Comparison of Autism Screening in Younger and Older Toddlers
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This study examined the effect of age at completion of an autism screening test on item failure rates contrasting older (>20 months) with younger (<20 months) toddlers in a community primary care sample of 73,564 children. Items related to social development were categorized into one of three age sets per criteria from Inada et al. (Research in Autism Spectrum Disorders 4(4):605–611, 2010). Younger toddlers produced higher rates of item failure than older toddlers and items in both of the later acquired item sets had higher probability rates for failure than the earliest acquired item set (prior to 8 months). Use of the same items and the same scoring throughout the target age range for autism screening may not be the best strategy for identifying the youngest toddlers at risk for autism.
KeywordsAutism screening M-CHAT Developmental screening Test development
We are grateful to all of the participating practices using CHADIS for clinical care. This project was funded in part by a grant from the NIMH Grant No. R44MH085399.
RS and BH conceived of the study, participated in its design and coordination and drafted the manuscript; LS and TEA participated in the design and interpretation of the data; PB participated in the design of the study and performed the statistical analysis. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
This study was conducted by the Center for Promotion of Child Development through Primary Care and its for-profit subsidiary, Total Child Health (TCH), Inc. CHADIS, the web-tool used in the study, was developed by Dr. Sturner and his spouse, Dr. Howard. Dr Sturner is Director of the Center and Dr. Howard is President of TCH. Both are members of the Board of Directors of both entities and are paid consultants to both entities.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- Autism Speaks. (2016). Modified checklist for autism in toddlers, revised (M-CHAT-R). Retrieved August 3, 2016, from http://www.autismspeaks.org/what-autism/diagnosis/screen-your-child.
- Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S., & Drew, A. (2000). A screening instrument for autism at 18 months of age: A 6-year follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 39(6), 694–702. doi: 10.1097/00004583-200006000-00007.CrossRefGoogle Scholar
- Barbaro, J., & Dissanayake, C. (2010). Prospective identification of autism spectrum disorders in infancy and toddlerhood using developmental surveillance: The social attention and communication study. Journal of Developmental & Behavioral Pediatrics, 31(5), 376–385. doi: 10.1097/DBP.0b013e3181df7f3c.CrossRefGoogle Scholar
- Centers for Disease Control and Prevention (CDC). (2015). Autism spectrum disorder: Screening and diagnosis for health care providers. Retrieved August 8, 2016, from http://www.cdc.gov/ncbddd/autism/hcp-screening.html.
- CHADIS—Comprehensive Health & Development Interactive System. http://www.chadis.com/site/. Accessed 15 July 2017.
- Christensen, D. L., et al. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ.Google Scholar
- Dudova, I., Markova, D., Kasparova, M., Zemankova, J., Beranova, S., Urbanek, T., & Hrdlicka, M. (2014). Comparison of three screening tests for autism in preterm children with birth weights less than 1,500 grams. Neuropsychiatric Disease and Treatment, 10, 2201–2208. doi: 10.2147/NDT.S72921.CrossRefPubMedPubMedCentralGoogle Scholar
- Guy, A., Seaton, S. E., Boyle, E. M., Draper, E. S., Field, D. J., Manktelow, B. N., … Johnson, S. (2015). Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age. The Journal of Pediatrics, 166(2), 269–275. doi: 10.1016/j.jpeds.2014.10.053.CrossRefPubMedGoogle Scholar
- Kamio, Y., Inada, N., Koyama, T., Inokuchi, E., Tsuchiya, K., & Kuroda, M. (2014). Effectiveness of using the Modified Checklist for Autism in Toddlers in two-stage screening of autism spectrum disorder at the 18-month health check-up in Japan. Journal of Autism and Developmental Disorders, 44(1), 194–203. doi: 10.1007/s10803-013-1864-1.CrossRefPubMedGoogle Scholar
- Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H. C., Esser, E. L., & Barton, M. (2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827–839. doi: 10.1007/s10803-007-0450-9.CrossRefPubMedPubMedCentralGoogle Scholar
- National Autism Association. (2015). Signs and symptoms of autism. Retrieved August 8, 2016, from http://nationalautismassociation.org/resources/signs-of-autism/.
- National Research Council. (2001). Educating children with autism. Washington, DC: National Academies Press.Google Scholar
- Pandey, J., Verbalis, A., Robins, D. L., Boorstein, H., Klin, A., Babitz, T., & Fein, D. (2008). Screening for autism in older and younger toddlers with the Modified Checklist for Autism in Toddlers. Autism: The International Journal of Research and Practice, 12(5), 513–535. doi: 10.1177/1362361308094503.CrossRefGoogle Scholar
- Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.CrossRefPubMedGoogle Scholar
- Siegel, B. (2004). Pervasive developmental disorders screening test-ii (pddst-ii). San Antonio, TX: Harcourt.Google Scholar
- Stenberg, N., Bresnahan, M., Gunnes, N., Hirtz, D., Hornig, M., Lie, K. K., & Schjølberg, S. (2014). Identifying children with autism spectrum disorder at 18 months in a general population sample. Paediatric and Perinatal Epidemiology, 28(3), 255–262. doi: 10.1111/ppe.12114.CrossRefPubMedPubMedCentralGoogle Scholar
- Sturner, R. A., Howard, B., Morrel, T., Bergmann, P., Walton, K., Marks, D., & Landa, R. (2013). Accurate autism screening at the 18 month visit requires different strategies than at 24 months. Presented at the Pediatric Academic Societies annual meeting, Washington, D. C.Google Scholar
- U.S. Preventive Services Task Force. (2016). Final Recommendation Statement: Autism spectrum disorder in young children: Screening. Accessed March 14, 2017, from http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/autism-spectrum-disorder-in-young-children-screening.
- Wetherby, A. M., Brosnan-Maddox, S., Peace, V., & Newton, L. (2008). Validation of the infant-toddler checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism: The International Journal of Research and Practice, 12(5), 487–511. doi: 10.1177/1362361308094501.CrossRefGoogle Scholar