1
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McNally Keehn R, Paxton A, Delaney M, Ciccarelli M. Training and Sustaining: Training and Learning Collaborative Outcomes Across a Statewide Network for Early Autism Diagnosis. J Dev Behav Pediatr 2024:00004703-990000000-00206. [PMID: 39190424 DOI: 10.1097/dbp.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 07/08/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE The objective of this study was to describe the development of a primary care professional (PCP) autism diagnosis training model and to report on outcomes related to PCP training and sustained engagement in a longitudinal learning collaborative. METHODS We developed Accelerating the Diagnosis of Autism with Primary care Training (ADAPT), a training program to prepare PCPs to develop independent competency in evaluation of autism in children aged 14 to 48 months. ADAPT includes didactic and case-based modules and practice-based coaching delivered by an expert diagnostic specialist; after training, PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. RESULTS From 2021 to 2023, 13 PCPs completed ADAPT didactic and practicum training to reach competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge after didactic training (p = 0.02). Scoring agreement on an autism observational assessment tool between clinicians and expert diagnosticians improved over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert diagnosticians. After training, PCPs attended 57% of monthly learning collaborative sessions. CONCLUSION Training PCPs to deliver autism evaluations for young children as part of tiered community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standardized PCP training model that results in achievement of independent competency and sustained engagement in autism evaluation. Effectiveness-implementation studies are needed to ensure scalability and sustainability of training models.
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2
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Corona LL, Wagner L, Hooper M, Weitlauf A, Foster TE, Hine J, Miceli A, Nicholson A, Stone C, Vehorn A, Warren Z. A Randomized Trial of the Accuracy of Novel Telehealth Instruments for the Assessment of Autism in Toddlers. J Autism Dev Disord 2024; 54:2069-2080. [PMID: 37185923 PMCID: PMC10129298 DOI: 10.1007/s10803-023-05908-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Telemedicine approaches to autism (ASD) assessment have become increasingly common, yet few validated tools exist for this purpose. This study presents results from a clinical trial investigating two approaches to tele-assessment for ASD in toddlers. METHODS 144 children (29% female) between 17 and 36 months of age (mean = 2.5 years, SD = 0.33 years) completed tele-assessment using either the TELE-ASD-PEDS (TAP) or an experimental remote administration of the Screening Tool for Autism in Toddlers (STAT). All children then completed traditional in-person assessment with a blinded clinician, using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3), and Autism Diagnostic Observation Schedule (ADOS-2). Both tele-assessment and in-person assessment included a clinical interview with caregivers. RESULTS Results indicated diagnostic agreement for 92% of participants. Children diagnosed with ASD following in-person assessment who were missed by tele-assessment (n = 8) had lower scores on tele- and in-person ASD assessment tools. Children inaccurately identified as having ASD by tele-assessment (n = 3) were younger than other children and had higher developmental and adaptive behavior scores than children accurately diagnosed with ASD by tele-assessment. Diagnostic certainty was highest for children correctly identified as having ASD via tele-assessment. Clinicians and caregivers reported satisfaction with tele-assessment procedures. CONCLUSION This work provides additional support for the use of tele-assessment for identification of ASD in toddlers, with both clinicians and families reporting broad acceptability. Continued development and refinement of tele-assessment procedures is recommended to optimize this approach for the needs of varying clinicians, families, and circumstances.
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Affiliation(s)
- Laura L Corona
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Liliana Wagner
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madison Hooper
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Amy Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tori E Foster
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra Miceli
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
| | - Amy Nicholson
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin Stone
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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Frazier TW, Whitehouse AJO, Leekam SR, Carrington SJ, Alvares GA, Evans DW, Hardan AY, Uljarević M. Reliability of the Commonly Used and Newly-Developed Autism Measures. J Autism Dev Disord 2024; 54:2158-2169. [PMID: 37017861 DOI: 10.1007/s10803-023-05967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The aim of the present study was to compare scale and conditional reliability derived from item response theory analyses among the most commonly used, as well as several newly developed, observation, interview, and parent-report autism instruments. METHODS When available, data sets were combined to facilitate large sample evaluation. Scale reliability (internal consistency, average corrected item-total correlations, and model reliability) and conditional reliability estimates were computed for total scores and for measure subscales. RESULTS Generally good to excellent scale reliability was observed for total scores for all measures, scale reliability was weaker for RRB subscales of the ADOS and ADI-R, reflecting the relatively small number of items for these measures. For diagnostic measures, conditional reliability tended to be very good (> 0.80) in the regions of the latent trait where ASD and non-ASD developmental disability cases would be differentiated. For parent-report scales, conditional reliability of total scores tended to be excellent (> 0.90) across very wide ranges of autism symptom levels, with a few notable exceptions. CONCLUSIONS These findings support the use of all of the clinical observation, interview, and parent-report autism symptom measures examined, but also suggest specific limitations that warrant consideration when choosing measures for specific clinical or research applications.
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Affiliation(s)
- Thomas W Frazier
- Department of Psychology, John Carroll University, Cleveland, OH, USA.
- Departments of Pediatrics and Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.
| | | | - Susan R Leekam
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Sarah J Carrington
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - David W Evans
- Department of Psychology, Program in Neuroscience, Bucknell University, Lewisburg, PA, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Nasir AK, Strong-Bak W, Bernard M. Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care. J Prim Care Community Health 2024; 15:21501319241247997. [PMID: 38650542 PMCID: PMC11036916 DOI: 10.1177/21501319241247997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. METHODS Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. RESULTS Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. CONCLUSIONS This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.
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Affiliation(s)
- Arwa K. Nasir
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Marie Bernard
- University of Nebraska Medical Center, Omaha, NE, USA
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Khairetdinov OZ, Rubakova LI. Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review. CONSORTIUM PSYCHIATRICUM 2023; 4:55-64. [PMID: 38249532 PMCID: PMC10795948 DOI: 10.17816/cp12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.
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Affiliation(s)
- Oleg Z. Khairetdinov
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | - Luciena I. Rubakova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
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6
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Boccaccio FM, Platania GA, Guerrera CS, Varrasi S, Privitera CR, Caponnetto P, Pirrone C, Castellano S. Autism Spectrum Disorder: recommended psychodiagnostic tools for early diagnosis. Health Psychol Res 2023; 11:77357. [PMID: 37670796 PMCID: PMC10477006 DOI: 10.52965/001c.77357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
| | | | - Claudia Savia Guerrera
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, CT, Italy
| | - Simone Varrasi
- Department of Educational Sciences, University of Catania, 95124 Catania, CT, Italy
| | | | - Pasquale Caponnetto
- Department of Educational Sciences, University of Catania, 95124 Catania, CT, Italy
| | - Concetta Pirrone
- Department of Educational Sciences, University of Catania, 95124 Catania, CT, Italy
| | - Sabrina Castellano
- Department of Educational Sciences, University of Catania, 95124 Catania, CT, Italy
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7
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Curtis PR, Estabrook R, Roberts MY, Weisleder A. Sensitivity to Semantic Relationships in U.S. Monolingual English-Speaking Typical Talkers and Late Talkers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2404-2420. [PMID: 37339002 PMCID: PMC10468120 DOI: 10.1044/2023_jslhr-22-00563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/09/2023] [Accepted: 03/29/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Late talkers (LTs) are a group of children who exhibit delays in language development without a known cause. Although a hallmark of LTs is a reduced expressive vocabulary, little is known about LTs' processing of semantic relations among words in their emerging vocabularies. This study uses an eye-tracking task to compare 2-year-old LTs' and typical talkers' (TTs') sensitivity to semantic relationships among early acquired words. METHOD U.S. monolingual English-speaking LTs (n = 21) and TTs (n = 24) completed a looking-while-listening task in which they viewed two images on a screen (e.g., a shirt and a pizza), while they heard words that referred to one of the images (e.g., Look! Shirt!; target-present condition) or a semantically related item (e.g., Look! Hat!; target-absent condition). Children's eye movements (i.e., looks to the target) were monitored to assess their sensitivity to these semantic relationships. RESULTS Both LTs and TTs looked longer at the semantically related image than the unrelated image on target-absent trials, demonstrating sensitivity to the taxonomic relationships used in the experiment. There was no significant group difference between LTs and TTs. Both groups also looked more to the target in the target-present condition than in the target-absent condition. CONCLUSIONS These results reveal that, despite possessing smaller expressive vocabularies, LTs have encoded semantic relationships in their receptive vocabularies and activate these during real-time language comprehension. This study furthers our understanding of LTs' emerging linguistic systems and language processing skills. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23303987.
