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Comparison of Autism Screening in Younger and Older Toddlers

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Abstract

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.

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References

  • American Academy of Pediatrics. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.

    Article  Google Scholar 

  • Araceli, R. C., Pablo, M. M. J., & Penélope, G. H. (2016). Maturational changes of the auditory system in normal preschool children assessed by brainstem auditory evoked potentials (BAEPs). Clinical Neurophysiology, 127(9), e320–e321. doi:10.1016/j.clinph.2016.05.351.

    Article  Google Scholar 

  • 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.

    Article  Google 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.

    Article  Google Scholar 

  • Barger, B. D., Campbell, J. M., & McDonough, J. D. (2013). Prevalence and onset of regression within autism spectrum disorders: A meta-analytic review. Journal of Autism and Developmental Disorders, 43(4), 817–828. doi:10.1007/s10803-012-1621-x.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S., Allen, J., & Giliberg, C. (1992). Can autism be detected at 18 months? The needle, the haystack, and the CHAT. British Journal of Psychiatry, 161, 839–843.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightingale, N. A. T. A. S. H. A., Morgan, K. A. T. E., ... Charman, T. (1996). Psychological markers in the detection of autism in infancy in a large population. The British Journal of Psychiatry, 168(2), 158–163.

    Article  PubMed  Google 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.

  • Chlebowski, C., Robins, D. L., Barton, M. L., & Fein, D. (2013). Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics, 131(4), e1121–e1127. doi:10.1542/peds.2012-1525.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  • Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 114(1), 23–41. doi:10.1352/2009.114:23;nd41.

    Article  PubMed  Google Scholar 

  • Inada, N., Kamio, Y., & Koyama, T. (2010). Developmental chronology of preverbal social behaviors in infancy using the M-CHAT: Baseline for early detection of atypical social development. Research in Autism Spectrum Disorders, 4(4), 605–611. doi:10.1016/j.rasd.2009.12.003.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  • Kim, S. H., Joseph, R. M., Frazier, J. A., O’Shea, T. M., Chawarska, K., Alfred, E. N., Leviton, A., & Kuban, K. K. (2016). Predictive validity of the Modified Checklist for Autism in Toddlers (M-CHAT) born very preterm. The Journal of Pediatrics, 178, 101–107.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuzniewicz, M. W., Wi, S., Qian, Y., Walsh, E. M., Armstrong, M. A., & Croen, L. A. (2014). Prevalence and neonatal factors associated with autism spectrum disorders in preterm infants. The Journal of Pediatrics, 164(1), 20–25. doi:10.1016/j.jpeds.2013.09.021.

    Article  PubMed  Google Scholar 

  • Mahoney, A. D., Minter, B., Burch, K., & Stapel-Wax, J. (2013). Autism spectrum disorders and prematurity: A review across gestational age subgroups. Advances in Neonatal Care, 13(4), 247–251. doi:10.1097/ANC.0b013e31828d02a1.

    Article  PubMed  Google 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 

  • Ozonoff, S., Heung, K., Byrd, R., Hansen, R., & Hertz-Picciotto, I. (2008). The onset of autism: Patterns of symptom emergence in the first years of life. Autism Research, 1(6), 320–328. doi:10.1002/aur.53.

    Article  PubMed  PubMed Central  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.

    Article  Google Scholar 

  • Robins, D. L., Casagrande, K., Barton, M., Chen, C. M., 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. doi:10.1542/peds.2013-1813.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Srisinghasongkram, P., Pruksananonda, C., Chonchaiya, W. (2016). Two-step screening of the modified checklist for autism in toddlers in Thai children with language delay and typically developing children. Journal of Autism and Developmental Disorders, 46, 3317–3329.

    Article  PubMed  Google Scholar 

  • Størvold, G. V., Aarethun, K., & Bratberg, G. H. (2013). Age for onset of walking and prewalking strategies. Early Human Development, 89(9), 655–659. doi:10.1016/j.earlhumdev.2013.04.010.

    Article  PubMed  Google Scholar 

  • Sturner, R., Howard, B., Bergmann, P., Morrel, T., Andon, L., Marks, D., Rao, P., & Landa, R. (2016) Autism screening with online decision support by primary care pediatricians aided by M-CHAT/F. Pediatrics, 138(3), e20153036.

    Article  PubMed  PubMed Central  Google 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.

  • 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.

    Article  Google Scholar 

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Acknowledgments

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.

Author Contributions

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.

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Authors and Affiliations

  1. Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Raymond Sturner & Barbara Howard

  2. Foresight Logic, Inc., Saint Paul, MN, USA

    Paul Bergmann

  3. PrairieCare Institute, Minneapolis, MN, USA

    Paul Bergmann

  4. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Lydia Stewart

  5. Loyola University, Baltimore, MD, USA

    Talin E. Afarian

Authors
  1. Raymond Sturner
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  2. Barbara Howard
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  3. Paul Bergmann
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  4. Lydia Stewart
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  5. Talin E. Afarian
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Corresponding author

Correspondence to Raymond Sturner.

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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.

Ethical Approval

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.

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Sturner, R., Howard, B., Bergmann, P. et al. Comparison of Autism Screening in Younger and Older Toddlers. J Autism Dev Disord 47, 3180–3188 (2017). https://doi.org/10.1007/s10803-017-3230-1

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  • DOI: https://doi.org/10.1007/s10803-017-3230-1

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