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Felix G, Deavenport-Saman A, Stavros S, Farboodi N, Arvizu RD, Garcia J, Yin L, Gera MP. Standardizing and Improving Primary Care-Based Electronic Developmental Screening for Young Children in Federally Qualified Health Center Clinics. Matern Child Health J 2024:10.1007/s10995-024-03970-y. [PMID: 39133384 DOI: 10.1007/s10995-024-03970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Many barriers to implementation of developmental screening in primary care exist, especially for children from under-resourced communities. Developmental screening is vital to early detection of developmental delay and autism spectrum disorder, and early intervention (EI) referral. This study sought to examine whether implementation of a standardized clinical workflow using electronic screening tools improved both rates of developmental screening, and the number of children identified at risk for developmental delay, in a federally qualified health center (FQHC). METHODS A retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher's Exact analyses were conducted. RESULTS ASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001). CONCLUSIONS FOR PRACTICE Implementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.
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Affiliation(s)
- Gladys Felix
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Sophia Stavros
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Niloofar Farboodi
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA
| | - Ramon Durazo Arvizu
- Keck School of Medicine of USC, Los Angeles, CA, USA
- Biostatistics and Data Analysis Core, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joanna Garcia
- Institute of Health Equity, AltaMed Health Services Corporation, Los Angeles, CA, USA
| | - Larry Yin
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Mona Patel Gera
- Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
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2
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Ronconi L, Cantiani C, Riva V, Franchin L, Bettoni R, Gori S, Bulf H, Valenza E, Facoetti A. Infants' reorienting efficiency depends on parental autistic traits and predicts future socio-communicative behaviors. Cereb Cortex 2024; 34:40-49. [PMID: 38696607 DOI: 10.1093/cercor/bhae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 05/04/2024] Open
Abstract
Attentional reorienting is dysfunctional not only in children with autism spectrum disorder (ASD), but also in infants who will develop ASD, thus constituting a potential causal factor of future social interaction and communication abilities. Following the research domain criteria framework, we hypothesized that the presence of subclinical autistic traits in parents should lead to atypical infants' attentional reorienting, which in turn should impact on their future socio-communication behavior in toddlerhood. During an attentional cueing task, we measured the saccadic latencies in a large sample (total enrolled n = 89; final sample n = 71) of 8-month-old infants from the general population as a proxy for their stimulus-driven attention. Infants were grouped in a high parental traits (HPT; n = 23) or in a low parental traits (LPT; n = 48) group, according to the degree of autistic traits self-reported by their parents. Infants (n = 33) were then longitudinally followed to test their socio-communicative behaviors at 21 months. Results show a sluggish reorienting system, which was a longitudinal predictor of future socio-communicative skills at 21 months. Our combined transgenerational and longitudinal findings suggest that the early functionality of the stimulus-driven attentional network-redirecting attention from one event to another-could be directly connected to future social and communication development.
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Affiliation(s)
- Luca Ronconi
- School of Psychology, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Chiara Cantiani
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Via Don Luigi Monza, 20, 23842 Lecco, Italy
| | - Valentina Riva
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Via Don Luigi Monza, 20, 23842 Lecco, Italy
| | - Laura Franchin
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, 38068 Rovereto, Italy
| | - Roberta Bettoni
- Department of Psychology, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Simone Gori
- Department of Human and Social Sciences, University of Bergamo, Piazzale Sant'Agostino, 2, 24129 Bergamo, Italy
| | - Herman Bulf
- Department of Psychology, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Eloisa Valenza
- Department of Developmental and Social Psychology, Via Venezia 8, University of Padova, 35131 Padova, Italy
| | - Andrea Facoetti
- Developmental and Cognitive Neuroscience Lab, Department of General Psychology, Via Venezia 8, University of Padova, 35131 Padova, Italy
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3
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Islam A, Ronco A, Becker SM, Blackburn J, Schittny JC, Kim K, Stein-Wexler R, Wexler AS. Can lung airway geometry be used to predict autism? A preliminary machine learning-based study. Anat Rec (Hoboken) 2024; 307:457-469. [PMID: 37771211 DOI: 10.1002/ar.25332] [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: 08/10/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
The goal of this study is to assess the feasibility of airway geometry as a biomarker for autism spectrum disorder (ASD). Chest computed tomography images of children with a documented diagnosis of ASD as well as healthy controls were identified retrospectively. Fifty-four scans were obtained for analysis, including 31 ASD cases and 23 controls. A feature selection and classification procedure using principal component analysis and support vector machine achieved a peak cross validation accuracy of nearly 89% using a feature set of eight airway branching angles. Sensitivity was 94%, but specificity was only 78%. The results suggest a measurable difference in airway branching angles between children with ASD and the control population.
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Affiliation(s)
- Asef Islam
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Anthony Ronco
- Department of Radiology, University of California, Davis, California, USA
| | - Stephen M Becker
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
| | - Jeremiah Blackburn
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
| | - Johannes C Schittny
- Institute of Anatomy, University of Bern, Bern, Switzerland
- Center for Health and the Environment, University of California, Davis, California, USA
| | - Kyoungmi Kim
- Department of Public Health Science, University of California, Davis, California, USA
| | | | - Anthony S Wexler
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
- Department of Civil and Environmental Engineering, University of California, Davis, California, USA
- Department of Land, Air and Water Resources, University of California, Davis, California, USA
- Air Quality Research Center, University of California, Davis, California, USA
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4
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Cirnigliaro L, Valle MS, Casabona A, Randazzo M, La Bruna F, Pettinato F, Narzisi A, Rizzo R, Barone R. The Developmental Autism Early Screening (DAES): A Novel Test for Screening Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06184-3. [PMID: 38109035 DOI: 10.1007/s10803-023-06184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/19/2023]
Abstract
This study was undertaken to set a novel developmental screening test for autism spectrum disorder (ASD) using the Griffiths Scales of Child Development (Griffith III) (Green et al., 2016; Stroud et al., 2016), in order to intercept the early atypical developmental patterns indicating ASD risk in the first 3 years of age. An observational and interactive ASD screener, the Developmental Autism Early Screening (DAES), was developed by detecting Griffiths III items differentiating toddlers with ASD risk from those with global developmental delay (DD) or neurotypical development. The DAES was validated with ASD-specific diagnostic instruments (ADOS-2) and the cut-off score based on sensitivity, specificity and positive predictive value that best differentiates between ASD and non-ASD children was identified. We enrolled a total sample of 297 subjects, including children at risk for ASD or DD and neurotypical children. At a cut-off score of 12.5, the DAES had a sensitivity of 93%, specificity of 98.4%, positive predictive value of 96.3% and negative predictive value of 96.9% for identifying children at risk for ASD from non-ASD participants (DD/neurotypical children). The DAES total score correlated significantly with the ADOS-2 calibrated severity scores (CSS) (R = 0.53, p < 0.001). Three ASD risk ranges were identified according to DAES total and ADOS-2 CSS: Little-to-no risk (CSS: 1-3, DAES: 1-7); Mild-to-moderate risk (CSS: 4-5, DAES: 8-14); Moderate-to-severe risk (CSS: 6-10, DAES ≥ 15). The DAES provides a direct approach based on developmental profiles to stratify risk for ASD in early childhood ensuring at risk children the most appropriate diagnostic procedures and targeted intervention.
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Affiliation(s)
- Lara Cirnigliaro
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy
| | - Maria Stella Valle
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Antonino Casabona
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Martina Randazzo
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy
| | - Francesca La Bruna
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy
| | - Fabio Pettinato
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy
| | | | - Renata Rizzo
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy
| | - Rita Barone
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico Via Santa Sofia, 78, 95123, Catania, Italy.
- Reseach Unit of Rare Diseases and Neurodevelopmental Disorders, Oasi Research Institute-IRCCS, Troina, Italy.
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5
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McFayden TC, Culbertson S, DeRamus M, Kramer C, Roush J, Mankowski J. Assessing Autism in Deaf/Hard-of-Hearing Youths: Interdisciplinary Teams, COVID Considerations, and Future Directions. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1492-1507. [PMID: 37314896 PMCID: PMC10271818 DOI: 10.1177/17456916231178711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Autism spectrum disorders are more prevalent in children who are Deaf or Hard of Hearing (D/HH) than in the general population. This potential for diagnostic overlap underscores the importance of understanding the best approaches for assessing autism spectrum disorder in D/HH youths. Despite the recognition of clinical significance, youths who are D/HH are often identified as autistic later than individuals with normal hearing, which results in delayed access to appropriate early intervention services. Three primary barriers to early identification include behavioral phenotypic overlap, a lack of "gold-standard" screening and diagnostic tools for this population, and limited access to qualified clinicians. In the current article, we seek to address these barriers to prompt an appropriate identification of autism by providing recommendations for autism assessment in children who are D/HH from an interdisciplinary hearing and development clinic, including virtual service delivery during COVID-19. Strengths, gaps, and future directions for implementation are addressed.
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Affiliation(s)
- Tyler C. McFayden
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill
| | - Shannon Culbertson
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Margaret DeRamus
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill
| | - Christine Kramer
- The Children’s Cochlear Implant Center, University of North Carolina at Chapel Hill
| | - Jackson Roush
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Jean Mankowski
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill
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6
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Screening for Intellectual Disabilities and/or Autism Amongst Older Children and Young Adults: a Systematic Review of Tools for Use in Africa. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
There are many well-developed screening tools for both intellectual disabilities and autism, but they may not be culturally appropriate for use within Africa. Our specific aims were to complete a systematic review to (1) describe and critically appraise short screening tools for the detection of intellectual disabilities and autism for older children and young adults, (2) consider the psychometric properties of these tools, and (3) judge the cultural appropriateness of these tools for use within Africa. Six screening tools for intellectual disabilities and twelve for autism were identified and appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. We identified two screening tools which appeared appropriate for validation for use within African nations.
