AUTISM SPECTRUM DISORDERS: INSTRUMENTS OF EARLY DETECTION SCREENING TOOLS

Transcription

1 AUTISM SPECTRUM DISORDERS: INSTRUMENTS OF EARLY DETECTION SCREENING TOOLS Romina Moavero

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3 SCREENING TOOLS: Population Level 1 Level 2 Population-based screening Specific screening tool after developmemtal delay risk confirmation at a routine developmental surveillance

4 L1 CHAT M-CHAT Q-CHAT PDDST-II ESAT ITC FYI CESDD SACS L2 M-CHAT Q-CHAT FYI CHAT-23 BISCUIT STAT

5 LEVEL 3: Gold Standard Tests Level 3 Used in ASD specialty clinics: ADI-R ADOS-2

6 LEVEL 1 EARLY DETECTION LEVEL 2 LEVEL 3 EARLY DIAGNOSIS EARLY INTERVENTION

7 SCREENING TOOLS: AGE < 12 months of age ITC CESDD >12 months of age CHAT-23 FYI ESAT STAT SACS >18 months of age CHAT M-CHAT Q-CHAT BISCUIT

8 In particular < 12 months 12/14 months 17/18 months Less specificity Developmental delay Language delay Early onset ASD Serious ASD More Specificity Late onset ASD Regression

9 SCREENING TOOLS: Administration INDIRECT DIRECT Parent Questionnaire or Interview Clinical observation

10 CHAT-CHecklist for Autism in Toddlers L1,L2 >18 months 14 items; yes/no. 2 sections: üa (9 items) indirect: parents interview üb (5items) direct: clinical observation Baron-Cohen, Allen, Gillberg 1992

11 CHAT-Checklist for Autism in Toddlers Pros: low price, way of administration (time), low percentage of false positive rate Cons: high percentage of false negative rate* *Scambler D et al 2001

12 M-CHAT- Modified Checklist for Autism in Toddlers (20-48 months) Parent report 23 items No section B Children at risk: follow-up telephone interview Good specificity and sensitivity Robins et al 2001

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14 M-CHAT items (M-CHAT) + 5 items of direct clinical observation (Section B, CHAT) 4 points Likert (from Never to Often) Wong et al 2004

15 M-CHAT Pros: Low cost, way of administration, better specificity and sensitivity compared to CHAT Cons: high false negative rate (mild ASD, high functioning), high false positive rate USA: effective tool for screening low-risk toddlers, reducing age of diagnosis by 2 years* *Robins DL et al 2014

16 Q-CHAT-Quantitative Check-list for Parents questionnaire 25 items (some from CHAT and MCHAT + new items) Likert Scale 5 points (Often, Never) Good Sensitivity (identify mild sintomatology) Pros: low cost, administration (time) Cons: no follow-up data, no statistics information Italy: (NIDA) Autism in Toddlers Allison et al 2008

17 PDDST-II-Pervasive Developmental Disorder Screening Test-II (<18 months) Level 1,2 Three sections: ü Primary Care Screener, 22 items, Paediatrician ü Developmental Clinic Screener, 14 items, Specialist ü Autism Clinic Severity Screener, 12 items, Specialist Yes (1)/No(0) PCS: high false positive rate DCS: 50% less false positive rate ACSS: underestimate 40% Italy (?)

18 PDDST-II-Pervasive Developmental Disorder Screening Test-II Pros: differents sections. Cons: no many researches (psycometric properties should be verified)

19 STAT-Screening Tool for Autism in two-years-old (12-36 months) Level 2 Differentiate ASD/DD Clinical Observation for Specialist (evaluation, follow-up) 12 items (20 minutes) 4 social-communicative fields Score 0-4 Cons: professional training Italy (?) Stone et al 2004

20 ITC- Infant-Toddler Checklist (6-24 Level 1 Parents questionnaire/interview Paediatrician 24 questions (multiple choice) + 1 open (principal worries) Score < 10 centileà another caregiver questionnaire, behaviour sample ASD, Language Impairment, Developmental Disorder Italy (?) months)

21 ESAT- Early Screening of Autistic Traits (14/15months) Low functioning ASD Questionnaire/Interview (yes/no) Two sections: ü Pre-screening (4 items): Paediatrician ü Second part (14 items): Specialist Italy (?) Cons: high false negative rate Willemsen-Swinkels et al 2006;2009

22 FYI-First Inventory (12 months) Questionnaire 63 items (multiple choice, open questions) Early onset and serious ASD Good Specificity Italy: available for research, Muratori et al 2009 Reznick et al 2007

23 BISCUIT- Baby and Infant Screen for Children with Autism Traits (17-37 months) Level 2 Parents interview + complementary clinical observation Three sections: ü Part 1 (62 items): differentiate ASD/DD ü Part 2(71 items): comorbidity (ADHD, TIC, OCD) ü Part 3 (17 items): problematic behaviour Likert Scale 3 points Pros: evaluate 3 fields, low cost, easy to administrate Cons: high false positive rate, no outcome information Italy (?) Matson et al 2007

24 CESDD- Checklist for Early Signs of Developmental Disorders (3-36 months) DD+ASD Sensitivity>ESAT Specificity<<<< Pros: wide range of age Cons: Level1àhigh false positive and negative rate, no ASD high functioning Italy (?) Dereu et al 2010

25 SACS- Social Attention and Communication Study (12-24 months) Level 1 3 schedule of clinical observation (12, 18, 24 months) Yes/no Paediatrician Pros: low false positive, >40% identified < 18 months Cons: professional training, no follow-up information Barbaro and Dissanayake 2010;2013

26 Level 1 ITC, CESDD: specificity 90%, sensitivity 80% M-CHAT: specificity and sensitivity >90% Level 2 BISCUIT: specificity 95%sensitivity 95% STAT: specificity 85%sensitivity 92%

27 AGE < 18 MONTHS DD + ASD ASD L1 FYI (indirect) ESAT (indirect: questionnaire) L1 SACS (direct) L1,L2 CSBS-DP (ITC, indirect: questionnaire) CESDD (direct) FYI (12 Months, questionnaire)

28 AGE > 18 MONTHS ASD L1 M-CHAT (indirect: questionnaire) SACS (direct) L2 BISCUIT (direct+ indirect) CHAT-23 (direct+ indirect)

29 SCREENING OUTCOMES Screening outcomes are influenced by several factors: üage of administration ülevel of functioning and autism severity üparental compliance rate üprotocol adherence

30 Difficulties in differentiating ASD from other DD at very early ageà high false-positive rate* Level of functioning and autism severity are important factors to consider when evaluating screening methods (CHAT, M- CHAT)** Milder ASD and high functionning ASD could be missed at young age Performing screening through a two-stage process may help to narrow down false-positive rate and reduce the possible side effects of screening (false positive, false negative rate) *Dietz et al 2006, Dereu et al 2010 ; **Scambler et al 2001, Oosterling IJ 2010

31 CONCLUSIONS Need of routine screening implementation for ASD and/or other developmental disorder à require reorganisation of the health care in many countries Reduce the gap between the first parental concerns, the first consultation and the age at which the diagnosis is made General Paediatrician should be trained and encouraged to use appropriate tools that can help in detecting possible early signs of ASD.