A Two-Stage Screening Approach with I-TC and Q-CHAT to Identify Toddlers at Risk for Autism Spectrum Disorder within the Italian Public Health System

Abstract

Standardized screening programs ensure that children are monitored for early signs of autism spectrum disorder (ASD) in order to promote earlier diagnosis and intervention. The aim of this study is to identify early signs of atypical development consistent with ASD or other developmental disorders in a population of 224 low-risk toddlers through a two-stage screening approach applied at 12 and 18 months of age. We adopted two screening tools combined: 1. the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant–Toddler Checklist (I-TC) and 2. The Quantitative Checklist for Autism in Toddlers (Q-CHAT). We assessed their sensitivity and specificity related to the diagnostic outcome at 36 months. The results showed that autistic signs can be detected as early as the first year even through a few questions extrapolated from both screeners and that our model could be used as a screening procedure in the Italian public health system.

The Criterion Validity of the First Year Inventory and the Quantitative-CHecklist for Autism in Toddlers: A Longitudinal Study

“…The second screening tool applied in the current study was the Quantitative-CHecklist for Autism in Toddler (Q-CHAT). Its psychometric properties have been examined in six validation studies [ 36 , 53 , 54 , 55 , 56 , 57 ]. Three studies with a cross-sectional design included the general population [ 36 , 56 ] whereas one study involved a group of children with ASD using a prospective design [ 55 ].…”

“…Three studies with a cross-sectional design included the general population [ 36 , 56 ] whereas one study involved a group of children with ASD using a prospective design [ 55 ]. Three studies with a longitudinal design explored the general population [ 54 , 57 ] as well as a sample of low-risk children [ 53 ].…”

“…The authors also demonstrated the cross-cultural validity and the explorative factorial structure on the Singaporean general population. More recently, Devescovi et al [ 53 ] revealed significant associations between the Q-CHAT, ADOS-2 [ 58 ], and Bayley Scales of Infant and Toddler Development [ 61 ] scores among Italian low-risk children. Furthermore, the authors selected four items that appeared to be more significantly related to autism including social responses, joint attention, communication gestures, and stereotyped movement of fingers.…”

Use of Machine Learning to Investigate The Quantitative Checklist For Autism in Toddlers (Q-CHAT) Towards Early Autism Screening

“…(eg, stroking their hair, hugging them)? (15) When your child is playing alone, does s/he line objects up?…”

“…Other screening tools, such as the Social Communication Questionnaire (SCQ), reported poor balance between sensitivity and speci city in high-likelihood toddlers [9], while measures like the Screening Tool for Autism in Two-years-old (STAT) [10] and the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) [11] have been tested only in case-control studies, requiring further prospective population studies. With the shift from a categorical to a dimensional approach to autism diagnosis, a quantitative measure of autistic traits, the Quantitative CHecklist for Autism in Toddlers (Q-CHAT) has been tested in different sample populations and cultures, in both case-control studies and primary care settings, displaying fair to good psychometric properties and predictive validity as well as good cultural stability [12][13][14][15][16][17][18]. A short Q-CHAT version, the Q-CHAT-10, including the best 10 predictive items was also developed [19], aiming to create a quick "red ags" tool suitable for the time constraints of pediatric check-ups and to help further reduce the delay for potential referrals.…”