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%-91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%-69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%-21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%). CONCLUSIONS Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.
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Affiliation(s)
- Robin L Hansen
- Department of Pediatrics, University of California-Davis School of Medicine, Davis, California; MIND Institute, University of California-Davis, Sacramento, California;
| | - Nathan J Blum
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Gaham
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Justine Shults
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Autism Diagnostic Interview-Revised (ADI-R) Algorithms for Toddlers and Young Preschoolers: Application in a Non-US Sample of 1,104 Children. J Autism Dev Disord 2016; 45:2076-91. [PMID: 25682078 PMCID: PMC4471312 DOI: 10.1007/s10803-015-2372-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The current study aimed to investigate the Autism Diagnostic Interview-Revised (ADI-R) algorithms for toddlers and young preschoolers (Kim and Lord, J Autism Dev Disord 42(1):82-93, 2012) in a non-US sample from ten sites in nine countries (n = 1,104). The construct validity indicated a good fit of the algorithms. The diagnostic validity was lower, with satisfactorily high specificities but moderate sensitivities. Young children with clinical ASD and lower language ability were largely in the mild-to-moderate or moderate-to-severe concern ranges of the ADI-R, nearly half of the older and phrase speech ASD-group fell into the little-to-no concern range. Although broadly the findings support the toddler algorithms, further work is required to understand why they might have different properties in different samples to further inform research and clinical use.
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Barnard-Brak L, Brewer A, Chesnut S, Richman D, Schaeffer AM. The sensitivity and specificity of the social communication questionnaire for autism spectrum with respect to age. Autism Res 2015; 9:838-45. [PMID: 26608837 DOI: 10.1002/aur.1584] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/01/2015] [Indexed: 11/11/2022]
Abstract
The age neutrality of the Social Communication Questionnaire (SCQ) was examined as a common screener for ASD. Mixed findings have been reported regarding the recommended cutoff score's ability to accurately classify an individual as at-risk for autism spectrum disorder (ASD) (sensitivity) versus accurately classifying an individual as not at-risk for ASD (specificity). With a sample from the National Database for Autism Research, this study examined the SCQ's sensitivity versus specificity. Analyses indicated that the actual sensitivity and specificity scores were lower than initially reported by the creators of the SCQ. Autism Res 2016, 9: 838-845. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | - Adam Brewer
- Texas Tech University College of Education, P.O. Box 41071, Lubbock, Texas, 79409
| | - Steven Chesnut
- Texas Tech University College of Education, P.O. Box 41071, Lubbock, Texas, 79409
| | - David Richman
- Texas Tech University, P.O. Box 41071, Lubbock, Texas, 79409
| | - Anna Marie Schaeffer
- Texas Tech University College of Education, P.O. Box 41071, Lubbock, Texas, 79409
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Kim JH, Sunwoo HJ, Park SB, Noh DH, Jung YK, Cho IH, Cho SC, Kim BN, Shin MS, Kim JW, Park TW, Son JW, Chung US, Yoo HJ. A Validation Study of the Korean Version of Social Communication Questionnaire. Soa Chongsonyon Chongsin Uihak 2015. [DOI: 10.5765/jkacap.2015.26.3.197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bergmann T, Sappok T, Diefenbacher A, Dames S, Heinrich M, Ziegler M, Dziobek I. Music-based Autism Diagnostics (MUSAD) - A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:123-135. [PMID: 26183337 DOI: 10.1016/j.ridd.2015.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/20/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
UNLABELLED The MUSAD was developed as a diagnostic observational instrument in an interactional music framework. It is based on the ICD-10/DSM-5 criteria for autism spectrum disorder (ASD) and was designed to assess adults on a lower level of functioning, including individuals with severe language impairments. This study aimed to evaluate the psychometric properties of the newly developed instrument. METHODS Calculations were based on a consecutive clinical sample of N=76 adults with intellectual and developmental disabilities (IDD) suspected of ASD. Objectivity, test-retest reliability, and construct validity were calculated and a confirmatory factor analysis was applied to verify a reduced and optimized test version. RESULTS The structural model showed a good fit, while internal consistency of the subscales was excellent (ω>.92). Item difficulties ranged between .04≤pi≤.82 and item-total correlation from .21 to .85. Objectivity was assessed by comparing the scorings of two external raters based on a subsample of n=12; interrater agreement was .71 (ICC 2, 1). Reliability was calculated for four test repetitions: the average ICC (3, 1) was .69. Convergent ASD measures correlated significantly with the MUSAD, while the discriminant Modified Overt Aggression Scale (MOAS) showed no significant overlap. CONCLUSION Confirmation of factorial structure and acceptable psychometric properties suggest that the MUSAD is a promising new instrument for diagnosing ASD in adults with IDD.