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7
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Samandra R, Haque ZZ, Rosa MGP, Mansouri FA. The marmoset as a model for investigating the neural basis of social cognition in health and disease. Neurosci Biobehav Rev 2022; 138:104692. [PMID: 35569579 DOI: 10.1016/j.neubiorev.2022.104692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/23/2023]
Abstract
Social-cognitive processes facilitate the use of environmental cues to understand others, and to be understood by others. Animal models provide vital insights into the neural underpinning of social behaviours. To understand social cognition at even deeper behavioural, cognitive, neural, and molecular levels, we need to develop more representative study models, which allow testing of novel hypotheses using human-relevant cognitive tasks. Due to their cooperative breeding system and relatively small size, common marmosets (Callithrix jacchus) offer a promising translational model for such endeavours. In addition to having social behavioural patterns and group dynamics analogous to those of humans, marmosets have cortical brain areas relevant for the mechanistic analysis of human social cognition, albeit in simplified form. Thus, they are likely suitable animal models for deciphering the physiological processes, connectivity and molecular mechanisms supporting advanced cognitive functions. Here, we review findings emerging from marmoset social and behavioural studies, which have already provided significant insights into executive, motivational, social, and emotional dysfunction associated with neurological and psychiatric disorders.
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Affiliation(s)
- Ranshikha Samandra
- Cognitive Neuroscience Laboratory, Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Zakia Z Haque
- Cognitive Neuroscience Laboratory, Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Marcello G P Rosa
- Department of Physiology and Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; ARC Centre for Integrative Brain Function, Monash University, Australia.
| | - Farshad Alizadeh Mansouri
- Cognitive Neuroscience Laboratory, Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; ARC Centre for Integrative Brain Function, Monash University, Australia.
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8
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Pham C, Symeonides C, O'Hely M, Sly PD, Knibbs LD, Thomson S, Vuillermin P, Saffery R, Ponsonby AL. Early life environmental factors associated with autism spectrum disorder symptoms in children at age 2 years: A birth cohort study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1864-1881. [PMID: 35012378 DOI: 10.1177/13623613211068223] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
LAY ABSTRACT Mounting evidence indicates the contribution of early life environmental factors in autism spectrum disorder. We aim to report the prospective associations between early life environmental factors and autism spectrum disorder symptoms in children at the age of 2 years in a population-derived birth cohort, the Barwon Infant Study. Autism spectrum disorder symptoms at the age of 2 years strongly predicted autism spectrum disorder diagnosis by the age of 4 years (area under curve = 0.93; 95% CI (0.82, 1.00)). After adjusting for child's sex and age at the time of behavioural assessment, markers of socioeconomic disadvantage, such as lower household income and lone parental status; maternal health factors, including younger maternal age, maternal pre-pregnancy body mass index, higher gestational weight gain and prenatal maternal stress; maternal lifestyle factors, such as prenatal alcohol and environmental air pollutant exposures, including particulate matter < 2.5 μm at birth, child secondhand tobacco smoke at 12 months, dampness/mould and home heating with oil, kerosene or diesel heaters at 2 years postnatal. Lower socioeconomic indexes for area, later birth order, higher maternal prenatal depression and maternal smoking frequency had a dose-response relationship with autism spectrum disorder symptoms. Future studies on environmental factors and autism spectrum disorder should consider the reasons for the socioeconomic disparity and the combined impact of multiple environmental factors through common mechanistic pathways.
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Affiliation(s)
- Cindy Pham
- Murdoch Children's Research Institute, Parkville, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- The University of Melboure, Parkville, Australia
| | - Christos Symeonides
- Murdoch Children's Research Institute, Parkville, Australia
- The University of Melboure, Parkville, Australia
| | - Martin O'Hely
- Murdoch Children's Research Institute, Parkville, Australia
- Deakin University, Geelong, Australia
| | - Peter D Sly
- The University of Queensland, South Brisbane, Australia
| | | | - Sarah Thomson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- The University of Melboure, Parkville, Australia
| | - Peter Vuillermin
- Murdoch Children's Research Institute, Parkville, Australia
- Deakin University, Geelong, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia
- The University of Melboure, Parkville, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Parkville, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- The University of Melboure, Parkville, Australia
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9
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Sturner R, Howard B, Bergmann P, Attar S, Stewart-Artz L, Bet K, Allison C, Baron-Cohen S. Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners. Mol Autism 2022; 13:2. [PMID: 34980240 PMCID: PMC8722322 DOI: 10.1186/s13229-021-00480-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.
Methods This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.
Results While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Limitations Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Conclusions Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00480-4.
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Affiliation(s)
- Raymond Sturner
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA. .,Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.
| | - Barbara Howard
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Paul Bergmann
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,Foresight Logic, Inc., St. Paul, MN, USA
| | - Shana Attar
- CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA.,University of Washington, Seattle, WA, USA
| | - Lydia Stewart-Artz
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA
| | - Kerry Bet
- Center for Promotion of Child Development Through Primary Care, Baltimore, MD, USA.,CHADIS, Inc., 6017 Altamont Place, Baltimore, MD, USA
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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10
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Thi Vui L, Duc DM, Thuy Quynh N, Giang NTH, Mai VTT, Ha BTT, Van Minh H. Early screening and diagnosis of autism spectrum disorders in Vietnam: A population-based cross-sectional survey. J Public Health Res 2021; 11. [PMID: 34850618 PMCID: PMC8973207 DOI: 10.4081/jphr.2021.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Early detection of autism spectrum disorders (ASDs) is essential given the under-reported cases in low- and middle-income countries. This first national representative survey was conducted to explore the prevalence of ASDs amongst 18 and 30 months in seven provinces in Vietnam. Design and methods: During 2017-2018, a national cross-sectional and population-based survey for autism spectrum disorder (ASD) amongst 40,243 children aged 18 to 30 months was conducted in 7 provinces representing the socio-economic regions of Vietnam. M-CHAT was used to screen children and then confirmed by diagnostic assessment using DSM-IV criteria. Results: The prevalence of ASDs amongst children aged 18 and 30 months in Vietnam was high (0.758% or 1 in 132 children). Urban setting, male gender, and hereditable genes were associated with ASD prevalence. Conclusions: ASDs amongst children aged 18 and 30 months in Vietnam tend to be increasing and are similar to this rate in other middle-income countries but lower than that in Western countries. This under-recognized public health problem amongst children should be addressed by early detection and intervention for families with affected children. Significance for public health This first nationally representative and population-based survey adds empirical data about autism spectrum disorder (ASD) amongst children aged 18 to 30 months in Vietnam. Using M-CHAT as screening tool and DSM-IV criteria for confirmation, ASD amongst children aged 18 and 30 months shows an increasing trend with the prevalence as high as 0.758% in 2018. Early detection and intervention should be conducted to provide affected child with the potential for a better life.
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Affiliation(s)
- Le Thi Vui
- Hanoi University of Public Health, Hanoi.
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11
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Mazurek MO, Kuhlthau K, Parker RA, Chan J, Sohl K. Autism and General Developmental Screening Practices Among Primary Care Providers. J Dev Behav Pediatr 2021; 42:355-362. [PMID: 33507041 DOI: 10.1097/dbp.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Using standardized screening tools increases accuracy in early identification of autism. The American Academy of Pediatrics recommends systematic developmental screening at all 9-, 18-, and 24- or 30-month well-child visits (WCVs) and autism-specific screening at all 18- and 24-month WCVs. The study objectives were to examine the extent to which these guidelines have been adopted in practice among primary care providers (PCPs) and to identify potential provider-level factors associated with screening practices. METHOD Participants included 94 PCPs (79% pediatricians) from 13 states enrolled in a study of an autism training program. Self-report and chart-review data collected before training were examined. Screening practices were assessed through chart review of all 9-, 18-, and 24-month WCVs within a 30-day window. RESULTS Sixty-four percent of PCPs administered developmental screening tools at all 9-month WCVs, and 62% at all 18-month WCVs. Fifty-one percent administered autism screening tools at all 18-month WCVs, and 41% at all 24-month WCVs. Screening practices varied by provider type (pediatrician vs other PCP), self-efficacy in screening and identification, and previous autism training (autism screening only), but not by years of experience. CONCLUSION Overall, general developmental and autism-specific screenings are not being consistently administered across recommended WCVs in primary care practices. Provider self-efficacy in autism identification and screening and previous autism training were associated with increased autism screening. As such, these results suggest a need for increased training and dissemination of information on screening implementation for practicing PCPs.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, University of Virginia, Charlottesville, VA
| | - Karen Kuhlthau
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Robert A Parker
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - James Chan
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Kristin Sohl
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO
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12
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DiGuiseppi C, Rosenberg SA, Tomcho MA, Colborn K, Hightshoe K, Gutiérrez-Raghunath S, Cordova JM, Dooling-Litfin JK, Robinson Rosenberg C. Family navigation to increase evaluation for autism spectrum disorder in toddlers: Screening and Linkage to Services for Autism pragmatic randomized trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:946-957. [PMID: 33246390 PMCID: PMC8723795 DOI: 10.1177/1362361320974175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Young children with autism spectrum disorder can benefit from early detection and intervention to moderate autism spectrum disorder's effect on their development. Routine screening with standardized instruments facilitates early identification. However, many screen-positive children do not receive referrals for evaluation, complete diagnostic evaluations, or engage in services. This is especially true for children of color and those from less educated or low-income families. The Screening and Linkage to Services for Autism trial evaluated the effect of family navigation on referral and evaluation for autism spectrum disorder in screen-positive toddlers. The trial was conducted in an urban, low-income population. It was designed to test "real-world" implementation of family navigation. We randomly assigned 275 children aged 16-30 months with an initial positive autism spectrum disorder screen to receive navigation if indicated or usual care. Navigation increased the number of at-risk toddlers who were evaluated for autism spectrum disorder. It also improved the quality of autism spectrum disorder screening in primary care clinics. However, many children failed to receive indicated referrals for evaluation. Navigation did not improve referral rates. Furthermore, nearly half of families who were potentially eligible for navigation could not be contacted. Other ways of structuring the navigation program may be necessary to improve families' access to and acceptance of navigation, especially in the setting of financial, cultural, and linguistic barriers. Our trial nevertheless showed that family navigation may be an important tool for reducing systemic inequalities in the early identification and treatment of young children with autism spectrum disorder.