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Affiliation(s)
- Philip R. Curtis
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Ryne Estabrook
- Department of Psychology, University of Illinois Chicago
| | - Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Adriana Weisleder
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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8
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Choueiri R, Garrison WT, Tokatli V. Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities. Indian J Pediatr 2023; 90:377-386. [PMID: 35604589 PMCID: PMC9125962 DOI: 10.1007/s12098-022-04172-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identification may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identification of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identified. The goal is to recommend models that are culturally appropriate and scientifically valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identification of ASD. Starting locally by simplifying and demystifying the ASD identification process and building community connections will inform global researchers and policymakers while making a difference in the lives of the children and families affected by ASD.
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Affiliation(s)
- Roula Choueiri
- Autism Spectrum Center, Department of Neurology, Boston Children's Hospital, 2 Brookline Place, Brookline, MA, 02445, USA.
| | - William T Garrison
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Tokatli
- Autism Spectrum Center, Department of Neurology, Boston Children's Hospital, 2 Brookline Place, Brookline, MA, 02445, USA.,Division of Developmental and Behavioral Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
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9
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Sohl K, Levinstein L, James A, Greer S, Boles K, Curran AB, Mahurin M, Mazurek MO, Nanclares V. ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based Primary Care Diagnosis of Autism Spectrum Disorder. J Dev Behav Pediatr 2023; 44:e177-e184. [PMID: 36978232 DOI: 10.1097/dbp.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD. METHODS Through this diagnostic accuracy study, 20 patients diagnosed with ASD by clinicians trained through the ECHO (Extension for Community Healthcare Outcomes) Autism STAT program participated in an independent gold-standard evaluation at a regional autism center. Caregiver perceptions of the diagnostic process were also assessed. RESULTS Of the 20 patients who received a diagnosis of ASD by a trained clinician and completed the study, 19 diagnoses were confirmed by a gold-standard evaluation. Caregivers indicated that undergoing diagnosis in their local community rather than an autism specialty center was helpful (4.8/5 on a 5-point Likert scale, n = 19). Results of this study demonstrate that primary care clinicians can be trained to reliably diagnose ASD in children 14 to 48 months with unambiguous symptoms. CONCLUSION Diagnosis in the primary care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. Given the potential impact of increasing access to high-quality diagnostic services, the role of primary care clinicians in the diagnosis of ASD should be further evaluated.
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Affiliation(s)
- Kristin Sohl
- University of Missouri, School of Medicine, Columbia, MO
- Department of Child Health, University of Missouri, Columbia, MO
| | | | - Alexandra James
- University of Missouri, School of Medicine, Columbia, MO
- Department of Child Health, University of Missouri, Columbia, MO
| | - Sophia Greer
- University of Missouri, School of Medicine, Columbia, MO
| | - Katrina Boles
- Department of Child Health, University of Missouri, Columbia, MO
| | | | - Melissa Mahurin
- Department of Child Health, University of Missouri, Columbia, MO
| | - Micah O Mazurek
- University of Virginia, School of Education and Human Development, Charlottesville, VA
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10
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Curtis PR, Estabrook R, Roberts MY, Weisleder A. Specificity of phonological representations in U.S. English-speaking late talkers and typical talkers. INFANCY 2023. [PMID: 36939533 DOI: 10.1111/infa.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
Late talkers are a heterogeneous group of children who experience delayed language development in the absence of other known causes. Late talkers show delays in expressive phonological development, but less is known about their receptive phonological development. In the current study, U.S. monolingual English-speaking typical talkers (TTs) (n = 23, mean age = 26.27 months, 57% male; 78.3% White) and late talkers (n = 22, mean age = 24.57 months, 59% male, 72.7% White) completed a Looking-While-Listening task to assess their sensitivity to mispronunciations. Results revealed that late talkers and TTs looked to the referent of a word for a shorter duration when it was mispronounced than when it was correctly pronounced, suggesting they were sensitive to mispronunciations. However, there were no significant differences between the two groups in their sensitivity to mispronunciations.
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Affiliation(s)
- Philip R Curtis
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan Y Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Adriana Weisleder
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
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Tagavi DM, Dick CC, Attar SM, Ibanez LV, Stone WL. The implementation of the screening tool for autism in toddlers in Part C early intervention programs: An 18-month follow-up. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:173-187. [PMID: 35403446 PMCID: PMC9550885 DOI: 10.1177/13623613221086329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT The early detection of autism spectrum disorder can lead to access to autism spectrum disorder-specific services that have been shown to have a large impact on a child's overall development. Although a stable diagnosis of autism spectrum disorder can be made by age 2 years, most children are not diagnosed until much later. To address this issue, this study examined the effectiveness of training Part C Early Intervention providers to use an interactive autism spectrum disorder screening tool, the Screening Tool for Autism in Toddlers. Sixty-nine providers attended a 1-day training workshop on the use of the Screening Tool for Autism in Toddlers. After the workshop, providers reported increased knowledge about recognizing the early signs of autism spectrum disorder, and about 45% of the providers reported using the Screening Tool for Autism in Toddlers with families in their caseloads 18 months after the training. These results suggest that the Screening Tool for Autism in Toddlers is feasible for use within Early Intervention settings. In addition, they suggest that specific providers might serve as a screening "point-person," rather than expecting the Screening Tool for Autism in Toddlers to be used by all providers. Future research should aim to identify specific characteristics of agencies or providers that might be best suited for using the Screening Tool for Autism in Toddlers.
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12
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Sobieski M, Sobieska A, Sekułowicz M, Bujnowska-Fedak MM. Tools for early screening of autism spectrum disorders in primary health care – a scoping review. BMC PRIMARY CARE 2022; 23:46. [PMID: 35291950 PMCID: PMC8925080 DOI: 10.1186/s12875-022-01645-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests itself in early childhood. Early diagnosis of these disorders allows for the initiation of early therapy, which is crucial for the child's further functioning in society.
Objectives
This review aims to gather and present the existing ASD screening tools that can be used in primary care and adapted to different countries conditions linguistically and culturally.
Eligibility criteria
We searched for English-language publications on ASD screening tools for children aged 0–3 years suitable for use in primary care (i.e. free, requiring no additional training or qualifications).
Sources of evidence
Four databases were explored to find English studies on ASD screening tools intended for the rapid assessment of children aged 0–3.
Charting methods
The information sought (specific features of the questionnaires relevant to primary health care workers, psychometric and diagnostic values of a given cultural adaptation of screening tools, and the linguistic and cultural changes made) were extracted and collected to create profiles of these tools.
Results
We found 81 studies which met inclusion criteria and underwent full data extraction. Three additional data sources were included. These allowed to create 75 profiles of adaptations for 26 different screening tools and collect data on their psychometric values and characteristic features.
Conclusions
The results of our study indicate the availability of several diagnostic tools for early ASD screening in primary care setting concordant culturally and linguistically with a given population. They could be an effective method of accelerating the diagnostic process and starting personalized therapy faster. However, most tools have significant limitations – some are only available for research purposes, while others do not have scientific evidence to prove their effectiveness.
