Early Detection of Autism: Comparison of Three Screening Instruments
Grantee: University of Connecticut
Principal Investigator: Deborah A. Fein
Project Number: R40MC00270
Project Date: 09/01/2001
Final Report
Released
Age group(s)
- Perinatal/Infancy (0-12 months)
- Early Childhood (3-5 years)
- Young Adulthood (19-25 years)
Abstract
Autism and other pervasive developmental disorders (PDD) are severe disorders of development, often leading to life-long disability. Early detection and intervention can substantially improve prognosis; however, with available screening instruments early detection is difficult. Diagnosis and intervention often follow initial suspicion by as much as three years or more. The proposed study involves the comparison of three parent checklist screening instruments for 24-month-olds: (1) The Checklist for Autism in Toddlers (CHAT)-Parent Report section (Baron-Cohen, Allen, & Gillberg, 1992; Baron-Cohen et al, 1996), (2) The Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, & Barton, in press), and (3) the Yale Autism/PDD Screener. The CHAT parent report has 9 items. To form the M-CHAT, items were added to the CHAT and after pilot testing, refined to a 23-item scale. Pilot data on 1293 two-year-olds from pediatric practices and early intervention sites, 58 of whom were evaluated and 39 of whom were diagnosed with autism or PDD, demonstrates excellent promise of effectiveness for both the CHAT and M-CHAT, with the M-CHAT showing slightly better screening properties. A follow-up study of the first 600 participants at the age of 42-48 months, to ascertain true sensitivity, has been started. The Yale Autism/PDD Screener, a 14-item parent checklist, has been used to study young children referred for possible autism. All but 4 items have been found to discriminate children with autism/PDD from children with other developmental disorders or normal development. The proposed study will investigate the effectiveness of this 14-item screener in an unselected population of 2-year olds. In the proposed project, 33,000 children will be screened, 30,000 from an unselected sample of children at pediatric visits, and 3,000 from a high risk sample of children referred for early intervention. A projected 120 with PDD (and approximately 30 false positives) will be evaluated at 24 months and again at 42 months. All pediatricians and early intervention sites in the State of Connecticut will be contacted; pilot data have successfully included a representative demographic sample of SES and ethnicity and include urban, suburban and rural communities. Evaluations will include psychiatric diagnoses and assessment of cognitive, language, and adaptive functioning. Analyses at both time points will use signal detection and discriminant function analyses to assess and compare the sensitivity and specificity of each instrument, and to determine the optimal set of items to detect PDD. The proposed study should greatly advance the development of an effective early screening tool for autism and related disorders. Planned future studies include replication in other states, and cross-cultural comparisons in such countries as Japan.Publications
Listed is descending order by year published.
Adams SH, Park MJ, Brindis CD, Irwin Jr. CE. Adolescents’ receipt of care in a medical home: Results from a national survey. J Adol Health. 2023;1-5
Barney A, Raymond Flesch M et al. Telemedicine in an Adolescent and Young Adult Medicine Clinic: A Mixed Methods Study. BMC Health Serv Res. 2023;23:680
Giovanelli AG, Rowe J, Taylor M, Berna M, Tebb KP, Penilla C, Pugatch M, Lester J, & Ozer EM. Supporting Adolescent Engagement with AI-Driven Digital Health Behavior Change Interventions. J Med Internet Res. 2023;25:e40306
McConnochie KM, Wood NE, Alarie C, Ronis S. Care offered by an information-rich pediatric acute illness connected care model. Telemed J E Health. 2016 Jun;22(6):465-472. doi: 10.1089/tmj.2015.0161. PMID: 26701609.
Kleinman J, Robins D, Ventola P, Pandey J, Boorstein H, Esser E, et al. The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord. 2008 May;38(5):827-39.
Kleinman JM, Ventola PE, Pandey J, Verbalis AD, Barton M, Hodgson S, Green J, Dumont-Mathieu T, Robins DL, Fein D. Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord. 2008 Apr;38(4):606-15. Epub 2007 Oct 9.
Pandey J, Verbalis A, Robins DL, Boorstein H, Klin AM, Babitz T, Chawarska K, Volkmar F, Green J, Barton M, Fein D. Screening for autism in older and younger toddlers with the Modified Checklist for Autism in Toddlers. Autism. 2008 Sep;12(5):513-35.
Mraz KD, Green J, Dumont-Mathieu T, Makin S, Fein D. Correlates of head circumference growth in infants later diagnosed with autism spectrum disorders. J Child Neurol. 2007 Jun;22(6):700-13.
Sutera S, Pandey J, Esser EL, Rosenthal MA, Wilson LB, Barton M, et al. Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. J Autism Dev Disord. 2007 Jan;37(1):98-107. Epub 2007 Jan 6.
Ventola P, Kleinman J, Pandey J, Wilson L, Esser E, Boorstein H. Differentiating between autism spectrum disorders and other developmental disabilities in children who failed a screening instrument for ASD. Journal of Autism and Developmental Disorders. J Autism Dev Disord. 2007 Mar;37(3):425-36.
Ventola P, Kleinman J, Pandey J, Barton M, Allen S, Green J, et al. Agreement among four diagnostic instruments for autism spectrum disorders in toddlers. J Autism Dev Disord. 2006 Oct;36(7):839-47.
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