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Affiliation(s)
| | | | | | - Kathryn Colborn
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Does the M-Chat-R Give Important Information for the Diagnosis of the Autism Spectrum Disorder? Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42:67-75. [PMID: 33894115 DOI: 10.2478/prilozi-2021-0005] [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: 11/21/2022]
Abstract
Having in mind the rising rates of the incidence for autism worldwide, the early diagnosis of this neuro-developmental disorder is of the high priority. For that purpose, several checklists have been constructed and used. Nevertheless, there are no universal and uniform criteria for assessing and diagnosing autism, and even if there existed, not every country has the resources to manage such an assessment for diagnosis.A recently validated, revised version of the M-CHAT, the M-CHAT-Revised with Follow up (M-CHAT-R/F) has demonstrated strong psychometric properties.The aim of this article is to discuss our results obtained with M-CHAT-R applied in a sample of 131 children aged 31,9 ±9,4 months, recruited for diagnosis and treatment at the University Children's Hospital in Skopje.Our results confirmed that for screening the use of M-CHAT-R/F is currently the very exact instrument which allows the early suspicion, but also possible follow up the symptoms of this disorder. Additionally, we showed the significant negative correlation between age and scores obtained on the checklist.
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14
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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15
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Shahrokhi H, Ghiasi A, Gholipour K, Fanid LM, Shamekhi HR, Iezadi S. Considerations about the implementation of an autism screening program in Iran from the viewpoints of professionals and parents: a qualitative study. BMC Psychiatry 2021; 21:55. [PMID: 33485323 PMCID: PMC7825177 DOI: 10.1186/s12888-021-03061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aims of this study were to explore to explore the viewpoints of parents of children with Autism Spectrum Disorders (ASD) and professionals regarding the implementation of screening programs for ASD, to explore the challenges of the implementation of a universal screening program for ASD in Iran from their viewpoints, and, to explore their recommendations to overcome the potential challenges. METHOD This qualitative study was conducted using an inductive content analysis, between June 2018 and December 2018, in East-Azerbaijan province of Iran. Data was collected through in-depth interviews and focus group discussions. The participants were purposively selected among two groups: representatives of health system and representatives of children with ASD. A sample of 32 parents and 30 professionals were recruited in this study. RESULTS Totally, 9 main themes and 23 sub-themes were extracted in three main areas including: viewpoints of the participants about universal screening for ASD, challenges in implementation of the universal screening program, and participants' recommendations about how to overcome the potential challenges. Main challenges in implementation of the universal screening program included: shortages of ASD screening tools, weakness of the health system, lack of coordination among the ASD service providers, and social and ethical issues. CONCLUSION The parents and the professionals had different viewpoints about the implementation of ASD universal screening program in Iran. According to the professionals, there is not enough rational to implement ASD screening program for all children. However, the parents believed that universal screening program is inevitable, and it should be implemented in primary health centers during the early child-care visits. The results of this study open up unspoken issues that could help in initiating the screening program not only in Iran but also in other low- and middle-income countries as well.
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Affiliation(s)
- Hassan Shahrokhi
- grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Ghiasi
- grid.267572.30000 0000 9494 8951HEB School of Business & Administration, University of the Incarnate Word, San Antonio, TX USA
| | - Kamal Gholipour
- grid.412888.f0000 0001 2174 8913Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Mehdizadeh Fanid
- grid.412831.d0000 0001 1172 3536Division of Cognitive Neuroscience. Department of Psychology, Faculty of Education and Psychology. University of Tabriz, Tabriz, Iran
| | - Hamid Reza Shamekhi
- Education Development Office (EDO), Faculty of Medicine, Tabriz Azad Islamic University, Tabriz, Iran
| | - Shabnam Iezadi
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Quon JL, Jin MC, Seekins J, Yeom KW. Harnessing the potential of artificial neural networks for pediatric patient management. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Scarlytt de Oliveira Holanda N, Delgado Oliveira da Costa L, Suelen Santos Sampaio S, Gomes da Fonseca Filho G, Batista Bezerra R, Guerra Azevedo I, Alves Pereira S. Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207675. [PMID: 33096698 PMCID: PMC7589640 DOI: 10.3390/ijerph17207675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4–5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born prematurely and hospitalized in a neonatal intensive care unit (NICU) and explore the association with pre-, peri- and postnatal factors. Methods: The children’s families were contacted by telephone when their child was between 18 and 24 months of age, to apply the Modified Checklist for Autism in Toddlers (M-CHAT). The sample consisted of 40 children (57.5% boys). M-CHAT screening revealed that 50% of the sample showed early signs of ASD. Although the frequency of delayed development was higher in boys, this difference was not statistically significant between the sexes (p = 0.11). Assessment of the association between perinatal conditions and early signs of autism in children hospitalized in an NICU exhibited no correlation between the factors analyzed (birth weight and type of delivery). The findings indicate a high risk of ASD in premature children, demonstrating no associations with gestational and neonatal variables or the hospitalization conditions of the NICUs investigated.
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Affiliation(s)
- Norrara Scarlytt de Oliveira Holanda
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
| | - Lidiane Delgado Oliveira da Costa
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
| | - Sabrinne Suelen Santos Sampaio
- Post-graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (S.S.S.S.); (G.G.d.F.F.)
| | - Gentil Gomes da Fonseca Filho
- Post-graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (S.S.S.S.); (G.G.d.F.F.)
- Instituto Santos Dumont, Macaíba 59280-000, Rio Grande do Norte, Brazil
| | - Ruth Batista Bezerra
- Rehabilitation Sciences Graduate Program, Faculty of Health Sciences of Trairi/ Universidade Federal do Rio Grande do Norte (FACISA/UFRN), Santa Cruz 59200-000, Rio Grande do Norte, Brazil;
| | - Ingrid Guerra Azevedo
- Department of Therapeutic Processes, Universidad Católica de Temuco, Temuco 4813302, La Araucania, Chile
- Correspondence:
| | - Silvana Alves Pereira
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
- Rehabilitation Sciences Graduate Program, Faculty of Health Sciences of Trairi/ Universidade Federal do Rio Grande do Norte (FACISA/UFRN), Santa Cruz 59200-000, Rio Grande do Norte, Brazil;
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18
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Abstract
As the prevalence of autism spectrum disorder (ASD) has increased in recent years, so too has the body of research describing the importance of early diagnosis and early intervention. Unfortunately, a large proportion of children with the disorder do not receive a diagnosis until after their fourth birthday. Various reasons exist for late diagnosis, including limited understanding of nuanced early warning signs and limited knowledge of effective early detection mechanisms among healthcare providers. Since early diagnosis enables access to treatment, and early intensive intervention improves long-term developmental outcomes, early detection by pediatric healthcare providers is critical. This article will review ASD prevalence rates, describe correlates and factors that might influence prevalence estimates, and highlight recent advances in early detection methods and intervention services.
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Affiliation(s)
- Stephen N James
- Research Department, Southwest Autism Research and Resource Center, Phoenix, AZ.
| | - Christopher J Smith
- Research Department, Southwest Autism Research and Resource Center, Phoenix, AZ
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19
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Richa S, Khoury R, JRouhayem J, Chammay R, Kazour F, Bou Khalil R, Kheir W, Choueifaty D, Kouba-Hreich E, Gerbaka B, Adib S. Estimating the prevalence of autism spectrum disorder in Lebanon. Encephale 2020; 46:414-419. [PMID: 32928536 DOI: 10.1016/j.encep.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 11/15/2022]
Abstract
This cross-sectional survey examines the prevalence rate of Autism spectrum disorder (ASD) in 818 children (16-48 months) across all Lebanese regions. Screening was done using the revised form of the Modified-Checklist for Autism in Toddlers. Based on the total score of items failed, children were classified into 3 categories of ASD risk (low, moderate and high). Phone calls follow-up interviews and clinical assessments for diagnosis ascertainment were conducted. Given the caregivers' reluctance to participate, the prevalence rate was estimated between 49 and 513 per 10,000 with a male predominance. Our prevalence estimation, even under restrictive assumptions, is higher than elsewhere in the Arab region. Anti- stigma interventions adapted to the socio-cultural context are needed prior to future research in the field.