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Mengi M, Malhotra D. A systematic literature review on traditional to artificial intelligence based socio-behavioral disorders diagnosis in India: Challenges and future perspectives. Appl Soft Comput 2022. [DOI: 10.1016/j.asoc.2022.109633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sheldrick RC, Carter AS, Eisenhower A, Mackie TI, Cole MB, Hoch N, Brunt S, Pedraza FM. Effectiveness of Screening in Early Intervention Settings to Improve Diagnosis of Autism and Reduce Health Disparities. JAMA Pediatr 2022; 176:262-269. [PMID: 34982099 PMCID: PMC8728657 DOI: 10.1001/jamapediatrics.2021.5380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE The American Academy of Pediatrics recommends referring children at elevated risk of autism spectrum disorder (ASD) for Part C early intervention (EI) services, but notes that EI services often fail to provide ASD screening. OBJECTIVE To evaluate the hypothesis that a multistage screening protocol for ASD implemented in 3 EI settings will increase autism detection, especially among Spanish-speaking families. DESIGN, SETTING, AND PARTICIPANTS Difference-in-differences analyses with propensity score weighting of a quasi-experimental design using administrative data on 3 implementation EI agencies and 9 comparison EI agencies from 2012 to 2018 provided by the Massachusetts Department of Public Health. Eligible children were aged 14 to 36 months, enrolled in EI, had no prior ASD diagnosis or medical condition precluding participation, and had parents who spoke English or Spanish. The final analytic sample included 33 326 unique patients assessed across 150 200 person-quarters. EXPOSURES Multistage ASD assessment protocol including ASD screening questionnaires, observational screener, and diagnostic evaluation. MAIN OUTCOMES AND MEASURES Increased incidence of ASD diagnoses as documented in Department of Public Health records and reductions in language-associated health care disparities. RESULTS Implementation of screening at 3 EI sites was associated with a significant increase in the rate of ASD diagnoses (incidence rate ratios [IRR], 1.6; 95% CI, 1.3-2.1; P < .001), representing an additional 8.1 diagnoses per 1000 children per quarter. Among Spanish-speaking families, screening was also associated with a significant increase in the rate of ASD diagnoses (IRR, 2.6; 95% CI, 1.6-4.3; P < .001), representing 15.4 additional diagnoses per 1000 children per quarter-a larger increase than for non-Spanish-speaking families (interaction IRR, 1.8; 95% CI, 1.0-3.1; P = .005). Exploratory analyses revealed that screening was associated with a larger increase in the rate of ASD diagnoses among boys (IRR, 1.8; 95% CI, 1.4-2.3; P < .001) than among girls (IRR, 1.1; 95% CI, 0.6-1.7; P = .84). CONCLUSIONS AND RELEVANCE In this study, associations between increased rates of ASD diagnoses and reductions in disparities for Spanish-speaking households support the effectiveness of multistage screening in EI. This study provides a comprehensive evaluation of ASD screening in EI settings as well as a rigorous evaluation of ASD screening in any setting with a no-screening comparison condition. Given that the intervention included multiple components, mechanisms of action warrant further research, as do disparities by child sex.
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Affiliation(s)
| | | | | | - Thomas I. Mackie
- State University of New York Downstate Health Sciences University, Brooklyn
| | | | - Noah Hoch
- University of Massachusetts Boston, Boston,Clark University, Worcester, Massachusetts
| | - Sophie Brunt
- University of Massachusetts Boston, Boston,University of Virginia, Charlottesville
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15
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Stavropoulos KKM, Bolourian Y, Blacher J. A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS One 2022; 17:e0263062. [PMID: 35143494 PMCID: PMC8830614 DOI: 10.1371/journal.pone.0263062] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. Methods and procedures Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. Outcomes and results A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80–91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. Conclusions and implications Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers—particularly in rural and/or otherwise under-served communities.
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Affiliation(s)
| | - Yasamin Bolourian
- School of Education, University of California, Riverside, CA, United States of America
| | - Jan Blacher
- School of Education, University of California, Riverside, CA, United States of America
- Department of Psychology, University of California, Los Angeles, CA, United States of America
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16
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Hudock RL, Esler AN. Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children. Clin Neuropsychol 2022; 36:921-942. [DOI: 10.1080/13854046.2022.2025907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebekah L. Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Amy N. Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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17
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Binns AV, Cunningham BJ, Andres A, Oram Cardy J. Current practices, supports, and challenges in speech-language pathology service provision for autistic preschoolers. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221120768. [PMID: 36382071 PMCID: PMC9620702 DOI: 10.1177/23969415221120768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Speech-language pathology services are among the most frequently accessed services for young autistic children. Therefore, understanding the nature of these services, what challenges these clinicians face, and what supports they value is critical for developing appropriate policies and practices that can maximize positive outcomes for children and families. This study had two primary aims. The first was to examine the self-reported assessment and intervention practices of community-based Speech Language Pathologists (SLPs) and communicative disorders assistants (CDAs; who provide services under the supervision of a SLP) in supporting preschool children with suspected and diagnosed autism. The second aim was to identify barriers and supports (facilitators) to providing services in the community using the Consolidated Framework for Implementation Research (CFIR) as a framework. Methods A cross-sectional online survey was used to collect qualitative and quantitative data from clinicians in Ontario Canada who were providing speech and language services to preschool children with suspected or diagnosed autism. Quantitative data were used to describe clinicians" practices, and qualitative data captured their perspectives on barriers and supports to providing services. Results A total of 258 clinicians participated in the survey. On average, clinicians reported almost half of the preschoolers on their caseload had either diagnosed or suspected autism. There was consistency across the skill development areas assessed by SLPs, and targeted during therapy sessions, with the top four areas targeted being: foundational social communication, language, play and pragmatics. However, there was wide variation in speech and language assessment and intervention practices reported by this sample of clinicians (i.e., service delivery models, tools or programs used, length and duration of therapy services, level of collaboration with other professionals). Clinicians identified several barriers to providing services: limited funding and time, lack of inter-professional collaboration, difficulty accessing services, community messaging about autism services, family readiness and clinician knowledge. Supports (facilitators) included: access to autism-focused professional development, inter- and intra-professional collaboration, and access to additional supports in the community.
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Affiliation(s)
- Amanda V Binns
- Bloorview Research Institute, Holland Bloorview
Kids Rehabilitation Hospital, Toronto, Ontario, Canada; School of
Communication Sciences and Disorders, Western University, London, Ontario,
Canada; The Institute for Education Research, University Health Network,
Toronto, Ontario, Canada
| | - Barbara Jane Cunningham
- School of Communication Sciences and Disorders,
University of Western Ontario, London, Canada; CanChild, McMaster
University, Hamilton, Ontario, Canada
| | - Allison Andres
- Communication Sciences and Disorders, University of Western
Ontario, London, Canada
| | - Janis Oram Cardy
- Communication Sciences and Disorders, University of Western
Ontario, London, Canada
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18
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Tangviriyapaiboon D, Sirithongthaworn S, Apikomonkon H, Suyakong C, Srikummoon P, Kawilapat S, Traisathit P. Development and psychometric evaluation of a Thai Diagnostic Autism Scale for the early diagnosis of Autism Spectrum Disorder. Autism Res 2021; 15:317-327. [PMID: 34697914 PMCID: PMC9297913 DOI: 10.1002/aur.2631] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Abstract
The Thai Diagnostic Autism Scale (TDAS) was developed for use as a diagnostic tool for the early diagnosis of Autism Spectrum Disorder (ASD) in Thai children aged 12–48 months old. TDAS consists of 23 items (13 and 17 items in the observational and interview sections, respectively) classified into seven domains (A1–A3 and B1–B4) according to the criteria in the Diagnostic and Statistical Manual of Mental Disorder, fifth edition (DSM‐5). Children with a single score in the A1–A3 domains and at least two of the B1–B4 domains were classified with ASD. The item‐objective congruence (IOC) index, confirmatory factor analysis, and Kappa coefficient were used to evaluate the content, constructs, and inter‐rater validity levels between the evaluators and concurrent validity between TDAS and physicians' diagnoses, respectively. TDAS showed good overall content validity (IOC range 0.71–1.00), suitable construct validity (root‐mean‐squared errors of approximation of 0.076 and 0.067, comparative fit indexes of 0.902 and 0.858, and Tucker‐Lewis indexes of 0.882 and 0.837 for the observation and interview sections, respectively), and excellent diagnostic agreement between TDAS and the evaluators (Kappa = 1.000) as well as between TDAS and the physicians' diagnoses (Kappa = 0.871). The sensitivity and specificity of TDAS were 100% and 82.4%, respectively. In conclusion, TDAS yielded a high level of content validity, concurrent validity, and inter‐rater reliability for the early diagnosis of ASD in Thai children. A large‐scale study using TDAS is needed to determine an appropriate cut‐off point as well as its efficacy. The Thai Diagnostic Autism Scale was developed for use as a diagnostic tool for the early diagnosis of Autism Spectrum Disorder (ASD) among Thai children. It contains 23 items in seven domains for the screening via observations and interviews. The psychometric properties of this diagnostic tool provide its reliability and suitability for the early diagnosis of ASD. A large‐scale study using it is needed to determine an appropriate cut‐off point as well as its efficacy.
