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Autism Screening Practices in Preschools and Early Childcare Centers: A Systematic Review

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Abstract

Average age of autism diagnosis exceeds four years (Maenner et al., 2020), delaying access to services and limiting early developmental research (Zwaigenbaum et al., 2015; Fletcher-Watson et al., 2017). Autism screening in early childhood settings may be a tool for enabling earlier, equitable diagnosis. This systematic review investigated the landscape of autism screening in preschools/childcare centers. Thirty-one studies were identified (7 studies on classroom observations; 22 on teacher-report questionnaires, 2 others). Questionnaires completed by early childcare staff and observational screening methods administered directly in early childcare settings showed evidence of reliability and validity. Many approaches provided information not gleaned from other reports and corresponded well with diagnostic decisions. Implications for future research are discussed.

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References

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • Allaby, M., & Sharma, M. (2011). Screening for autism spectrum disorders in children below the age of 5 years: A draft report for the UK National Screening Committee. Solutions for Public Health.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • Andersson, G. W., Miniscalco, C., & Gillberg, C. (2014). Preschoolers assessed for autism: Parent and teacher experiences of the diagnostic process. Research in Developmental Disabilities, 35(12), 3392–3402. https://doi.org/10.1016/j.ridd.2014.08.027

    Article  PubMed  Google Scholar 

  • Andersson, G. W., Miniscalco, C., & Gillberg, C. (2013a). Autism in preschoolers: does individual clinician’s first visit diagnosis agree with final comprehensive diagnosis?. The Scientific World Journal2013a.

  • Andersson, G. W., Miniscalco, C., Johansson, U., & Gillberg, C. (2013b). Autism in toddlers: can observation in preschool yield the same information as autism assessment in a specialized clinic?. The Scientific World Journal2013b.

  • Au, A. H., Shum, K. K., Cheng, Y., Tse, H. M., Wong, R. M., Li, J., & Au, T. K. (2021). Autism spectrum disorder screening in preschools. Autism, 25(2), 516–528. https://doi.org/10.1177/1362361320967529

    Article  PubMed  Google Scholar 

  • Bara, T., Farias, A. C., Felden, E., & Cordeiro, M. (2018). Receiver operating characteristic curve analysis of the Child Behavior Checklist and Teacher’s Report Form for assessing autism spectrum disorder in preschool-aged children. Neuropsychiatric Disease and Treatment, 14, 95–102. https://doi.org/10.2147/NDT.S151185

    Article  PubMed  Google Scholar 

  • Bauminger-Zviely, N., & Shefer, A. (2021). Naturalistic evaluation of preschoolers’ spontaneous interactions: The Autism Peer Interaction Observation Scale. Autism, 1362361321989919.https://doi.org/10.1177/1362361321989919

  • Carbone, P. S., Campbell, K., Wilkes, J., Stoddard, G. J., Huynh, K., Young, P. C., & Gabrielsen, T. P. (2020). Primary care autism screening and later autism diagnosis. Pediatrics146(2).

  • Carpenter, B., Happé, F., & Egerton, J. (Eds.). (2019). Girls and autism: educational, family and personal perspectives. Routledge.

  • Chan, H. L., Liu, W. S., Hsieh, Y. H., Lin, C. F., Ling, T. S., & Huang, Y. (2016). Screening for attention deficit and hyperactivity disorder, autism spectrum disorder, and developmental delay in Taiwanese aboriginal preschool children. Neuropsychiatric Disease and Treatment, 12, 2521–2526. https://doi.org/10.2147/NDT.S113880

    Article  PubMed  PubMed Central  Google Scholar 

  • Constantino, J. N., Przybeck, T., Friesen, D., & Todd, R. D. (2000). Reciprocal social behavior in children with and without pervasive developmental disorders. Journal of Developmental Behavior Pediatrics, 21(1), 2–11.

    Article  CAS  Google Scholar 

  • Constantino, J.N. & Gruber, C.P. (2012). Social Responsiveness Scale, Second Edition (SRS-2). Torrance, CA: Western Psychological Services.