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Affiliation(s)
- S Richa
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon.
| | - R Khoury
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
| | - J JRouhayem
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
| | - R Chammay
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
| | - F Kazour
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
| | - R Bou Khalil
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
| | - W Kheir
- Ministry of public health, Lebanon
| | - D Choueifaty
- Department of Nursing, Saint-Joseph University, Beirut, Lebanon
| | - E Kouba-Hreich
- Department of Nursing, Saint-Joseph University, Beirut, Lebanon
| | - B Gerbaka
- Department of Pediatrics, Saint-Joseph University, Beirut, Lebanon
| | - S Adib
- Department of Epidemiology, American University of Beirut, Beirut, Lebanon
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ECHO Autism: Integrating Maintenance of Certification with Extension for Community Healthcare Outcomes Improves Developmental Screening. J Dev Behav Pediatr 2020; 41:420-427. [PMID: 32735419 DOI: 10.1097/dbp.0000000000000796] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent estimates indicate that most pediatricians do not consistently meet the American Academy of Pediatrics developmental screening guidelines, contributing to the delay of vital evaluations and interventions for autism spectrum disorder (ASD). Our objective was to evaluate the utility of Maintenance of Certification (MOC) Quality Improvement (QI) training designed to improve developmental screening rates in underserved, rural primary care practices. Trainings on best screening practices were disseminated to primary care providers (PCPs) through Extension for Community Healthcare Outcomes (ECHO) Autism, a virtual learning network. METHOD Across 2 cohorts, 24 PCPs were enrolled in MOC Part 4 training modules delivered through the ECHO Autism QI Learning Network. Throughout the 12 months of enrollment, PCPs reported information on general and ASD-specific developmental screenings conducted at 18- and 24-month well-child visits. A 1-year follow-up was conducted to assess the maintenance of screening rates. RESULTS Baseline rates for general and ASD-specific developmental screenings were 53.3% and 68.3%, respectively. By the end of the 12-month learning module, screening rates increased significantly for general development (88.6%) and ASD-specific screenings (99.0%). At the 1-year follow-up, the rate for general developmental screening was 96.7% and for ASD-specific screening was 97.1%. CONCLUSION Maintenance of Certification Part 4 training delivered through the ECHO Autism QI Learning Network was found to be incentivizing and highly effective in shaping and maintaining PCP developmental screening practices. Improved screening rates show promise in decreasing time to critical developmental evaluations, interventions, and resources. Our methodology is likely transferable to other ECHO communities and may facilitate expedient implementation of best practice standards in primary care.
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21
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Tenenbaum EJ, Carpenter KLH, Sabatos-DeVito M, Hashemi J, Vermeer S, Sapiro G, Dawson G. A Six-Minute Measure of Vocalizations in Toddlers with Autism Spectrum Disorder. Autism Res 2020; 13:1373-1382. [PMID: 32212384 PMCID: PMC7881362 DOI: 10.1002/aur.2293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/24/2019] [Accepted: 03/03/2020] [Indexed: 01/08/2023]
Abstract
To improve early identification of autism spectrum disorder (ASD), we need objective, reliable, and accessible measures. To that end, a previous study demonstrated that a tablet-based application (app) that assessed several autism risk behaviors distinguished between toddlers with ASD and non-ASD toddlers. Using vocal data collected during this study, we investigated whether vocalizations uttered during administration of this app can distinguish among toddlers aged 16-31 months with typical development (TD), language or developmental delay (DLD), and ASD. Participant's visual and vocal responses were recorded using the camera and microphone in a tablet while toddlers watched movies designed to elicit behaviors associated with risk for ASD. Vocalizations were then coded offline. Results showed that (a) children with ASD and DLD were less likely to produce words during app administration than TD participants; (b) the ratio of syllabic vocalizations to all vocalizations was higher among TD than ASD or DLD participants; and (c) the rates of nonsyllabic vocalizations were higher in the ASD group than in either the TD or DLD groups. Those producing more nonsyllabic vocalizations were 24 times more likely to be diagnosed with ASD. These results lend support to previous findings that early vocalizations might be useful in identifying risk for ASD in toddlers and demonstrate the feasibility of using a scalable tablet-based app for assessing vocalizations in the context of a routine pediatric visit. LAY SUMMARY: Although parents often report symptoms of autism spectrum disorder (ASD) in infancy, we are not yet reliably diagnosing ASD until much later in development. A previous study tested a tablet-based application (app) that recorded behaviors we know are associated with ASD to help identify children at risk for the disorder. Here we measured how children vocalize while they watched the movies presented on the tablet. Children with ASD were less likely to produce words, less likely to produce speechlike sounds, and more likely to produce atypical sounds while watching these movies. These measures, combined with other behaviors measured by the app, might help identify which children should be evaluated for ASD. Autism Res 2020, 13: 1373-1382. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Elena J Tenenbaum
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Kimberly L H Carpenter
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jordan Hashemi
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Saritha Vermeer
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Guillermo Sapiro
- Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Computer Science, Duke University, Durham, North Carolina, USA
- Department of Mathematics, Duke University, Durham, North Carolina, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Karabulut B, Sahbudak B. Autism Spectrum Disorder Screening at 18-36 Months in Infants with Moderate and Severe Neonatal Encephalopathy: Is Routine Screening Required? PSYCHOPHARMACOLOGY BULLETIN 2020; 50:8-22. [PMID: 32733108 PMCID: PMC7377542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hypoxia, acidosis, and inflammation cause impairment of neuronal development due to lack of sufficient oxygen and nutrition, and there may be an increased risk of ASD in neonates with Neonatal Encephalopathy (NE). To evaluate the frequency of Autism Spectrum Disorder (ASD) in moderate and severe NE requiring therapeutic hypothermia at 18-36 months. METHODS In this prospective study, infants with moderate and severe NE requiring hypothermia were included. RESULTS Throughout the study period, 33 of 85 neonates with NE admitted to our unit were included in the study. M-CHAT results of six infants included in the study showed positive and results of twenty-seven patients were negative. Four of six infants with a positive screening test completed a psychiatric examination, and two infants did not complete the clinical examination. The results of the examination showed that one infant was diagnosed with ASD, one was diagnosed with attention deficit hyperactivity disorder (ADHD), and two infants were diagnosed with no psychiatric disorder. CONCLUSION Our results showed that the risk of ASD increases in infants with moderate and severe NE, and this relationship should be considered in long-term clinical follow-ups.
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Affiliation(s)
- Birol Karabulut
- Karabulut, Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Izmir, Turkey. Sahbudak, Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Child and Adolescent Psychiatry
| | - Begum Sahbudak
- Karabulut, Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Izmir, Turkey. Sahbudak, Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Child and Adolescent Psychiatry
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Levy SE, Wolfe A, Coury D, Duby J, Farmer J, Schor E, Van Cleave J, Warren Z. Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review. Pediatrics 2020; 145:S47-S59. [PMID: 32238531 DOI: 10.1542/peds.2019-1895h] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). OBJECTIVES We systematically reviewed evidence for universal screening of children for ASD in PC. DATA SOURCES We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. STUDY SELECTION We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. DATA EXTRACTION At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. LIMITATIONS Potential limitations include publication bias, selective reporting within studies, and a constrained search. CONCLUSIONS ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4.
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Affiliation(s)
- Susan E Levy
- Center for Autism Research, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Audrey Wolfe
- Spaulding Rehabilitation Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Daniel Coury
- Autism Intervention Research Network on Physical Health and Autism Treatment Network, MassGeneral Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Nationwide Children's Hospital and School of Medicine, The Ohio State University, Columbus, Ohio
| | - John Duby
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Justin Farmer
- Autism Intervention Research Network on Physical Health and Autism Treatment Network, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Edward Schor
- Lucille Packard Foundation for Children's Health, Palo Alto, California
| | - Jeanne Van Cleave
- General Pediatrics, Children's Hospital Colorado and University of Colorado Anshutz Medical Campus, Aurora, Colorado; and
| | - Zachary Warren
- Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders, Departments of Pediatrics, Psychiatry, and Special Education, Vanderbilt University, Nashville, Tennessee
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Ruel A, Chiarella SS, Crivello C, Poulin-Dubois D. Concurrent Validity of the Modified Checklist for Autism in Toddlers (M-CHAT): Socio-cognitive and Verbal Skills in 18-Month-Old Infants. J Autism Dev Disord 2020; 51:933-949. [DOI: 10.1007/s10803-020-04379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Chahin SS, Apple RW, Kuo KH, Dickson CA. Autism spectrum disorder: psychological and functional assessment, and behavioral treatment approaches. Transl Pediatr 2020; 9:S66-S75. [PMID: 32206585 PMCID: PMC7082250 DOI: 10.21037/tp.2019.11.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There have been significant changes in the way Autism has been defined especially in the last decade. The changes encompass criteria over a spectrum rather than individual diagnoses based on clusters of criteria. With these changes, there has been a push for earlier screening and diagnosis to be made to ensure individual impacted by the deficits have ample time and opportunity to receive the services they need. Additionally, with the changes that have come up, screening tools and assessments have also been changed and improved to assist with the increasing demand of early screening. Screeners have been created to help in primary care settings so physicians can gauge the severity of symptoms and refer patients to the appropriate resources. The assessment and diagnostic process for Autism involves a large battery including parental interviews and forms, the ADOS-II, and a multitude of other intellectual assessments to get a full picture of what the individual is experiencing. Once an individual is diagnosed with Autism, the interventionist team, physicians, and clinicians assist the family in finding the appropriate resources and treatment plan. There are several evidence-based therapies that exist that have been effective in improving the quality of life of individuals with Autism Spectrum Disorder diagnoses. Although several interventions and therapies exist, there are some potential interventions some use that need to more research to know how truly effective they are.