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Affiliation(s)
| | | | - Hataichanok Apikomonkon
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Chidawan Suyakong
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
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19
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Pileggi ML, Brane N, Bradshaw J, Delehanty A, Day T, McCracken C, Stapel-Wax J, Wetherby AM. Early Observation of Red Flags in 12-Month-Old Infant Siblings Later Diagnosed With Autism Spectrum Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1846-1855. [PMID: 33989505 PMCID: PMC8702865 DOI: 10.1044/2020_ajslp-20-00165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Purpose Valid and reliable screening tools are needed to improve early detection and optimize developmental outcomes for toddlers at risk for autism spectrum disorder (ASD). The current study aimed to evaluate the utility of the Systematic Observation of Red Flags (SORF) for ASD at 12 months of age in a sample of high-risk infant siblings of children with ASD. Method As part of a prospective, longitudinal study, we examined the sensitivity and specificity of the SORF at 12 months for predicting a diagnosis of ASD at 24 months in a sample of 122 infants, 31 of whom were diagnosed with ASD. Results The optimal SORF Composite cutoff score of 18 correctly identified 24 of the 31 twelve-month-olds who were diagnosed with ASD, yielding a sensitivity of .77 and a specificity of .76. The optimal SORF Red Flags cutoff score of 7 correctly identified 20 of the 31 infants, yielding a sensitivity of .65 and a specificity of .75. Conclusion This preliminary study demonstrates the potential of the SORF as an effective observational screening measure for 12-month-olds at risk for ASD with good discrimination, sensitivity, and specificity.
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Affiliation(s)
| | - Natalie Brane
- Marcus Autism Center, Children's Healthcare of Atlanta, GA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia
| | - Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Taylor Day
- Department of Psychology, Florida State University, Tallahassee
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Amy M. Wetherby
- Department of Clinical Sciences, Florida State University, Tallahassee
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20
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Corona LL, Weitlauf AS, Hine J, Berman A, Miceli A, Nicholson A, Stone C, Broderick N, Francis S, Juárez AP, Vehorn A, Wagner L, Warren Z. Parent Perceptions of Caregiver-Mediated Telemedicine Tools for Assessing Autism Risk in Toddlers. J Autism Dev Disord 2021; 51:476-486. [PMID: 32488583 PMCID: PMC7266386 DOI: 10.1007/s10803-020-04554-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine tools have potential for increasing access to diagnostic services for children with autism spectrum disorder (ASD). Past work has utilized tele-assessment procedures in which remote psychologists observe administration of interactive screening instruments by trained, on-site providers. Although promising, this approach relies on two clinicians, limiting its efficiency and scalability. The present study examined the use, acceptability, and parents’ perceptions of two caregiver-mediated tools for assessing ASD risk in toddlers, in which remote clinicians guided parents to complete interactive screening activities with their children. Most parents found tele-assessment to be comfortable, and many reported liking the parent-led nature of these tools. Parents also offered constructive feedback, which was used to modify the tele-assessment process for future study.
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Affiliation(s)
- Laura L Corona
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA.
| | - Amy S Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Berman
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra Miceli
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Nicholson
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin Stone
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neill Broderick
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara Francis
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Pablo Juárez
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Alison Vehorn
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Liliana Wagner
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Special Education, Vanderbilt University, Nashville, TN, USA
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21
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Mackie TI, Schaefer AJ, Ramella L, Carter AS, Eisenhower A, Jimenez ME, Fettig A, Sheldrick RC. Understanding How Parents Make Meaning of Their Child's Behaviors During Screening for Autism Spectrum Disorders: A Longitudinal Qualitative Investigation. J Autism Dev Disord 2021; 51:906-921. [PMID: 32328857 PMCID: PMC7954750 DOI: 10.1007/s10803-020-04502-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A family's journey in understanding their child's behaviors in relation to Autism Spectrum Disorders (ASD) frequently begins with screening. This study aimed to characterize the interpretive processes that unfold for parents. We employed longitudinal interviews with 19 families engaged in a community-based multi-stage screening protocol. Parents participated in 1-6 interviews dependent upon children's length of engagement in the screening protocol; data were analyzed through modified grounded theory. Parents who moved towards understanding their child's behaviors as ASD expressed (1) sensitization to ASD symptoms, (2) differentiation from other developmental conditions, and (3) use of the ASD diagnosis to explain the etiology of concerning behaviors. Identifying interpretive processes involved during ASD screening provides new opportunities for shared decision-making.
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Affiliation(s)
- Thomas I Mackie
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA.
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Ave, New Brunswick, NJ, 08901, USA.
| | - Ana J Schaefer
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Leah Ramella
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, USA
| | - Abbey Eisenhower
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, USA
| | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 89 French Street, New Brunswick, NJ, 08901, USA
| | - Angel Fettig
- College of Education - Special Education, University of Washington, 2012 Skagit Lane, Box 353600, Seattle, WA, 98195, USA
| | - R Christopher Sheldrick
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA
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22
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Campbell K, Carbone PS, Liu D, Stipelman CH. Improving Autism Screening and Referrals With Electronic Support and Evaluations in Primary Care. Pediatrics 2021; 147:e20201609. [PMID: 33568493 PMCID: PMC7919108 DOI: 10.1542/peds.2020-1609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Universal screening for autism promotes early evidence-based treatment. However, many children are not screened, and screened children are often not referred for autism evaluation. METHODS We implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series. We evaluated changes in referral for autism evaluation by calculating the rate ratio for referral. RESULTS In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline. CONCLUSIONS We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.
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Affiliation(s)
- Kathleen Campbell
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Paul S Carbone
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Diane Liu
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
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23
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Detection of Early Warning Signs in Autism Spectrum Disorders: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020164. [PMID: 33671540 PMCID: PMC7926898 DOI: 10.3390/children8020164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/03/2022]
Abstract
Due to the exponential increase of autism spectrum disorders’ prevalence in Western countries, it is necessary to improve early detection and intervention to enhance developmental milestones. This systematic review identified the most effective screening instrument, which can be used at an early age and which identifies the maximum number of autism cases. We identified several instruments with adequate predictive properties—the Autism Parent Screen for Infants (APSI), Battelle Development Inventory, second edition (BDI-2); Brief Infant-Toddler Social and Emotional Assessment (BITSEA); First Year Inventory (FYI); Infant-Toddler Checklist/Communication and Symbolic Behavior Scales Developmental Profile (ITC/CSBS-DP); Program of Research and Studies on AUTISM (PREAUT-Grid); Checklist for Early Signs of Developmental Disorders (CESDD); Social Attention and Communication Study (SACS); and the Screening Tool for Autism in Toddlers and Young Children (STAT)—that can be applied from 12 months of age in Western countries. The ITC/CSBS-DP has been proposed for universal screening from 12 months of age onwards, complemented by the Modified Checklist for Autism in Toddlers, Revised/Revised with Follow-Up (M-CHAT-R/F), which can be used from 15 months of age onwards. This strategy could improve early detection in at-risk children within the current health system, thus allowing for early intervention.