  • Dereu, M., Warreyn, P., Raymaekers, R., Meirsschaut, M., Pattyn, G., Schietecatte, I., & Roeyers, H. (2010). Screening for Autism Spectrum Disorders in Flemish Day-Care Centres with the Checklist for Early Signs of Developmental Disorders. Journal of Autism and Developmental Disorders, 40(10), 1247–1258. https://doi.org/10.1007/s10803-010-0984-0

    Article  PubMed  Google Scholar 

  • Dereu, M., Raymaekers, R., Warreyn, P., Schietecatte, I., Meirsschaut, M., & Roeyers, H. (2012). Can Child Care Workers Contribute to the Early Detection of Autism Spectrum Disorders? A Comparison Between Screening Instruments with Child Care Workers Versus Parents as Informants. Journal of Autism and Developmental Disorders, 42(5), 781–796. https://doi.org/10.1007/s10803-011-1307-9

    Article  PubMed  Google Scholar 

  • DeVincent, C., Gadow, K. D., Strong, G., Schwartz, J., & Cuva, S. (2008). Screening for Autism Spectrum Disorder with the Early Childhood Inventory-4. Journal of Developmental & Behavioral Pediatrics, 29(1), 1–10. https://doi.org/10.1097/DBP.0b013e3181468c32

    Article  Google Scholar 

  • Dosreis, S., Weiner, C. L., Johnson, L., & Newschaffer, C. J. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental & Behavioral Pediatrics, 27(2), S88–S94.

    Article  Google Scholar 

  • Evans, S. C., Boan, A. D., Bradley, C., & Carpenter, L. A. (2019). Sex/gender differences in screening for autism spectrum disorder: Implications for evidence-based assessment. Journal of Clinical Child & Adolescent Psychology, 48(6), 840–854.

    Article  Google Scholar 

  • Fletcher-Watson, S., Apicella, F., Auyeung, B., Beranova, S., Bonnet-Brilhault, F., Canal-Bedia, R., Charman, T., Chericoni, N., Conceição, I.C., Davies, K., Farroni, T., Gomot, M, Jones, E., Kaale, A., Kapica, K., Kawa, R., Kylliäinen, A., Larsen, K., Lefort-Besnard, J., Malvey, J, ..., & Yirmiya, N. (2017). Attitudes of the autism community to early autism research. Autism21(1), 61-74.

  • Fuentes, J., Hervás, A., & Howlin, P. (2021). ESCAP practice guidance for autism: A summary of evidence-based recommendations for diagnosis and treatment. European Child & Adolescent Psychiatry, 30(6), 961–984.

    Article  Google Scholar 

  • Glascoe, F. P. (1998). Collaborating with parents: Using Parents' Evaluation of Developmental Status to detect and address developmental and behavioral problems. Ellsworth & Vandermeer Press.

  • Goforth, A. N., Farmer, R. L., Kim, S. Y., Naser, S. C., Lockwood, A. B., & Affrunti, N. W. (2021). Status of school psychology in 2020: Part 1, demographics of the NASP membership survey. NASP Research Reports, 5(2), 1–17.

    Google Scholar 

  • Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observation Schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627.

    Article  PubMed  Google Scholar 

  • Harris, J. F., Coffield, C. N., Janvier, Y. M., Mandell, D., & Cidav, Z. (2021). Validation of the developmental check-in tool for low-literacy autism screening. Pediatrics147(1).

  • Head start programs. Office of Head Start. ( 2021, November 3 HYPERLINK "file:///Users/edelucia/Documents/Research/Childcare Review/RJADD Submission/). https:"). https://www.acf.hhs.gov/ohs/about/head-start

  • Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7(4), 306–317.

    Article  Google Scholar 

  • Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics145(1).