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Affiliation(s)
- Summer S Chahin
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kailin H Kuo
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Ip A, Dupuis A, Anagnostou E, Loh A, Dodds T, Munoz A, Smile S. General paediatric practice in autism spectrum disorder screening in Ontario, Canada: Opportunities for improvement. Paediatr Child Health 2019; 26:e33-e38. [PMID: 33542776 DOI: 10.1093/pch/pxz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Screening is important for early identification of children with autism spectrum disorder (ASD), potentially leading to earlier intervention. Research has identified some barriers to early identification of ASD, however, information about ASD screening in Canadian general paediatric practice is lacking. Objectives The aim of the study is to better understand ASD screening practice patterns by examining the use of ASD and general developmental screening tools by general paediatricians. Methods The research team conducted a cross-sectional survey of general paediatricians. Results Two-hundred and sixty-seven paediatricians responded and 132 were eligible for the study. Ninety-three per cent of the responders used a developmental screening tool. Eighty-five per cent of the responders used an ASD screening tool when there were concerns for ASD, and 15% never used one. The most commonly used ASD screening tool was the M-CHAT. Children suspected of having ASD were referred to specialists not only to confirm the diagnosis but also to facilitate access to resources. General paediatricians were keen to incorporate formal ASD screening tools in their practice but identified the need for clearer guidelines. Conclusion Previous studies have shown that children at risk of ASD continue to be missed through developmental surveillance and targeted screening. Paediatricians are interested in implementing an ASD screening tool and cite brevity and forms that can be completed by parents as factors that would support the use of a screening tool. Clearer guidelines and tools to support ASD screening and access to resources are needed.
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Affiliation(s)
- Angie Ip
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of British Columbia, Vancouver, British Columbia
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Evdokia Anagnostou
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
| | - Alvin Loh
- Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario.,Surrey Place Centre, Toronto, Ontario
| | - Tyler Dodds
- Bloorview Research Institute, Toronto, Ontario
| | | | - Sharon Smile
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
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Mårland C, Lubke G, Degl’Innocenti A, Råstam M, Gillberg C, Nilsson T, Lundström S. The development of a brief screener for autism using item response theory. BMC Psychiatry 2019; 19:337. [PMID: 31684913 PMCID: PMC6829932 DOI: 10.1186/s12888-019-2333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Brief screening instruments focusing on autism spectrum disorder (ASD) that can be administered in primary care are scarce; there is a need for shorter and more precise instruments. The Autism-Tics, AD/HD and other Comorbidities inventory (A-TAC) has previously been validated for ASD reporting excellent validity. This study aims to determine the psychometric properties of each item in the ASD domain (17 items) in the A-TAC using item response theory (IRT), and thereby construct and validate a short form that could be used as a screening instrument in the general population. METHODS Since 2004, parents of all 9-year-old Swedish twins have been invited to participate in a telephone interview in the Child and Adolescent Twin Study in Sweden (CATSS). The CATSS is linked to the National Patient Register (NPR), which includes data from in- and outpatient care. Data on ASD (A-TAC) collected in CATSS were compared with diagnoses from the NPR. Diagnoses that had been made both before (previous validity) and after (predictive validity) the interviews were included. The sample was divided into a developmental sample and a validation sample. An IRT model was fitted to the developmental sample and item parameters were used to select a subset of items for the short form. The performance of the proposed short form was examined in the validation sample by the use of receiver operation characteristic curves. RESULTS Four items which were able to discriminate among individuals with more autism traits were deemed sufficient for use in the short form. The values of the area under the receiver operating characteristic curve for a clinical diagnosis of ASD was .95 (previous validity) and .72 (predictive validity). CONCLUSIONS The proposed short form with 4 out of the original 17 items from A-TAC, showed excellent previous validity while the predictive validity was fair. The validity of the short form was in agreement with previous validations of the full ASD domain. The short form can be a valuable screening instrument in primary care settings in order to identify individuals in need for further assessment and for use in epidemiological studies.
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Affiliation(s)
- Caroline Mårland
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gitta Lubke
- 0000 0001 2168 0066grid.131063.6Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Alessio Degl’Innocenti
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Råstam
- 0000 0001 0930 2361grid.4514.4Department of Clinical Sciences Lund, Lund University, Lund, Sweden ,0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
| | - Christopher Gillberg
- 0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
| | - Thomas Nilsson
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19, Göteborg, Sweden.
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Zwaigenbaum L, Brian JA, Ip A. Le dépistage précoce du trouble du spectre de l’autisme chez les jeunes enfants. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
RésuméLe trouble du spectre de l’autisme (TSA) est un trouble neurodéveloppemental permanent qui se caractérise par des déficits de la communication sociale, un mode répétitif et restreint des comportements et des sensibilités ou des intérêts sensoriels inhabituels. Le TSA a des répercussions importantes sur la vie des enfants et de leur famille. À l’heure actuelle, sa prévalence estimative est de un cas sur 66 enfants et adolescents canadiens dans le groupe d’âge des cinq à 17 ans. Les pédiatres généraux, les médecins de famille et les autres professionnels de la santé rencontrent donc plus d’enfants ayant un TSA qu’auparavant dans leur pratique. Le diagnostic rapide de ce trouble et l’orientation des cas vers des interventions comportementales et éducationnelles intensives dès le plus jeune âge peuvent favoriser un meilleur pronostic clinique à long terme grâce à la neuroplasticité du cerveau à un plus jeune âge. Le présent docu-ment de principes contient des recommandations et des outils clairs, détaillés et fondés sur des données probantes pour aider les pédiatres communautaires et les autres dispensateurs de soins de première ligne à surveiller les tout premiers signes de TSA, ce qui constitue une étape importante vers un diagnostic précis et une évaluation détaillée des besoins pour planifier les interventions.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Jessica A Brian
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Angie Ip
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
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Zwaigenbaum L, Brian JA, Ip A. Early detection for autism spectrum disorder in young children. Paediatr Child Health 2019; 24:424-443. [PMID: 31660041 DOI: 10.1093/pch/pxz119] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/27/2019] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder, characterized by impairments in social communication, repetitive, restricted patterns of behaviour, and unusual sensory sensitivities or interests. ASD significantly impacts the lives of children and their families. Currently, the estimated prevalence of ASD is 1 in 66 Canadians aged 5 to 17 years. General paediatricians, family physicians, and other health care professionals are, therefore, seeing more children with ASD in their practices. The timely diagnosis of ASD, and referral for intensive behavioural and educational interventions at the earliest age possible, may lead to better long-term outcomes by capitalizing on the brain's neuroplasticity at younger ages. This statement provides clear, comprehensive, evidence-informed recommendations and tools to help community paediatricians and other primary care providers monitor for the earliest signs of ASD-an important step toward an accurate diagnosis and comprehensive needs assessment for intervention planning.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Jessica A Brian
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Angie Ip
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
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Zwaigenbaum L, Maguire J. Autism Screening: Where Do We Go From Here? Pediatrics 2019; 144:peds.2019-0925. [PMID: 31562253 DOI: 10.1542/peds.2019-0925] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry and .,Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathon Maguire
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; and.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics and
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31
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Lee HY, Vigen C, Zwaigenbaum L, Bryson S, Smith I, Brian J, Watson LR, Crais ER, Turner-Brown L, Reznick JS, Baranek GT. The Performance of the First Year Inventory (FYI) Screening on a Sample of High-Risk 12-Month-Olds Diagnosed with Autism Spectrum Disorder (ASD) at 36 Months. J Autism Dev Disord 2019; 49:4957-4973. [DOI: 10.1007/s10803-019-04208-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Iskrov G, Vasilev G, Mitev M, Nikolova R, Stoykova M, Stefanov R. Practice Patterns for Early Screening and Evaluation for Autism Spectrum Disorder Diagnosis in Bulgaria. J Autism Dev Disord 2019; 51:778-789. [PMID: 31414261 DOI: 10.1007/s10803-019-04170-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aims of this study were to describe the practice patterns for early screening and evaluation for ASD diagnosis in Bulgaria, as well as to identify potential barriers and facilitators in this process. We surveyed a sample of pediatricians and pediatric psychiatrists to analyze the use of standardized instruments, application of biomarkers, parental collaboration and future policy prospects. We found a significant support for the idea of a national program for ASD in Bulgaria. These insights provide an evidence-based analysis that could help improve services, guide research and inform policies in regard to ASD. Further work is necessary to better understand other stakeholders' opinions and perspectives, especially those of patients and their families.
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Affiliation(s)
- Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria. .,Institute for Rare Diseases, 22, Maestro Georgi Atanasov Str, Plovdiv, Bulgaria.
| | - Georgi Vasilev
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria
| | - Martin Mitev
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria
| | - Ralitsa Nikolova
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria
| | - Mariya Stoykova
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 15 A, Vasil Aprilov Blvd, 4002, Plovdiv, Bulgaria.,Institute for Rare Diseases, 22, Maestro Georgi Atanasov Str, Plovdiv, Bulgaria
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Abnormal axon guidance signals and reduced interhemispheric connection via anterior commissure in neonates of marmoset ASD model. Neuroimage 2019; 195:243-251. [DOI: 10.1016/j.neuroimage.2019.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
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Alawami AH, Perrin EC, Sakai C. Implementation of M-CHAT Screening for Autism in Primary Care in Saudi Arabia. Glob Pediatr Health 2019; 6:2333794X19852021. [PMID: 31211185 PMCID: PMC6545649 DOI: 10.1177/2333794x19852021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background. Integration of autism screening into primary care practice in Saudi Arabia is not well established. Objectives. To evaluate the feasibility and effectiveness of implementing the Arabic Modified Checklist for Autism in Toddlers (M-CHAT) in a primary care practice at John Hopkins Aramco Healthcare Center in Saudi Arabia. Method. The Arabic version of M-CHAT was distributed to caregivers of 1207 toddlers (16-32 months) from January to December 2014. Feasibility was assessed by measuring the proportion of visits with M-CHAT completed, and reports of workflow challenges and provider satisfaction. The effectiveness of screening was evaluated based on the number of referrals for autism evaluation and autism identification rates. Results. Total M-CHAT completion rate was 89% (1078 out of 1207 child-specific visits). Those identified as low risk (n = 951; 88%) were reassured and followed routinely. Those screening positive (n = 127; 12%) were referred for diagnostic assessment. Twelve (1% of toddlers screened) were diagnosed with autism at a mean age of 24 months. In addition, positive M-CHAT detected speech delay and social anxiety. Providers acknowledged their satisfaction with the M-CHAT implementation process; the main challenge was communicating to families the importance of screening. Referrals for diagnostic evaluations increased from 23 to 43 cases in the first year, and 35 in the second year. Conclusion. Implementation of the autism screening using the Arabic M-CHAT is feasible and effective in a primary care setting in Saudi Arabia. Sustaining the implementation of developmental screening in practice requires staff engagement and systematic monitoring of the impact of change.