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24
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Choueiri R, Lindenbaum A, Ravi M, Robsky W, Flahive J, Garrison W. Improving Early Identification and Access to Diagnosis of Autism Spectrum Disorder in Toddlers in a Culturally Diverse Community with the Rapid Interactive screening Test for Autism in Toddlers. J Autism Dev Disord 2021; 51:3937-3945. [PMID: 33423215 PMCID: PMC8510911 DOI: 10.1007/s10803-020-04851-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The objective of this study was to test a screening model that employs the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), in an underserved community to improve ASD detection. We collaborated with a large Early Intervention (EI) program and trained 4 providers reliably on the RITA-T. Toddlers received the Modified Checklist for Autism in Toddlers (MCHAT-R/F), the RITA-T, developmental and autism testing, and a best-estimate clinical diagnosis. Eighty-One toddlers were enrolled: 57 with ASD and 24 with Developmental Delay (DD) non-ASD. Wait-time for diagnosis was on average 6 weeks. The RITA-T correlated highly with autism measures and EI staff integrated this model easily. The RITA-T significantly improved the identification and wait time for ASD in this underserved community.
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Affiliation(s)
- Roula Choueiri
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | | | - Manasa Ravi
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - William Robsky
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - William Garrison
- Developmental and Behavioral Pediatrics, University of Massachusetts Medical School/Children's Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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25
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Zwaigenbaum L, Bryson SE, Brian J, Smith IM, Sacrey L, Armstrong V, Roberts W, Szatmari P, Garon N, Vaillancourt T, Roncadin C. Assessment of Autism Symptoms From 6 to 18 Months of Age Using the Autism Observation Scale for Infants in a Prospective High-Risk Cohort. Child Dev 2020; 92:1187-1198. [PMID: 33368222 DOI: 10.1111/cdev.13485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objectives were to characterize behavioral signs of autism spectrum disorder (ASD) in younger siblings of diagnosed children (high-risk; HR) and examine classification features of the Autism Observation Scale for Infants (AOSI). Participants (501 HR and 180 low-risk [LR]) were assessed between 6 and 18 months using the AOSI and at age 3 for ASD diagnoses. Total AOSI scores differentiated HR infants later diagnosed with ASD starting at 12 months. ROC analyses identified 12- and 18-month cutoff scores associated with 0.52 sensitivity and 0.74 specificity and 0.73 sensitivity and 0.65 specificity, respectively. Although classification accuracy does not support use as a standalone screen, the AOSI identifies features associated with ASD starting at 6 months and differentiates HR infants with ASD by 12 months.
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Affiliation(s)
| | | | | | | | | | | | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders
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Brewer N, Young RL, Lucas CA. Autism Screening in Early Childhood: Discriminating Autism From Other Developmental Concerns. Front Neurol 2020; 11:594381. [PMID: 33362696 PMCID: PMC7758341 DOI: 10.3389/fneur.2020.594381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022] Open
Abstract
Early identification of autism, followed by appropriate intervention, has the potential to improve outcomes for autistic individuals. Numerous screening instruments have been developed for children under 3 years of age. Level 1 screeners are used in large-scale screening to detect at-risk children in the general population; Level 2 screeners are concerned with distinguishing children with signs of autism from those with other developmental problems. The focus here is evaluation of Level 2 screeners. However, given the contributions of Level 1 screeners and the necessity to understand how they might interface with Level 2 screeners, we briefly review Level 1 screeners and consider instrument characteristics and system variables that may constrain their effectiveness. The examination of Level 2 screeners focuses on five instruments associated with published evaluations in peer-reviewed journals. Key criteria encompass the traditional indices of test integrity such as test reliability (inter-rater, test-retest) and construct validity, including concurrent and predictive validity, sensitivity (SE), and specificity (SP). These evaluations reveal limitations, including inadequate sample sizes, reliability issues, and limited involvement of independent researchers. Also lacking are comparative test evaluations under standardized conditions, hindering interpretation of differences in discriminative performance across instruments. Practical considerations constraining the use of such instruments—such as the requirements for training in test administration and test administration time—are canvassed. Published Level 2 screener short forms are reviewed and, as a consequence of that evaluation, future directions for assessing the discriminative capacity of items and measures are suggested. Suggested priorities for future research include targeting large and diverse samples to permit robust appraisals of Level 2 items and scales across the 12–36 month age range, a greater focus on precise operationalization of items and response coding to enhance reliability, ongoing exploration of potentially discriminating items at the younger end of the targeted age range, and trying to unravel the complexities of developmental trajectories in autistic infants. Finally, we emphasize the importance of understanding how screening efficacy is dependent on clinicians' and researchers' ability not only to develop screening tests but also to negotiate the complex organizational systems within which screening procedures must be implemented.
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Affiliation(s)
- Neil Brewer
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
| | - Robyn L Young
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
| | - Carmen A Lucas
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
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Young RL, Nah Y. Examining Autism Detection in Early Childhood (ADEC) in the Early Identification of Young Children with Autism Spectrum Disorders (ASD). AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lai M, Lee J, Chiu S, Charm J, So WY, Yuen FP, Kwok C, Tsoi J, Lin Y, Zee B. A machine learning approach for retinal images analysis as an objective screening method for children with autism spectrum disorder. EClinicalMedicine 2020; 28:100588. [PMID: 33294809 PMCID: PMC7700906 DOI: 10.1016/j.eclinm.2020.100588] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is characterised by many of features including problem in social interactions, different ways of learning, some children showing a keen interest in specific subjects, inclination to routines, challenges in typical communication, and particular ways of processing sensory information. Early intervention and suitable supports for these children may make a significant contribution to their development. However, considerable difficulties have been encountered in the screening and diagnosis of ASD. The literature has indicated that certain retinal features are significantly associated with ASD. In this study, we investigated the use of machine learning approaches on retinal images to further enhance the classification accuracy. METHODS Forty-six ASD participants were recruited from three special needs schools and 24 normal control were recruited from the community. Among them, 23 age-gender matched ASD and normal control participant-pairs were constructed for the primary analysis. All retinal images were captured using a nonmydriatic fundus camera. Automatic retinal image analysis (ARIA) methodology applying machine-learning technology was used to optimise the information of the retina to develop a classification model for ASD. The model's validity was then assessed using a 10-fold cross-validation approach to assess its validity. FINDINGS The sensitivity and specificity were 95.7% (95% CI 76.0%, 99.8%) and 91.3% (95% CI 70.5%, 98.5%) respectively. The area under the ROC curve was 0.974 (95% CI 0.934, 1.000); however, it was noted that the specificity for female participants might not be as high as that for male participants. INTERPRETATION Because ARIA is a fully automatic cloud-based algorithm and relies only on retinal images, it can be used as a risk assessment tool for ASD screening. Further diagnosis and confirmation can then be made by professionals, and potential treatment may be provided at a relatively early stage.