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Affiliation(s)
- Thomas Bergmann
- Protestant Hospital Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365 Berlin, Germany(1).
| | - Tanja Sappok
- Protestant Hospital Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365 Berlin, Germany(1)
| | - Albert Diefenbacher
- Protestant Hospital Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365 Berlin, Germany(1)
| | - Sibylle Dames
- Statistics - Joint Masters Program Berlin, Freie Universität Berlin, Garystr. 21, 14195 Berlin, Germany
| | - Manuel Heinrich
- Protestant Hospital Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365 Berlin, Germany(1)
| | - Matthias Ziegler
- Faculty of Life Sciences/Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Isabel Dziobek
- Faculty of Life Sciences/Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
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Hoffmann W, Heinzel-Gutenbrunner M, Becker K, Kamp-Becker I. [Screening interview for early detection of high-functioning autism spectrum disorders]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2015; 43:207-18; quiz 218-9. [PMID: 26098008 DOI: 10.1024/1422-4917/a000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities. METHOD The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD. RESULTS The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74. CONCLUSION The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.
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Affiliation(s)
- Wiebke Hoffmann
- 1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Phillips-Universität Marburg
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Sappok T, Diefenbacher A, Gaul I, Bölte S. Validity of the social communication questionnaire in adults with intellectual disabilities and suspected autism spectrum disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 120:203-214. [PMID: 25928433 DOI: 10.1352/1944-7558-120.3.203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the validity of the Social Communication Questionnaire (SCQ) to identify autism spectrum disorder (ASD) in 151 adults with intellectual disabilities (ID) in Germany. Sensitivities and specificities for ASD were 98/47% for the SCQ-current version and 92/22% for the SCQ-lifetime version. Sensitivities and specificities were increased to 89/66% and 78/48% by adjusting the recommended cut-points. The SCQ-current score correlated with the Scale for Pervasive Developmental Disorders in Mentally Retarded Persons and the Autism Diagnostic Observation Schedule, whereas the SCQ-lifetime score correlated with the Autism Diagnostic Interview-Revised. Our findings support the use of the SCQ-current version for ASD screening in adults with ID, although the SCQ-lifetime version should be used with caution in this population.
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A Review of Level 2 Parent-Report Instruments Used to Screen Children Aged 1.5–5 for Autism: A Meta-Analytic Update. J Autism Dev Disord 2015; 45:2519-30. [DOI: 10.1007/s10803-015-2419-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Wei T, Chesnut SR, Barnard-Brak L, Richman D. Psychometric Analysis of the Social Communication Questionnaire Using an Item-Response Theory Framework: Implications for the Use of the Lifetime and Current Forms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9468-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Differentiation between attention-deficit/hyperactivity disorder and autism spectrum disorder by the social communication questionnaire. ACTA ACUST UNITED AC 2014; 6:221-9. [PMID: 24966019 DOI: 10.1007/s12402-014-0147-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
The differentiation of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) poses a clinical challenge. In children, overlap of psychopathological and cognitive findings has been found for both disorders. In addition, some children suffer from both disorders. The Social Communication Questionnaire (SCQ) is a screening instrument for ASD symptoms which indicates the presence of ASD in a rapid and economic way. However, validity to differentiate ASD and ADHD as differential or comorbid diagnoses has not been studied. Here, the differential validity was compared in groups of children with ASD, ADHD, ASD + ADHD, and typically developing (TD) children and IQ > 70. ROC analyses indicated an excellent differentiation between ASD and TD with ROC-AUC = .941 and between ASD + ADHD with ROC-AUC = .993. The optimal cutoff was below the originally recommended one of 15. The differentiation between children with ASD with (ROC-AUC = .982) or without ADHD (ROC-AUC = .864) and ADHD alone also showed acceptable differential validity, and here, the optimal cutoff corresponded to the recommended. Taken together, the SCQ can be recommended as a screening instrument for a first differentiation between children with ASD and typically developing children as well as children with ADHD.
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Anagnostou E, Zwaigenbaum L, Szatmari P, Fombonne E, Fernandez BA, Woodbury-Smith M, Brian J, Bryson S, Smith IM, Drmic I, Buchanan JA, Roberts W, Scherer SW. Autism spectrum disorder: advances in evidence-based practice. CMAJ 2014; 186:509-19. [PMID: 24418986 DOI: 10.1503/cmaj.121756] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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40
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Oner P, Oner O, Munir K. Three-item Direct Observation Screen (TIDOS) for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:733-42. [PMID: 24126869 DOI: 10.1177/1362361313487028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared ratings on the Three-Item Direct Observation Screen test for autism spectrum disorders completed by pediatric residents with the Social Communication Questionnaire parent reports as an augmentative tool for improving autism spectrum disorder screening performance. We examined three groups of children (18-60 months) comparable in age (18-24 month, 24-36 month, 36-60 preschool subgroups) and gender distribution: n = 86 with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) autism spectrum disorders; n = 76 with developmental delay without autism spectrum disorders; and n = 97 with typical development. The Three-Item Direct Observation Screen test included the following (a) Joint Attention, (b) Eye Contact, and (c) Responsiveness to Name. The parent Social Communication Questionnaire ratings had a sensitivity of .73 and specificity of .70 for diagnosis of autism spectrum disorders. The Three-Item Direct Observation Screen test item Joint Attention had a sensitivity of .82 and specificity of .90, Eye Contact had a sensitivity of .89 and specificity of .91, and Responsiveness to Name had a sensitivity of .67 and specificity of .87. In the Three-Item Direct Observation Screen test, having at least one of the three items positive had a sensitivity of .95 and specificity of .85. Age, diagnosis of autism spectrum disorder, and developmental level were important factors affecting sensitivity and specificity. The results indicate that augmentation of autism spectrum disorder screening by observational items completed by trained pediatric-oriented professionals can be a highly effective tool in improving screening performance. If supported by future population studies, the results suggest that primary care practitioners will be able to be trained to use this direct procedure to augment screening for autism spectrum disorders in the community.