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Sánchez-García AB, Galindo-Villardón P, Nieto-Librero AB, Martín-Rodero H, Robins DL. Toddler Screening for Autism Spectrum Disorder: A Meta-Analysis of Diagnostic Accuracy. J Autism Dev Disord 2019; 49:1837-1852. [PMID: 30617550 PMCID: PMC6483963 DOI: 10.1007/s10803-018-03865-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Great efforts focus on early detection of autism spectrum disorder, although some scientists and policy-makers have questioned early universal screening. The aim of this meta-analysis was to evaluate the diagnostic accuracy of the different screening tools. Several electronic databases were used to identify published studies. A Bayesian model was used to estimate the screening accuracy. The pooled sensitivity was 0.72 (95% CI 0.61–0.81), and the specificity was 0.98 (95% CI 0.97–0.99). Subgroup analyses to remove heterogeneity indicated sensitivity was 0.77 (95% CI 0.69–0.84), and specificity was 0.99 (95% CI 0.97–0.99; SD ≤ 0.01). Level 1 screening tools for ASD showed consistent statistically significant results and therefore are adequate to detect autism at 14–36 months.
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Affiliation(s)
| | | | - Ana B Nieto-Librero
- IBSAL-University of Salamanca, C/ Alfonso X El Sabio s/n, 37007, Salamanca, Spain
| | - Helena Martín-Rodero
- Medical School Library, University of Salamanca, C/ Alfonso X El Sabio s/n, 37007, Salamanca, Spain
| | - Diana L Robins
- AJ Drexel Autism Institute, 3020 Market Street, Suite 560, Philadelphia, PA, 19104-3734, USA
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Hoang VM, Le TV, Chu TTQ, Le BN, Duong MD, Thanh NM, Tac Pham V, Minas H, Bui TTH. Prevalence of autism spectrum disorders and their relation to selected socio-demographic factors among children aged 18-30 months in northern Vietnam, 2017. Int J Ment Health Syst 2019; 13:29. [PMID: 31168317 PMCID: PMC6487529 DOI: 10.1186/s13033-019-0285-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/17/2019] [Indexed: 12/27/2022] Open
Abstract
Background Autism spectrum disorders are increasing worldwide and in Vietnam. This study reports the prevalence of autism spectrum disorders and examines their relation to selected socio-demographic factors among children aged 18 and 30 months in three northern cities/provinces in Vietnam, 2017. Methods This was a cross-sectional study conducted among 17,277 children aged 18 and 30 months one city (Hanoi capital) and two provinces in northern Vietnam. The multi-stage sampling technique was applied in this study. We used M-CHAT to screen children with high risk of ASD. M-CHAT positive cases were diagnosed by pediatric neurologists from National Pediatrics Hospital using DSM-IV criteria. Descriptive and analytical statistics were performed. Results The overall prevalence of ASD among children aged 18 and 30 months in the three studied sites was 0.752% (95% CI 0.629–0.893%). The odds of having ASD were statistically significant higher among (a) children living in urban area as compared to those from rural settings (OR = 2.7, 95% CI 1.73–4.21); (b) boys as compared to girls (OR = 4.04, 95% CI 2.57–6.35); and (c) children of mothers who worked as farmers as compared to children of mothers who were government staff (OR = 4.72, 95% CI 2.03–10.97). Conclusions Our study revealed that the prevalence of ASD among children in Vietnam seems to be increasing. The significant correlates of ASD among the children were urban setting, male gender and mother’s occupation (farmer). Further and more in-depth studies on determinants of ASD are needed to provide insights into the problem.
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Affiliation(s)
- Van Minh Hoang
- 1Department of Health Economics and Finance, Hanoi University of Public Health, Hanoi, Vietnam
| | - Thi Vui Le
- 2Department of Demography-Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Thi Thuy Quynh Chu
- 2Department of Demography-Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bich Ngoc Le
- 3Department of Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Minh Duc Duong
- 2Department of Demography-Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ngoc Minh Thanh
- 4Department of Psychiatry, Vietnam National Hospital of Pediatrics, Hanoi, Vietnam
| | - Van Tac Pham
- 5Departments of Personnel and Organization, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Harry Minas
- Global and Cultural Mental Health Unit, Center for Mental Health, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Thi Thu Ha Bui
- 2Department of Demography-Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
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Rescorla LA, Given C, Glynn S, Ivanova MY, Achenbach TM. International comparisons of autism spectrum disorder behaviors in preschoolers rated by parents and caregivers/teachers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:2043-2054. [PMID: 30995081 DOI: 10.1177/1362361319839151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study tested international similarities and differences in scores on a scale comprising 12 items identified by international mental health experts as being very consistent with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) category of autism spectrum disorder. Participants were 19,850 preschoolers in 24 societies rated by parents on the Child Behavior Checklist for Ages 1½-5; 10,521 preschoolers from 15 societies rated by caregivers/teachers on the Caregiver-Teacher Report Form, and 7380 children from 13 societies rated by both types of informant. Rank ordering of the items with respect to base rates and mean ratings was more similar across societies for parent ratings than caregiver/teacher ratings, especially with respect to the items tapping restricted interests and repetitive behaviors. Items 80. Strange behavior; 63. Repeatedly rocks head or body; 67. Seems unresponsive to affection; and 98. Withdrawn, doesn't get involved with others had low base rates in these population samples across societies and types of informants, suggesting that they may be particularly discriminating for identifying autism spectrum disorder in young children. Cross-informant agreement was stronger for the items tapping social communication and interaction problems than restricted interests and repetitive behaviors. The findings support the feasibility of international use of the scale for autism spectrum disorder screening in population samples.
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Abstract
OBJECTIVE To characterize children presenting with concerns for autism spectrum disorder (ASD) missed by parent-report screeners and to examine benefits of a combined screening approach with the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Ages and Stages Questionnaire, Third Edition (ASQ-3). METHODS Participants included were 154 children aged 16 to 42 months presenting for an evaluation at an autism center. Caregivers completed the M-CHAT-R, ASQ-3, and a demographic questionnaire. Children participated in an autism diagnostic evaluation consisting of the Mullen Scales of Early Learning (Mullen) and Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). RESULTS A total of 124 children (81%) were diagnosed with ASD. The M-CHAT-R identified 85% (n = 105) of these children. Children with ASD missed by the M-CHAT-R had significantly higher scores on the Mullen and significantly lower scores on the ADOS-2. Of the ASQ-3 domains, the majority (n = 102, 82%) of children with ASD failed the communication domain; missed cases showed similar patterns of higher Mullen scores and lower ADOS-2 scores. When adopting a combined screening approach, using a failed screen from either the M-CHAT-R or ASQ-3 communication domain, 93% of children were identified. Parent-reported concerns on an open-ended questionnaire revealed ASD red flags for many missed cases. CONCLUSION Children with ASD missed by screeners had higher scores on developmental testing and lower scores on the ADOS-2; however, children still performed below average on developmental tests. Our findings suggest that a combined screening approach was most effective for identifying children with ASD from a sample group referred for an ASD evaluation.
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Yuen T, Penner M, Carter MT, Szatmari P, Ungar WJ. Assessing the accuracy of the Modified Checklist for Autism in Toddlers: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:1093-1100. [PMID: 29992541 DOI: 10.1111/dmcn.13964] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 12/29/2022]
Abstract
AIM The Modified Checklist for Autism in Toddlers (M-CHAT) could be appropriate for universal screening for autism spectrum disorder (ASD) at 18 months and 24 months. Validation studies, however, reported differences in psychometric properties across sample populations. This meta-analysis summarized its accuracy measures and quantified their change in relation to patient and study characteristics. METHOD Four electronic databases (MEDLINE, PsycINFO, CINAHL, and Embase) were searched to identify articles published between January 2001 and May 2016. Bayesian regression models pooled study-specific measures. Meta-regressions covariates were age at screening, study design, and proportion of males. RESULTS On the basis of the 13 studies included, the pooled sensitivity was 0.83 (95% credible interval [CI] 0.75-0.90), specificity was 0.51 (95% CI 0.41-0.61), and positive predictive value was 0.53 (95% CI 0.43-0.63) in high-risk children and 0.06 (95% CI <0.01-0.14) in low-risk children. Sensitivity was higher for screening at 30 months compared with 24 months. INTERPRETATION Findings indicate that the M-CHAT performs with low to moderate accuracy in identifying ASD among children with developmental concerns, but there was a lack of evidence on its performance in low-risk children or at age 18 months. Clinicians should account for a child's age and presence of developmental concern when interpreting their M-CHAT score. WHAT THIS PAPER ADDS The Modified Checklist for Autism in Toddlers (M-CHAT) performs with low-to-moderate accuracy in children with developmental concerns. There is limited evidence supporting its use at 18 months or in low-risk children.