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Affiliation(s)
- Maria Lai
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jack Lee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | | | | | - Wing Yee So
- The Jockey Club Hong Chi School, Wan Chai, Hong Kong SAR
| | - Fung Ping Yuen
- The Hong Chi Morninghill School, Tuen Mun, Hong Kong SAR
| | - Chloe Kwok
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jasmine Tsoi
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yuqi Lin
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Benny Zee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
- Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
- Corresponding author at: Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
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Bradbury K, Robins DL, Barton M, Ibañez LV, Stone WL, Warren ZE, Fein D. Screening for Autism Spectrum Disorder in High-Risk Younger Siblings. J Dev Behav Pediatr 2020; 41:596-604. [PMID: 32576788 PMCID: PMC7572497 DOI: 10.1097/dbp.0000000000000827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Most autism spectrum disorder (ASD) screening measures have been developed for use with low-risk (LR) children; however, measures may perform differently in high-risk (HR) younger sibling populations. The current study sought to investigate the performance of an ASD screening measure, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), in a sample of HR younger siblings and directly compared its performance with that in an LR sample. METHODS High-risk younger siblings (n = 187) and LR children (n = 15,848) were screened using the M-CHAT-R/F. Screen-positive children completed comprehensive evaluations. The M-CHAT-R/F psychometric properties and clinical characteristics were compared across the samples. RESULTS The M-CHAT-R/F demonstrated a significantly higher screen-positive rate and ASD detection rate in the HR sample compared with the LR sample. Children with ASD in the HR sample had stronger verbal, nonverbal, and overall cognitive abilities compared with children with ASD in the LR sample despite comparable ASD severity and adaptive functioning. High positive predictive value of the M-CHAT-R at initial screen, with only incremental change after Follow-Up, suggests that Follow-Up is less critical in HR than LR samples. A significantly lower number of changed responses during Follow-Up further supports improved reporting accuracy of parents with ASD experience compared with parents less familiar with ASD. CONCLUSION The findings suggest that the M-CHAT-R/F can distinguish between ASD and non-ASD at 18 to 24 months in an HR sibling sample, with performance comparable with or better than its performance in the general population.
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Affiliation(s)
- Kathryn Bradbury
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Marianne Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Lisa V. Ibañez
- Department of Psychology, University of Washington, Seattle, Washington
| | - Wendy L. Stone
- Department of Psychology, University of Washington, Seattle, Washington
| | - Zachary E. Warren
- Vanderbilt Kennedy Center Treatment and Research Institute for ASD, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
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The Utility of the Screening Tool for Autism in 2-Year-Olds in Detecting Autism in Taiwanese Toddlers Who are Less than 24 Months of Age: A Longitudinal Study. J Autism Dev Disord 2020; 50:1172-1181. [PMID: 31970598 DOI: 10.1007/s10803-019-04350-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present longitudinal study examined the utility of the screening tool for autism in 2-year-olds (STAT) in detecting autism spectrum disorder (ASD) in toddlers who are less than 24 months of age. The study sample, which consisted of 119 toddlers with developmental problems, were assessed when they were between 16 and 24 months of age (Time 1) and after a period of 18 months to finalize the diagnosis (Time 2); 57 children had ASD and 62 children had developmental delays. A cutoff score of 2.5 on the STAT yielded an optimal combination of high sensitivity and specificity. The STAT demonstrated adequate predictive validity in detecting ASD in Taiwanese toddlers who are less than 24 months of age.
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McNally Keehn R, Ciccarelli M, Szczepaniak D, Tomlin A, Lock T, Swigonski N. A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder. Pediatrics 2020; 146:peds.2019-3876. [PMID: 32632023 DOI: 10.1542/peds.2019-3876] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.
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Affiliation(s)
- Rebecca McNally Keehn
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Mary Ciccarelli
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Angela Tomlin
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Thomas Lock
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Nancy Swigonski
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and.,Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Geng X, Kang X, Wong PCM. Autism spectrum disorder risk prediction: A systematic review of behavioral and neural investigations. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 173:91-137. [PMID: 32711819 DOI: 10.1016/bs.pmbts.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A reliable diagnosis of autism spectrum disorder (ASD) is difficult to make until after toddlerhood. Detection in an earlier age enables early intervention, which is typically more effective. Recent studies of the development of brain and behavior in infants and toddlers have provided important insights in the diagnosis of autism. This extensive review focuses on published studies of predicting the diagnosis of autism during infancy and toddlerhood younger than 3 years using behavioral and neuroimaging approaches. After screening a total of 782 papers, 17 neuroimaging and 43 behavioral studies were reviewed. The features for prediction consist of behavioral measures using screening tools, observational and experimental methods, brain volumetric measures, and neural functional activation and connectivity patterns. The classification approaches include logistic regression, linear discriminant function, decision trees, support vector machine, and deep learning based methods. Prediction performance has large variance across different studies. For behavioral studies, the sensitivity varies from 20% to 100%, and specificity ranges from 48% to 100%. The accuracy rates range from 61% to 94% in neuroimaging studies. Possible factors contributing to this inconsistency may be partially due to the heterogeneity of ASD, different targeted populations (i.e., high-risk group for ASD and general population), age when the features were collected, and validation procedures. The translation to clinical practice requires extensive further research including external validation with large sample size and optimized feature selection. The use of multi-modal features, e.g., combination of neuroimaging and behavior, is worth further investigation to improve the prediction accuracy.
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Affiliation(s)
- Xiujuan Geng
- Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Xin Kang
- Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Patrick C M Wong
- Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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A Randomized Controlled Trial of an Intelligent Robotic Response to Joint Attention Intervention System. J Autism Dev Disord 2020; 50:2819-2831. [DOI: 10.1007/s10803-020-04388-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Dow D, Day TN, Kutta TJ, Nottke C, Wetherby AM. Screening for autism spectrum disorder in a naturalistic home setting using the systematic observation of red flags (SORF) at 18-24 months. Autism Res 2020; 13:122-133. [PMID: 31643148 PMCID: PMC6972690 DOI: 10.1002/aur.2226] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/06/2019] [Accepted: 09/26/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to examine the utility of the Systematic Observation of Red Flags (SORF; Dow et al., 2016) as a level 2 screener for autism spectrum disorder (ASD) in toddlers during a naturalistic video-recorded home observation. Psychometric properties of the SORF were examined in a sample of 228 toddlers-84 with ASD, 82 with developmental delay (DD), and 62 with typical development (TD). Trained undergraduate research assistants blind to diagnosis rated 22 red flags (RF) of ASD associated with DSM-5 diagnostic criteria using a 4-point scale. The following scores were computed: a total score summing all items, domain scores summing social communication and restricted, repetitive behavior items, and number of RF counting items with scores of 2 or 3 indicating clear symptom presence. The performance of the total, domain, and RF scores and individual items were examined. A composite score was formed with six items with the best psychometric performance: poor eye gaze directed to faces, limited showing and pointing, limited coordination of nonverbal communication, less interest in people than objects, repetitive use of objects, and excessive interest in particular objects, actions, or activities. The 6-item composite provides a brief measure with optimal performance, while the RF may be instrumental for clinicians who are interested in characterizing the range of observed symptoms. The SORF shows promise as a practical alternative to currently available screening methods for implementation by nonexperts with the potential to increase feasibility and reduce common obstacles to access to care. Autism Res 2020, 13: 122-133. © The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: Research suggests that current autism spectrum disorder (ASD) screening tools are not accurate enough to use in routine screening. The Systematic Observation of Red Flags was developed as a practical option for children at high risk for ASD. It can be used with video-recorded samples of parent-child interactions in the home and by raters who are not experts in ASD. It shows promise in predicting ASD risk in toddlers to determine if a full diagnostic evaluation is necessary.
