Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-Up Approach

Abstract

Objectives To determine the feasibility of implementing a broadband screen at the 1-year check-up to detect cases of autism spectrum disorders (ASD), language delay (LD), and developmental delay (DD). Study design The Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist was distributed at every 1-year pediatric check-up; 137 pediatricians and 225 infants participated. Screens were scored immediately, and failures referred for further evaluation. Results Pediatricians screened 10 479 infants at the 1-year check-up; 184 infants who failed the screen were evaluated and tracked. To date, 32 infants received a provisional or final diagnosis of ASD, 56 of LD, nine of DD, and 36 of “other.” Five infants who initially tested positive for ASD no longer met criteria at follow-up. The remainder of the sample was false positive results. Positive predictive value was estimated to be .75. Conclusions The 1-Year Well-Baby Check-Up Approach shows promise as a simple mechanism to detect cases of ASD, LD, and DD at 1 year. This procedure offers an alternative to the baby sibling design as a mechanism to study autism prospectively, the results of which will enrich our understanding of autism at an early age.

Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research

“…17, ASD screeners with published evaluation data include parent questionnaires such as the Modified Checklist for Autism in Toddlers (M-CHAT), 24 the Quantitative Checklist for Autism in Toddlers (Q-CHAT), 33 the Early Screening of Autistic Traits questionnaire (ESAT), 22,23 and the First Year Inventory (FYI). 20,48 Table 1 also summarizes ASD screening instruments with only preliminary data (eg, the Pervasive Developmental Disorders Rating Scale), 36 which will not be included in the present discussion.…”

“…Thus, the outcomes of screening may not simply berelatedtothemeasurementproperties of a tool but also to the successful implementation of other aspects to the overall care pathway for children with suspected ASD. 17,84 As such, researchers should explicitly define their screening strategy (ie, the screening instrument plus collateral changes to the system of care) as well as the outcomes of interest, and evaluate the effectiveness of these strategies in real-life community settings by using randomized designs. Randomized designs have become the standard in other ASD intervention research (eg, Dawson et al 5 ) and in other public health screening interventions.…”

“…Community-based interventions aimed at implementing or increasing utilization of ASD screening have emphasized training primary care physicians and their front-line staff, providing ongoing technical assistance (eg, scoring, data management support), and clear referral pathways for specialized assessments. 9,11,[14][15][16][17] However, ongoing debate regarding whether there is sufficient evidence in support of ASD screening to warrant widespread practice change 8,18 may undermine the degree to which community pediatricians are adopting the AAP policy.…”

Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)

“…An additional challenge is that many parentsofchildrenwhoinitiallyscreened positive did not complete additional steps in the study. 27 The current study had a disproportionately high number of African-American families who did not complete the study (eg, follow-up or evaluation), indicating that barriers continue to exist even under standardized protocols. In addition, maternal education was significantly higher in the GSU sample (mean: 14.93 years; SD: 2.53 years) than the UConn sample (mean: 14.57 years; SD: 2.46 years) (t [13 938] = 28.37; P , .001), although the effect size was very small (h 2 = 0.005).…”

Latest findings in autism research: how do they support the importance of early diagnosis and immediate intervention?

“…With a 19% risk to develop autism [14], siblings of an affected child represent the most studied population. Nowadays, structured questionnaires have been developed to screen for autism [15,16]. The classical autism diagnostic tools such as the Autism Diagnostic Interview (ADI, [17]) and the Autism Diagnostic Observation Schedule (ADOS [18]) have also been adapted to offer specific algorithms and modules for toddlers aged 12 to 30 months [19.…”