  • Jané, M. C., Canals, J., Ballespí, S., Viñas, F., Esparó, G., & Domènech, E. (2006). Parents and teachers reports of DSM-IV psychopathological symptoms in preschool children: Differences between urban-rural Spanish areas. Social Psychiatry and Psychiatric Epidemiology, 41(5), 386–393. https://doi.org/10.1007/s00127-006-0038-2

    Article  PubMed  Google Scholar 

  • Janvier, Y. M., Harris, J. F., Coffield, C. N., Louis, B., Xie, M., Cidav, Z., & Mandell, D. S. (2016). Screening for autism spectrum disorder in underserved communities: Early childcare providers as reporters. Autism, 20(3), 364–373. https://doi.org/10.1177/1362361315585055

    Article  PubMed  Google Scholar 

  • Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.

    Article  PubMed  Google Scholar 

  • Khowaja, M. K., Hazzard, A. P., & Robins, D. L. (2015). Sociodemographic barriers to early detection of autism: Screening and evaluation using the M-CHAT, M-CHAT-R, and follow-up. Journal of Autism and Developmental Disorders, 45(6), 1797–1808.

    Article  PubMed  PubMed Central  Google Scholar 

  • Larsen, K., Aasland, A., & Diseth, T. H. (2018a). Brief Report: Agreement Between Parents and Day-Care Professionals on Early Symptoms Associated with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 48(4), 1063–1106.

    Article  PubMed  Google Scholar 

  • Larsen, K., Aasland, A., & Diseth, T. H. (2018b). Identification of Symptoms of Autism Spectrum Disorders in the Second Year of Life at Day-Care Centres by Day-Care Staff: Step One in the Development of a Short Observation List. Journal of Autism and Developmental Disorders, 48(7), 2267–2277. https://doi.org/10.1007/s10803-018-3489-x

    Article  PubMed  Google Scholar 

  • Larsen, K., Aasland, A., Schjølberg, S., Hansen, U. I., & Diseth, T. H. (2020). Piloting the Use of a Short Observation List for ASD-Symptoms in Day-Care: Challenges and Further Possibilities. Journal of Autism and Developmental Disorders, 50(9), 3413–3423. https://doi.org/10.1007/s10803-019-04313-5

    Article  PubMed  Google Scholar 

  • Larson, K., Cull, W. L., Racine, A. D., & Olson, L. M. (2016). Trends in access to health care services for US children: 2000–2014. Pediatrics138(6).

  • Lo, B. H., Klopper, F., Barnes, E. H., & Williams, K. (2017). Agreement between concern about autism spectrum disorder at the time of referral and diagnosis, and factors associated with agreement: Early ASD concern and diagnostic outcome. Journal of Paediatrics and Child Health, 53(8), 742–748. https://doi.org/10.1111/jpc.13511

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P.C., Risi, S., Gotham, K., Bishop, S.L. (2012) Autism Diagnostic Observation Schedule2nd. Torrance, CA: Western Psychological Services.

  • Maenner, M. J., Shaw, K. A., & Baio, J. (2020). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2016. MMWR Surveillance Summaries, 69(4), 1.

    Article  PubMed Central  Google Scholar 

  • Major, S., Seabra-Santos, M. J., & Albuquerque, C. P. (2017). Validating the Preschool and Kindergarten Behavior Scales-2: Preschoolers with autism spectrum disorders. Research in Developmental Disabilities, 65, 86–96. https://doi.org/10.1016/j.ridd.2017.04.008

    Article  PubMed  Google Scholar 

  • Mandell, D. S., Listerud, J., Levy, S. E., & Pinto-Martin, J. A. (2002). Race differences in the age at diagnosis among Medicaid-eligible children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1447–1453.

    Article  Google Scholar 

  • Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116(6), 1480–1486.

    Article  PubMed  Google Scholar 

  • McConaughy, S. H., & Ritter, D. R. (2002). Best Practices in Multidimensional Assessment of Emotional or Behavioral Disorders.

  • McDonnell, C. G., DeLucia, E. A., Hayden, E. P., Penner, M., Curcin, K., Anagnostou, E., Nicolson, R., Kelley, E., Georgiades, S., Liu, X., & Stevenson, R. A. (2020). Sex differences in age of diagnosis and first concern among children with autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 1–11.

  • Merrell, K. W. (2002). PKBS-2. Preschool and Kindergarten Behavior Scales. Austin, Texas: PRO· ED.