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Affiliation(s)
- Deanna Dow
- Department of PsychologyFlorida State University, Autism InstituteTallahasseeFlorida
| | - Taylor N. Day
- Department of PsychologyFlorida State University, Autism InstituteTallahasseeFlorida
| | - Timothy J. Kutta
- College of MedicineFlorida State University Autism InstituteTallahasseeFlorida
| | - Charly Nottke
- College of MedicineFlorida State University Autism InstituteTallahasseeFlorida
| | - Amy M. Wetherby
- Department of Clinical Sciences, College of MedicineFlorida State University, Autism InstituteTallahasseeFlorida
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Al-Dewik N, Al-Jurf R, Styles M, Tahtamouni S, Alsharshani D, Alsharshani M, Ahmad AI, Khattab A, Al Rifai H, Walid Qoronfleh M. Overview and Introduction to Autism Spectrum Disorder (ASD). ADVANCES IN NEUROBIOLOGY 2020; 24:3-42. [PMID: 32006355 DOI: 10.1007/978-3-030-30402-7_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder generally manifesting in the first few years of life and tending to persist into adolescence and adulthood. It is characterized by deficits in communication and social interaction and restricted, repetitive patterns of behavior, interests, and activities. It is a disorder with multifactorial etiology. In this chapter, we will focus on the most important and common epidemiological studies, pathogenesis, screening, and diagnostic tools along with an explication of genetic testing in ASD.
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Affiliation(s)
- Nader Al-Dewik
- Clinical and Metabolic Genetics Section, Pediatrics Department, Hamad General Hospital (HGH), Women's Wellness and Research Center (WWRC) and Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha, Qatar. .,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar. .,Faculty of Health and Social Care Sciences, Kingston University, St. George's University of London, London, UK.
| | - Rana Al-Jurf
- Department of Biomedical Science, College of Health Science, Qatar University, Doha, Qatar
| | - Meghan Styles
- Health Profession Awareness Program, Health Facilities Development, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sona Tahtamouni
- Child Development Center, Hamad Medical Corporation, Doha, Qatar
| | - Dalal Alsharshani
- College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Mohammed Alsharshani
- Diagnostic Genetics Division (DGD), Department of Laboratory Medicine and Pathology (DLMP), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amal I Ahmad
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Newborn Screening Unit, Hamad Medical Corporation, Doha, Qatar
| | - M Walid Qoronfleh
- Research and Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar
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Conti E, Chericoni N, Costanzo V, Lasala R, Mancini A, Prosperi M, Tancredi R, Muratori F, Calderoni S, Apicella F. Moving Toward Telehealth Surveillance Services for Toddlers at Risk for Autism During the COVID-19 Pandemic. Front Psychiatry 2020; 11:565999. [PMID: 33424652 PMCID: PMC7793978 DOI: 10.3389/fpsyt.2020.565999] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Since 2016, the project "Early Bird Diagnostic Protocol for Autism Spectrum Disorders (ASD)" funded by the Italian Ministry of Health has been operative at IRCCS Fondazione Stella Maris (FSM), Pisa (IT), with the main aim of developing early age-specific diagnostic protocols by longitudinally enrolling two different populations at risk for ASD: (i) toddlers with older siblings with ASD (FR) and (ii) toddlers referred by a child psychiatrist or pediatrician for suspected ASD (CR). On January 30, 2020, when the World Health Organization declared the outbreak of coronavirus disease 2019 (COVID-19), 136 patients (85 FR; 51 CR; 93 males; 43 females) had been enrolled in the project with 324 completed time points and 64 still missing. Considering both the huge psychological burden on families with toddlers at risk for ASD during the lockdown and the longitudinal studies reporting the positive "surveillance effect" in terms of a better outcome in at-risk toddlers, our priority has been to maintain regular contact and support to enrolled families. To do this, the research team, being authorized for smart-working research activities, has set up a detailed remote surveillance protocol (RSP). The RSP includes three online interviews and one online video registration of parent-child play. In the current community case study, the authors report the telehealth procedure and discuss possible future directions in developing remote assessment and new evaluation modalities for ecological parent-child play video recordings in at-risk populations. Hopefully, the surveillance protocol will further improve our ability to detect risk and activate early tailored intervention.
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Affiliation(s)
- Eugenia Conti
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Natasha Chericoni
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Valeria Costanzo
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Roberta Lasala
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Alice Mancini
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Margherita Prosperi
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaella Tancredi
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | - Filippo Muratori
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Apicella
- Department of Developmental Neuroscience - Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
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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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Thabtah F, Peebles D. Early Autism Screening: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3502. [PMID: 31546906 PMCID: PMC6765988 DOI: 10.3390/ijerph16183502] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/15/2019] [Accepted: 09/15/2019] [Indexed: 12/27/2022]
Abstract
Autistic spectrum disorder (ASD) refers to a neurodevelopmental condition associated with verbal and nonverbal communication, social interactions, and behavioural complications that is becoming increasingly common in many parts of the globe. Identifying individuals on the spectrum has remained a lengthy process for the past few decades due to the fact that some individuals diagnosed with ASD exhibit exceptional skills in areas such as mathematics, arts, and music among others. To improve the accuracy and reliability of autism diagnoses, many scholars have developed pre-diagnosis screening methods to help identify autistic behaviours at an early stage, speed up the clinical diagnosis referral process, and improve the understanding of ASD for the different stakeholders involved, such as parents, caregivers, teachers, and family members. However, the functionality and reliability of those screening tools vary according to different research studies and some have remained questionable. This study evaluates and critically analyses 37 different ASD screening tools in order to identify possible areas that need to be addressed through further development and innovation. More importantly, different criteria associated with existing screening tools, such as accessibility, the fulfilment of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifications, comprehensibility among the target audience, performance (specifically sensitivity, specificity, and accuracy), web and mobile availability, and popularity have been investigated.
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Affiliation(s)
- Fadi Thabtah
- Department of Psychology, School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
| | - David Peebles
- Department of Psychology, School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
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41
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Juárez AP, Weitlauf AS, Nicholson A, Pasternak A, Broderick N, Hine J, Stainbrook JA, Warren Z. Early Identification of ASD Through Telemedicine: Potential Value for Underserved Populations. J Autism Dev Disord 2019. [PMID: 29527626 DOI: 10.1007/s10803-018-3524-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing access to diagnostic services is crucial for identifying ASD in young children. We therefore evaluated a telemedicine assessment procedure. First, we compared telediagnostic accuracy to blinded gold-standard evaluations (n = 20). ASD cases identified via telemedicine were confirmed by in-person evaluation. However, 20% of children diagnosed with ASD in-person were not diagnosed via telemedicine. Second, we evaluated telediagnostic feasibility and acceptability in a rural catchment. Children (n = 45) and caregivers completed the telemedicine procedure and provided feedback. Families indicated high levels of satisfaction. Remote diagnostic clinicians diagnosed 62% of children with ASD, but did not feel capable of ruling-in or out ASD in 13% of cases. Findings support preliminary feasibility, accuracy, and clinical utility of telemedicine-based assessment of ASD for young children.
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Affiliation(s)
- A Pablo Juárez
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy S Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Nicholson
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Pasternak
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neill Broderick
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Special Education, Vanderbilt University, Nashville, TN, USA.
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42
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Embedding Autism Spectrum Disorder Diagnosis Within the Medical Home: Decreasing Wait Times Through Streamlined Assessment. J Autism Dev Disord 2019; 48:2846-2853. [PMID: 29589272 DOI: 10.1007/s10803-018-3548-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Long waits for diagnostic assessment prevent early identification of children suspected of having autism spectrum disorder. We evaluated the benefit of embedded diagnostic consultation within primary care clinics. Using a streamlined diagnostic model, 119 children with concerns for autism spectrum disorder were seen over 14 months. Diagnostic clarity was determined through streamlined assessment for 59% of the children, while others required follow-up. Latency from first concern to diagnosis was 55 days and median age at diagnosis was 32 months: considerably lower than national averages or comparable tertiary clinics. Findings support that embedded processes for effective triage and diagnosis within the medical home is a viable mechanism for efficient access to diagnostic services and assists in bypassing a common barrier to specialized services.