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Affiliation(s)
- Tracy Yuen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Melissa T Carter
- Regional Genetics Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
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Li C, Zhu G, Feng J, Xu Q, Zhou Z, Zhou B, Hu C, Liu C, Li H, Wang Y, Yan W, Ge X, Xu X. Improving the early screening procedure for autism spectrum disorder in young children: Experience from a community‐based model in shanghai. Autism Res 2018; 11:1206-1217. [PMID: 30230702 DOI: 10.1002/aur.1984] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/19/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Chunyang Li
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Guowei Zhu
- Department of Child Healthcare Xuhui District Maternal and Child Healthcare Hospital Xuhui District Shanghai China
| | - Jingjing Feng
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Qiong Xu
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Zhaoe Zhou
- Department of Child Healthcare Xuhui District Maternal and Child Healthcare Hospital Xuhui District Shanghai China
| | - Bingrui Zhou
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Chunchun Hu
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Chunxue Liu
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Huiping Li
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
| | - Yi Wang
- Department of Neurology Children's Hospital of Fudan University Shanghai China
| | - Weili Yan
- Department of Clinical Epidemiology Children's Hospital of Fudan University Shanghai China
| | - Xiaoling Ge
- Department of Information Children's Hospital of Fudan University Shanghai China
| | - Xiu Xu
- Department of Child Healthcare Children's Hospital of Fudan University Shanghai
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Hirota T, So R, Kim YS, Leventhal B, Epstein RA. A systematic review of screening tools in non-young children and adults for autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:1-12. [PMID: 29879612 DOI: 10.1016/j.ridd.2018.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 05/21/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Existing reviews of screening tools for Autism Spectrum Disorder (ASD) focus on young children, and not all screening tools have been examined against validated diagnostic procedures. AIMS To examine the validity of screening tools for ASD in non-young children and adults to provide clinical recommendations about the use of these tools in a variety of clinical settings. METHODS AND PROCEDURES Electronic databases, including MEDLINE, EMBASE, PsychINFO, Cochrane Library and CINAHL, were searched through March 2017. Studies examining the validity of ASD screening tools against the Autism Diagnostic Observation Schedule and/or the Autism Diagnostic Interview - Revised in non-young children (age 4 or above) and adults were included. Three authors independently reviewed each article for data extraction and quality assessment. OUTCOMES AND RESULTS 14 studies met the inclusion criteria, of which 11 studies were with children (4-18 years of age) and 3 studies included adults only (19 years of age and above). Included studies were conducted in a general population/low-risk sample (N = 3) and a clinically referred/high-risk sample (N = 11). In total 11 tools were included. CONCLUSIONS AND IMPLICATIONS Only three screening tools (the Autism-Spectrum Quotient, the Social Communication Questionnaire, and the Social Responsiveness Scale) were examined in more than 2 studies. These tools may assist in differentiating ASD from other neurodevelopmental and psychiatric disorders or typically developed children. In young adult populations, the paucity of the existing research in this group limits definitive conclusion and recommendations.
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Affiliation(s)
- Tomoya Hirota
- Child and Adolescent Psychiatry, Department of Psychiatry, Langley Porter Psychiatric Institute, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Ryuhei So
- Department of Psychiatry, Okayama Psychiatric Medical Center, 3-16 Shikatahonmachi, Kita-ward, Okayama, Okayama, 700-0915, Japan; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Young Shin Kim
- Child and Adolescent Psychiatry, Department of Psychiatry, Langley Porter Psychiatric Institute, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Bennett Leventhal
- Child and Adolescent Psychiatry, Department of Psychiatry, Langley Porter Psychiatric Institute, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Richard A Epstein
- Chapin Hall Center for Children at the University of Chicago, 1313 E 60th St., Chicago, IL, 60637, USA
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Kerub O, Haas EJ, Meiri G, Davidovitch N, Menashe I. A Comparison Between Two Screening Approaches for ASD Among Toddlers in Israel. J Autism Dev Disord 2018; 50:1553-1560. [DOI: 10.1007/s10803-018-3711-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Zwaigenbaum L, Duku E, Fombonne E, Szatmari P, Smith IM, Bryson SE, Mirenda P, Vaillancourt T, Volden J, Georgiades S, Roberts W, Bennett T, Elsabbagh M, Waddell C, Steiman M, Simon R, Bruno R. Developmental functioning and symptom severity influence age of diagnosis in Canadian preschool children with autism. Paediatr Child Health 2018; 24:e57-e65. [PMID: 30906197 DOI: 10.1093/pch/pxy076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Early diagnosis of autism spectrum disorder (ASD) is essential in most Canadian jurisdictions to access interventions that improve long-term child outcomes. Our main objective was to identify factors associated with timing of ASD diagnosis in five provinces across Canada. Methods Factors influencing age of diagnosis were assessed in the analyses of an inception cohort of children diagnosed with ASD between ages 2 and 5 years. We examined bivariate associations and using a series of multiple variable regression models, evaluated the unique contributions of developmental functioning, ASD symptoms and demographic variables. Children with known genetic abnormalities, or severe sensory or motor impairments interfering with assessment were excluded. Results Participants were 421 children (84.6% boys). The mean age of diagnosis was 38.2 months (SD=8.7), an average of 19 months after parents identified initial concerns. Factors associated with later diagnosis included more advanced language and cognitive skills, and higher levels of restricted repetitive behaviour symptoms. Child sex and family demographics were not associated with age of diagnosis. In regression analyses, language and cognitive skills accounted for 6.8% of variance in age of diagnosis and ASD symptoms contributed an additional 5.5%. Provincial site accounted for 4.0% of variance in age of diagnosis, independent of developmental skills and ASD symptoms. Interpretation Diagnosis of ASD occurred, on average, 19 months after parents' initial concerns. Language and cognitive skills, symptom severity and provincial site accounted for variation in age of ASD diagnosis in this Canadian cohort. Variable presentation across the developmental continuum must be considered in planning assessment services to ensure timely ASD diagnosis so that outcomes can be improved. Policy and practice leadership is also needed to reduce interprovincial variability.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta.,Pediatric Division, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Eric Duku
- Offord Centre for Child Studies and McMaster Autism Research Team, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Eric Fombonne
- Departments of Psychiatry, Pediatrics and Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, Ontario.,Department of Psychiatry, Hospital for Sick Children and Centre for Addiction and Mental Health, Toronto, Ontario
| | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia.,Departments of Pediatrics, Psychology and Neurosciences, Dalhousie University, Halifax, Nova Scotia
| | - Susan E Bryson
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia.,Departments of Pediatrics, Psychology and Neurosciences, Dalhousie University, Halifax, Nova Scotia
| | - Pat Mirenda
- Departments of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, British Columbia
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, Ontario
| | - Joanne Volden
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, Alberta
| | - Stelios Georgiades
- Offord Centre for Child Studies and McMaster Autism Research Team, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Ontario
| | - Teresa Bennett
- Offord Centre for Child Studies and McMaster Autism Research Team, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, Quebec
| | - Charlotte Waddell
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia
| | - Mandy Steiman
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Rebecca Simon
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Ruth Bruno
- Department of Psychiatry, McGill University, Montreal, Quebec
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Sturner R, Howard B, Bergmann P, Morrel T, Landa R, Walton K, Marks D. Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months. J Autism Dev Disord 2018; 47:3296-3310. [PMID: 28762159 DOI: 10.1007/s10803-017-3231-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Accuracy of autism screening using M-CHAT plus the follow-up interview (M-CHAT/F) for children screened positive at 18-months was compared to screening at 24-months. Formal ASD testing was criterion for a community sample of M-CHAT positive children (n = 98), positive predictive value (PPV) was 0.40 for the M-CHAT and 0.58 for the M-CHAT/F. MCHAT/F PPV was 0.69 among children 20+ months compared to 0.36 for <20 months. Multivariate analyses incorporating data from the Ages and Stages Questionnaire, MacArthur-Bates Communicative Development Inventory, M-CHAT and M-CHAT/F results, and M-CHAT items suggest language variables carry greatest relative importance in contributing to an age-based algorithm with potential to improve PPV for toddlers <20 months to the same level as observed in older toddlers.