  • Mishaal, R. A., Ben-Itzchak, E., & Zachor, D. A. (2014). Age of autism spectrum disorder diagnosis is associated with child’s variables and parental experience. Research in Autism Spectrum Disorders, 8(7), 873–880.

    Article  Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morales-Hidalgo, P., Hernández-Martínez, C., Voltas, N., & Canals, J. (2017). EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder. International Journal of Clinical and Health Psychology, 17(3), 269–281.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morales-Hidalgo, P., Roigé-Castellví, J., Hernandez-Martinez, C., Voltas, N., & Canals, J. (2018). Prevalence and characteristics of autism spectrum disorder among Spanish school-age children. Journal of Autism and Developmental Disorders, 48(9), 3176–3190.

    Article  PubMed  Google Scholar 

  • National Center for Education Statistics (2016). National Household Education Surveys Program.https://nces.ed.gov/nhes/tables/ECPP_HoursPerWeek_Care.asp. Accessed 16 Sept 2020

  • National Center for Education Statistics. (2018, July). Digest of Education statistics, 2018. National Center for Education Statistics.https://nces.ed.gov/programs/digest/d18/tables/dt18_202.10.asp. Accessed 16 Sept 2020

  • Nazneen, N., Rozga, A., Smith, C. J., Oberleitner, R., Abowd, G. D., & Arriaga, R. I. (2015). A novel system for supporting autism diagnosis using home videos: Iterative development and evaluation of system design. JMIR mHealth and uHealth, 3(2), e4393.

    Article  Google Scholar 

  • Nilsson Jobs, E., Bölte, S., & Falck-Ytter, T. (2019a). Spotting signs of autism in 3-year-olds: Comparing information from parents and preschool staff. Journal of Autism and Developmental Disorders, 49(3), 1232–1241.

    Article  PubMed  Google Scholar 

  • Nilsson Jobs, E., Bölte, S., & Falck-Ytter, T. (2019b). Preschool Staff Spot Social Communication Difficulties, But Not Restricted and Repetitive Behaviors in Young Autistic Children. Journal of Autism and Developmental Disorders, 49(5), 1928–1936. https://doi.org/10.1007/s10803-018-03867-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Øien, R. A., Hart, L., Schjølberg, S., Wall, C. A., Kim, E. S., Nordahl-Hansen, A., & Shic, F. (2017). Parent-endorsed sex differences in toddlers with and without ASD: Utilizing the M-CHAT. Journal of Autism and Developmental Disorders, 47(1), 126–134.

    Article  PubMed  Google Scholar 

  • Patel, P., & Clinedinst, M. (2021). State-by-State Student-to-Counselor Ratio Maps by School District. National Association for College Admission Counseling.

  • Petrocchi, S., Levante, A., & Lecciso, F. (2020). Systematic review of level 1 and level 2 screening tools for autism spectrum disorders in toddlers. Brain Sciences, 10(3), 180.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pine, E., Luby, J., Abbacchi, A., & Constantino, J. N. (2006). Quantitative assessment of autistic symptomatology in preschoolers. Autism, 10(4), 344–352.

    Article  PubMed  Google Scholar 

  • Reis, H., Pereira, A., & Almeida, L. (2017). A comparison of parent and professional perceptions of children with autism spectrum disorder in Portugal. British Journal of Special Education, 44(3), 257–272.

    Article  Google Scholar 

  • Reszka, S. S., Boyd, B. A., McBee, M., Hume, K. A., & Odom, S. L. (2014). Brief Report: Concurrent Validity of Autism Symptom Severity Measures. Journal of Autism and Developmental Disorders, 44(2), 466–470. https://doi.org/10.1007/s10803-013-1879-7

    Article  PubMed  Google Scholar 

  • Riccio, A., Kapp, S. K., Jordan, A., Dorelien, A. M., & Gillespie-Lynch, K. (2021). How is autistic identity in adolescence influenced by parental disclosure decisions and perceptions of autism? Autism, 25(2), 374–388.