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43
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Ibañez LV, Stoep AV, Myers K, Zhou C, Dorsey S, Steinman KJ, Stone WL. Promoting early autism detection and intervention in underserved communities: study protocol for a pragmatic trial using a stepped-wedge design. BMC Psychiatry 2019; 19:169. [PMID: 31174514 PMCID: PMC6556010 DOI: 10.1186/s12888-019-2150-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the known benefits of early, specialized intervention for toddlers with Autism Spectrum Disorder (ASD), access to such intervention remains limited. This pragmatic trial examines a novel healthcare delivery model (Screen-Refer-Treat [SRT]), which capitalizes upon existing health care and early intervention (EI) infrastructure to increase community capacity for ASD detection and treatment before age 3, when it is likely to have the greatest impact. This model comprises three components: (1) universal use of Stage 1 ASD screening by primary care providers (PCPs) at 18-month well-child visits (i.e., Screen); (2) immediate referral of positive screens to a community-based EI program (i.e., Refer); and (3) provision of an inexpensive, evidence-based ASD-specialized treatment by EI providers, after verifying ASD risk with a Stage 2 screen (i.e., Treat). This paper describes our research design and the initial successes, challenges, and adaptations made during the early implementation phase. METHOD/DESIGN A stepped-wedge cluster RCT was used to implement the SRT model sequentially in four diverse Washington State counties ("clusters"). Counties are randomly assigned to the time of receipt of the SRT intervention, which comprises training workshops and technical assistance focused on the use of evidence-based ASD screening and intervention tools. Separate cohorts of families with toddlers (16-35 months old) with and without ASD concerns are recruited before and after the SRT intervention from participating PCP practices and EI programs. PCPs and EI providers complete measures on their screening, referral, and intervention practices before and after the SRT intervention. Each family cohort completes surveys about their well-being, parenting efficacy, health care satisfaction, and toddler's social-communicative behaviors. CONCLUSION This trial is the first of its kind to work simultaneously with two service delivery systems with the goal of improving early detection and treatment for ASD. Our approach was successful in attaining buy-in from PCPs and EI providers, building and maintaining partnerships with providers, and achieving high levels of retention and survey completion. Fostering provider engagement and problem-solving issues together as partners were integral to overcoming the main challenges. Numerous lessons have been learned thus far, which have applicability for implementation researchers in ASD and those in other fields. TRIAL REGISTRATION The registration number for this trial is NCT02409303 and it was posted on ClinicalTrials.gov on April 6, 2015.
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Affiliation(s)
- Lisa V. Ibañez
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
| | - Ann Vander Stoep
- 0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, Department of Epidemiology, University of Washington, Seattle, WA 98195 USA
| | - Kathleen Myers
- 0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - Chuan Zhou
- 0000000122986657grid.34477.33Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98195 USA ,0000 0000 9026 4165grid.240741.4Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145 USA
| | - Shannon Dorsey
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
| | - Kyle J. Steinman
- 0000000122986657grid.34477.33Departments of Neurology, Psychiatry & Behavioral Sciences, and Pediatrics, University of Washington, Seattle, WA 98195 USA ,0000 0000 9026 4165grid.240741.4Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101 USA
| | - Wendy L. Stone
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
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44
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Sheldrick RC, Frenette E, Vera JD, Mackie TI, Martinez-Pedraza F, Hoch N, Eisenhower A, Fettig A, Carter AS. What Drives Detection and Diagnosis of Autism Spectrum Disorder? Looking Under the Hood of a Multi-stage Screening Process in Early Intervention. J Autism Dev Disord 2019; 49:2304-2319. [PMID: 30726534 PMCID: PMC6595501 DOI: 10.1007/s10803-019-03913-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents' concerns, providers' concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.
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Affiliation(s)
- R Christopher Sheldrick
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA.
- Boston University, 715 Albany Street, Boston, MA, 02118, USA.
| | - Elizabeth Frenette
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Juan Diego Vera
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Thomas I Mackie
- Rutgers School of Public Health, Piscataway, NJ, USA
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | | - Noah Hoch
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Abbey Eisenhower
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Angel Fettig
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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45
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The Feasibility and Validity of Autism Spectrum Disorder Screening Instrument: Behavior Development Screening for Toddlers (BeDevel)—A Pilot Study. Autism Res 2019; 12:1112-1128. [DOI: 10.1002/aur.2117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/20/2019] [Accepted: 04/21/2019] [Indexed: 11/07/2022]
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46
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Mazurek MO, Curran A, Burnette C, Sohl K. ECHO Autism STAT: Accelerating Early Access to Autism Diagnosis. J Autism Dev Disord 2019; 49:127-137. [PMID: 30043354 DOI: 10.1007/s10803-018-3696-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although early diagnosis of autism is critical for promoting access to early intervention, many children experience significant diagnostic delays. Shortages of healthcare providers, limited capacity at autism centers, and geographic and socioeconomic challenges contribute to these delays. The current pilot study examined the feasibility of a new model for training community-based primary care providers (PCPs) in underserved areas in screening and diagnosis of young children at highest risk for autism. By combining hands-on training in standardized techniques with ongoing virtual mentorship and practice, the program emphasized both timely diagnosis and appropriate referral for more comprehensive assessment when necessary. Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, Curry School of Education, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22903, USA.
| | - Alicia Curran
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Courtney Burnette
- Center for Development and Disability, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Kristin Sohl
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Department of Child Health, University of Missouri, Columbia, MO, USA
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47
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Marlow M, Servili C, Tomlinson M. A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children: recommendations for use in low- and middle-income countries. Autism Res 2019; 12:176-199. [DOI: 10.1002/aur.2033] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marguerite Marlow
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
| | - Chiara Servili
- Department of Mental Health and Substance Abuse; World Health Organization; Geneva Switzerland
| | - Mark Tomlinson
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
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48
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A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children. J Dev Behav Pediatr 2019; 40:1-11. [PMID: 30461593 DOI: 10.1097/dbp.0000000000000621] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. METHODS Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). RESULTS The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. CONCLUSION Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.
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49
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Myers E, Stone WL, Bernier R, Lendvay T, Comstock B, Cowan C. The diagnosis conundrum: Comparison of crowdsourced and expert assessments of toddlers with high and low risk of autism spectrum disorder. Autism Res 2018; 11:1629-1634. [PMID: 30475456 DOI: 10.1002/aur.2030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 07/18/2018] [Accepted: 09/18/2018] [Indexed: 01/29/2023]
Abstract
As the diagnosis and treatment of Autism Spectrum Disorder (ASD) becomes a greater public health concern, access to professionals and expert assessment becomes increasingly more challenging. Novel techniques to improve efficiency of assessment of young children with social communication concerns are desperately needed to address significant barriers to accessing diagnostic evaluations. Utilizing crowdsourcing technology, we compared ratings by experts and crowdworkers of social communication behaviors in videos of 18-month-old children. Of note, 563 crowdworkers and 24 expert responses were collected in approximately 7 hr and 57 days, respectively. Summed scores of social communication behaviors observed by crowdworkers showed high correlation to those of experts. These data introduce a novel and perhaps efficient way in which to examine of social communication impairments in toddlers. Autism Research 2018, 11: 1629-1634. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This research compared crowdsourced assessments of social communication behaviors to assessments by experts, for toddlers whose behaviors ranged in severity from typical to atypical. Results showed that crowdsourced rankings of social communication behavior significantly correlate with those of experts.
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Affiliation(s)
- Emily Myers
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, Washington
| | - Raphael Bernier
- Department of Psychology, University of Washington, Seattle, Washington
| | - Thomas Lendvay
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Bryan Comstock
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Charles Cowan
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
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50
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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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