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Affiliation(s)
- Raymond Sturner
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. .,Center for Promotion of Child Development through Primary Care, Baltimore, MD, 21210, USA. .,, 6017 Altamont Place, Baltimore, MD, 21210, USA.
| | - Barbara Howard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Total Child Health, Baltimore, MD, 21210, USA
| | - Paul Bergmann
- Foresight Logic, Inc., Saint Paul, MN, USA.,PrairieCare Institute, Minneapolis, MN, USA
| | | | - Rebecca Landa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Kennedy Krieger Institute, Baltimore, MD, 21287, USA
| | - Kejuana Walton
- Total Child Health, Baltimore, MD, 21210, USA.,Baltimore Healthy Start, Baltimore, MD, 21218, USA
| | - Danielle Marks
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Sinai Hospital, Baltimore, MD, 21215, USA.,Maternal and Child Health Unit, Public Health Division, Wyoming Department of Health, Evanston, WY, USA
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Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries. Int J Ment Health Syst 2018; 12:22. [PMID: 29760771 PMCID: PMC5941599 DOI: 10.1186/s13033-018-0200-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/12/2018] [Indexed: 01/30/2023] Open
Abstract
Background Screening children for autism has gained wider acceptance within clinical practice, and early intervention has improved outcomes. Increasingly, adapting an existing screening instrument is a common, fast method to create a usable screening tool, especially for countries with limited resources and/or expertise. However, concerns have been raised regarding adaptation adequacy and the feasibility of screening across cultural groups. This study systematically examined the levels of cultural adaptation and feasibility aspects considered when screening for autism in non-English speaking countries to build upon the sparse knowledge that exists on this topic in the literature. Methods Nineteen studies, obtained from five electronic databases, were examined. PRISMA guidance was used for this review. The Ecological Validity Framework model, and Bowen Recommendations for Feasibility were adopted to extract relevant data, which was synthesised narratively. Results Cultural adaptation within the included studies mostly involved language translation with little information offered to enable conclusions on how the processes were guided and maintained. Few cultural adjustments involved modifying screening methods; clarifying difficult concepts and changing instrument content were employed to address the core values, competence, beliefs, and norms of the adapted culture. However, less attention was given to adapt the screening goals within the context of cultural values, and customs or to consider interactional match between the clients and assessors. The review also highlighted an acceptable level of practicality to screen for autism but did not encourage integrating autism screening within routine practice or beyond the study context for different cultures. Conclusion Concurring with previous literature, we agree that knowledge on cultural adaptation for autism screening instruments is limited and not sufficiently documented to establish adaptation levels (process and/or contents), and prove adequacy. However, this review provides an infrastructure to improve future adaptation processes. Integrating autism screening as routine medical practice is not encouraged and warrants further feasibility studies to minimize wasted resources and improve screening effectiveness in various health care systems.
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Johnson S, Waheed G, Manktelow BN, Field DJ, Marlow N, Draper ES, Boyle EM. Differentiating the Preterm Phenotype: Distinct Profiles of Cognitive and Behavioral Development Following Late and Moderately Preterm Birth. J Pediatr 2018; 193:85-92.e1. [PMID: 29254758 DOI: 10.1016/j.jpeds.2017.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To explore patterns of comorbidity in cognitive and behavioral outcomes at 2 years' corrected age among children born late or moderately preterm (LMPT) and to identify predictors of different patterns of comorbidity. STUDY DESIGN Geographical, prospective population-based cohort study of 1139 infants born LMPT (320/7 to 366/7 weeks' gestation) and 1255 infants born at term (370/7 to 426/7 weeks' gestation). Parent questionnaires were obtained to identify impaired cognitive and language development, behavioral problems, delayed social-emotional competence, autistic features, and clinically significant eating difficulties at 24 months corrected age for 638 (57%) children born LMPT and 765 (62%) children born at term. RESULTS Latent class analysis revealed 2 profiles of development among the term group: optimal (84%) and a profile of social, emotional, and behavioral impairments termed "nonoptimal" (16%). These 2 profiles were also identified among the LMPT group (optimal: 67%; nonoptimal: 26%). In the LMPT group, a third profile was identified (7%) that was similar to the phenotype previously identified in infants born very preterm. Nonwhite ethnicity, socioeconomic risk, and not receiving breast milk at hospital discharge were risk factors for nonoptimal outcomes in both groups. Male sex, greater gestational age, and pre-eclampsia were only associated with the preterm phenotype. CONCLUSIONS Among children born LMPT with parent-reported cognitive or behavioral impairments, most had problems similar to the profile of difficulties observed in children born at term. A smaller proportion of children born LMPT had impairments consistent with the "very preterm phenotype" which are likely to have arisen through a preterm pathway. These results suggest that prematurity may affect development through several etiologic pathways in the late and moderately preterm population.
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Affiliation(s)
- Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Ghazala Waheed
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - David J Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Department of Academic Neonatology, Institute for Women's Health, University College London, London, UK
| | | | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
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Distinct ERP profiles for auditory processing in infants at-risk for autism and language impairment. Sci Rep 2018; 8:715. [PMID: 29335488 PMCID: PMC5768787 DOI: 10.1038/s41598-017-19009-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/17/2017] [Indexed: 11/09/2022] Open
Abstract
Early identification of autism spectrum disorder (ASD) is crucial for the formulation of effective intervention programs. Language deficits may be a hallmark feature of ASD and language delay observed in ASD shows striking similarities to that observed in children with language impairment (LI). Auditory processing deficits are seen in both LI and ASD, however, they have not previously been compared directly using Event-Related Potentials (ERPs) in the two at-risk populations. This study aims to characterize infants at-risk for ASD (HR-ASD) at the electrophysiological level and to compare them with infants at-risk for LI (HR-LI) and controls, to find specific markers with predictive value. At 12-month-old, auditory processing in HR-ASD, HR-LI and controls was characterized via ERP oddball paradigm. All infants were then evaluated at 20 months, to investigate the associations between auditory processing and language/ASD-related outcomes. In both HR-ASD and HR-LI, mismatch response latency was delayed compared to controls, whereas only HR-ASD showed overall larger P3 amplitude compared to controls. Interestingly, these ERP measures correlated with later expressive vocabulary and M-CHAT critical items in the whole sample. These results may support the use of objective measurement of auditory processing to delineate pathophysiological mechanisms in ASD, as compared to LI.
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48
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Hus Y. Issues in Identification and Assessment of Children with Autism and a Proposed Resource Toolkit for Speech-Language Pathologists. Folia Phoniatr Logop 2017; 69:27-37. [PMID: 29248918 DOI: 10.1159/000477398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of autism spectrum disorder (ASD) has increased significantly in the last decade as have treatment choices. Nonetheless, the vastly diverse autism topic includes issues related to naming, description, iden-tification, assessment, and differentiation from other neu-rodevelopmental conditions. ASD issues directly impact speech-language pathologists (SLPs) who often see these children as the second contact, after pediatric medical practitioners. Because of shared symptomology, differentiation among neurodevelopmental disorders is crucial as it impacts treatment, educational choices, and the performance trajectory of affected children. OBJECTIVES To highlight issues in: identification and differentiation of ASD from other communication and language challenges, the prevalence differences between ASD gender phenotypes, and the insufficient consideration of cultural factors in evaluating ASD in children. A second objective was to propose a tool to assist SLPs in the management of autism in children. SUMMARY A universal resource toolkit development project for SLP communities at large is proposed. The resource is comprised of research-based observation and screening tools for caregivers and educators, as well as parent questionnaires for portraying the children's function in the family, cultural com-munity, and educational setting.
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Olliac B, Crespin G, Laznik MC, Cherif Idrissi El Ganouni O, Sarradet JL, Bauby C, Dandres AM, Ruiz E, Bursztejn C, Xavier J, Falissard B, Bodeau N, Cohen D, Saint-Georges C. Infant and dyadic assessment in early community-based screening for autism spectrum disorder with the PREAUT grid. PLoS One 2017; 12:e0188831. [PMID: 29216234 PMCID: PMC5720624 DOI: 10.1371/journal.pone.0188831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/14/2017] [Indexed: 12/04/2022] Open
Abstract
Background The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome. Methods We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children. Results Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0–36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65–220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%]. Conclusions The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.
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Affiliation(s)
- Bertrand Olliac
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Esquirol, Limoges, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1094, Tropical Neuroepidemiology, Limoges, France
| | - Graciela Crespin
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Marie-Christine Laznik
- Department of Child and Adolescent Psychiatry, Association Santé Mentale du 13ème, Paris, France
| | | | - Jean-Louis Sarradet
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Colette Bauby
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
- PMI Center (Center for Protection of Mother and Infant), Paris, France
| | - Anne-Marie Dandres
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
- PMI Center (Center for Protection of Mother and Infant), Paris, France
| | - Emeline Ruiz
- PREAUT Association Programme de Recherche et d’Etudes sur l’Autisme, Paris, France
| | - Claude Bursztejn
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, Strasbourg, France
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
| | - Bruno Falissard
- INSERM U669, Université Paris-Sud and Université Paris-Descartes, Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
| | - Catherine Saint-Georges
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- ISIR, CNRS, UMR 7222, UMPC, Paris, France
- Association CEREP-PHYMENTIN, Paris, France
- * E-mail:
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Srisinghasongkram P, Pruksananonda C, Chonchaiya W. Two-Step Screening of the Modified Checklist for Autism in Toddlers in Thai Children with Language Delay and Typically Developing Children. J Autism Dev Disord 2017; 46:3317-29. [PMID: 27460003 DOI: 10.1007/s10803-016-2876-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aimed to validate the use of two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening adapted for a Thai population. Our participants included both high-risk children with language delay (N = 109) and low-risk children with typical development (N = 732). Compared with the critical scoring criteria, the total scoring method (failing ≥3 items) yielded the highest sensitivity of 90.7 %; specificity was 99.7 %, positive predictive value 96.1 %, and negative predictive value 99.4 %. The two-step M-CHAT screening is a promising instrument that can be utilized to detect ASD in Thai children in both primary and clinical settings. Moreover, socio-cultural context should be considered when adopting the use and interpretation of the M-CHAT for each country.
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Affiliation(s)
- Pornchada Srisinghasongkram
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand
| | - Chandhita Pruksananonda
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand.,Division of Growth and Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Sor Kor Building 11th Floor, Bangkok, 10330, Thailand
| | - Weerasak Chonchaiya
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV. Road, Bangkok, Thailand. .,Division of Growth and Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Sor Kor Building 11th Floor, Bangkok, 10330, Thailand.
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