    Article  PubMed  Google Scholar 

  • Robins, D. L., Casagrande, K., Barton, M., Chen, C. M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Samadi, S. A., Mohammad, M. P., Ghanimi, F., & McConkey, R. (2016). The challenges of screening pre-school children for autism spectrum disorders in Iran. Disability and Rehabilitation, 38(17), 1739–1747. https://doi.org/10.3109/09638288.2015.1107637

    Article  PubMed  Google Scholar 

  • Self, T. L., Parham, D. F., & Rajagopalan, J. (2015). Autism spectrum disorder early screening practices: A survey of physicians. Communication Disorders Quarterly, 36(4), 195–207.

    Article  Google Scholar 

  • Sprafkin, J., Volpe, R. J., Gadow, K. D., Nolan, E. E., & Kelly, K. (2002). A DSM-IV–Referenced Screening Instrument for Preschool Children: The Early Childhood Inventory-4. Journal of the American Academy of Child & Adolescent Psychiatry, 41(5), 604–612. https://doi.org/10.1097/00004583-200205000-00018

    Article  Google Scholar 

  • Squires, J., & Bricker, D. (2009). Ages & Stages Questionnaires®, Third Edition (ASQ®-3): A Parent-Completed Child Monitoring System. Paul H. Brookes Publishing Co., Inc.

    Google Scholar 

  • Stickley, A., Tachibana, Y., Hashimoto, K., Haraguchi, H., Miyake, A., Morokuma, S., Nitta, H., Oda, M., Ohya, Y., Senju, A., Takahashi, H., Yamagata, T., & Kamio, Y. (2017). Assessment of autistic traits in children aged 2 to 4½ years with the preschool version of the Social Responsiveness Scale (SRS-P): Findings from Japan. Autism Research, 10(5), 852–865.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stone, W. L., Coonrod, E. E., & Ousley, O. Y. (2000). Brief report: Screening tool for autism in two-year-olds (STAT): Development and preliminary data. Journal of Autism and Developmental Disorders, 30(6), 607–612.

    Article  CAS  PubMed  Google Scholar 

  • Taresh, S., Aniza Ahmad, N., Roslan, S., Ma’rof, A. M., & Mohammed Zaid, S. (2020). Mainstream Preschool Teachers’ Skills at Identifying and Referring Children with Autism Spectrum Disorder (ASD). International Journal of Environmental Research and Public Health, 17(12), 4284. https://doi.org/10.3390/ijerph17124284

    Article  Google Scholar 

  • Thompson, B., & Winsler, A. (2018). Parent–teacher agreement on social skills and behavior problems among ethnically diverse preschoolers with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(9), 3163–3175.

    Article  PubMed  Google Scholar 

  • van’t Hof, M., Tisseur, C., van Berckelear-Onnes, I., van Nieuwenhuyzen, A., Daniels, A. M., Deen, M, ..., & Ester, W. A. (2021). Age at autism spectrum disorder diagnosis: A systematic review and meta-analysis from 2012 to 2019. Autism, 25(4), 862-873.

  • Volpe, R. J., DiPerna, J. C., Hintze, J. M., & Shapiro, E. S. (2005). Observing students in classroom settings: A review of seven coding schemes. School Psychology Review, 34(4), 454–474.

    Article  Google Scholar 

  • Walker, S., & Berthelsen, D. (2008). Children with autistic spectrum disorder in early childhood education programs: A social constructivist perspective on inclusion. International Journal of Early Childhood, 40(1), 33–51.

    Article  Google Scholar 

  • Zwaigenbaum, L., Bauman, M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J.C., Natowicz, M.R., Choueiri, R., Fein, D., Kasari, C., Pierce, K., Buie, T., Carter, A., Davis, P.A., Granpeesheh D., Mailloux, Z., Newschaffer C., Robins, D, …, & Wetherby, A. (2015). Early identification of autism spectrum disorder: recommendations for practice and research. Pediatrics136(Supplement 1), S10-S40.

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DeLucia, E.A., Dike, J., Andrzejewski, T.M. et al. Autism Screening Practices in Preschools and Early Childcare Centers: A Systematic Review. Rev J Autism Dev Disord 11, 1–20 (2024). https://doi.org/10.1007/s40489-022-00323-9

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