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Affiliation(s)
- Pinar Oner
- Dr Sami Ulus Children's Hospital, Child and Adolescent Psychiatry Department, Autism Center of Excellence, Ankara, Turkey
| | - Ozgur Oner
- Dr Sami Ulus Children's Hospital, Child and Adolescent Psychiatry Department, Autism Center of Excellence, Ankara, Turkey
| | - Kerim Munir
- Children's Hospital Boston, USA Harvard Medical School, USA
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Charman T, Gotham K. Measurement Issues: Screening and diagnostic instruments for autism spectrum disorders - lessons from research and practise. Child Adolesc Ment Health 2013; 18:52-63. [PMID: 23539140 PMCID: PMC3607539 DOI: 10.1111/j.1475-3588.2012.00664.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND SCOPE Significant progress has been made over the past two decades in the development of screening and diagnostic instruments for autism spectrum disorders (ASDs). This article reviews this progress, including recent innovations, focussing on those instruments for which the strongest research data on validity exists, and then addresses issues arising from their use in clinical settings. FINDINGS Research studies have evaluated the ability of screens to prospectively identify cases of ASD in population-based and clinically referred samples, as well as the accuracy of diagnostic instruments to map onto 'gold standard' clinical best estimate diagnosis. However, extension of the findings to clinical services must be done with caution, with a full understanding that instrument properties are sample-specific. Furthermore, we are limited by the lack of a true test for ASD which remains a behaviourally defined disorder. In addition, screening and diagnostic instruments help clinicians least in the cases where they are most in want of direction, as their accuracy will always be lower for marginal cases. CONCLUSION Instruments help clinicians to collect detailed, structured information and increase accuracy and reliability of referral for in-depth assessment and recommendations for support, but further research is needed to refine their effective use in clinical settings.
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Affiliation(s)
- Tony Charman
- Centre for Research in Autism and Education (CRAE), Institute of Education, University of London, UK
| | - Katherine Gotham
- University of Michigan Autism and Communication Disorders Center (UMACC), Ann Arbor, Michigan, USA
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Ghuman JK, Leone SL, Lecavalier L, Landa RJ. The screen for social interaction (SSI): a screening measure for autism spectrum disorders in preschoolers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2519-29. [PMID: 21821391 PMCID: PMC3191249 DOI: 10.1016/j.ridd.2011.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/08/2011] [Accepted: 07/11/2011] [Indexed: 05/31/2023]
Abstract
We report on the preliminary validity and utility of the Ghuman-Folstein Screen for Social Interaction (SSI), a measure of social interaction that can serve to screen for autism spectrum disorders (ASDs) in clinical samples of young high-risk children. Caregivers of 350 children (176 younger participants, ages 24-42 months, mean age = 34.1 months; and 174 older participants, ages 43 to 61 months, mean age = 52.4 months) with ASDs, non-ASD developmental and/or psychiatric disorders, or without developmental concerns completed the SSI. A series of analyses resulted in shortened versions of the SSI: a 26-item SSI-Younger (SSI-Y) and a 21-item SSI-Older (SSI-O) version. The SSI-Y and SSI-O showed moderate convergence with ASD diagnostic measures and significantly differentiated ASD and non-ASD clinical groups. Sensitivity and specificity values for discriminating ASD and non-ASD clinical participants were 0.87 and 0.71, respectively for the SSI-Y and 0.81 and 0.70, respectively for the SSI-O. Scoring recommendations were made based on the ROC results.
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Affiliation(s)
- Jaswinder K. Ghuman
- University of Arizona, Child and Adolescent Psychiatry, 1501 N. Campbell Avenue Tucson, Arizona 85724-5002, USA
| | - Sarah L. Leone
- Ohio State University, Nisonger Center, UAP, 1581 Dodd Drive, Columbus, Ohio 43210, USA
| | - Luc Lecavalier
- Ohio State University, Nisonger Center, UAP, 1581 Dodd Drive, Columbus, Ohio 43210, USA
| | - Rebecca J. Landa
- Johns Hopkins University, Kennedy Krieger Institute, Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, Maryland 21211, USA
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