Development and validation of DSM-5 based diagnostic tool for children with Autism Spectrum Disorder

Gulati, Sheffali; Kaushik, Jaya Shankar; Saini, Lokesh; Sondhi, Vishal; Madaan, Priyanka; Arora, Narendra K.; Pandey, Ravindra Mohan; Jauhari, Prashant; Manokaran, Ranjith Kumar; Sapra, Savita; Sharma, Shobha; Paul, Vinod K.; Sagar, Rajesh

doi:10.1371/journal.pone.0213242

Cited by 26 publications

(26 citation statements)

References 16 publications

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“…The parent/caregiver-report questionnaire was based closely on a tool specific for identification of ASD in an Indian context (INDT-ASD). Unsurprisingly, scores on this questionnaire significantly differed between all three groups (ASD, ID, TD) in the expected direction, replicating previous reports with the original tool (Gulati et al, 2019;Juneja et al, 2014).…”

Section: Parent/caregiver-report and Interaction Measuressupporting

confidence: 85%

“…Behavioural observations may emerge from parent reports of day-to-day activities of the child, or expert observation of social interaction and play. Brief parent-report tools such as the INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) (Juneja et al, 2014), and All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool (Gulati et al, 2019) have demonstrated high sensitivity in early screening and diagnosis of ASD in an Indian setting. Accordingly, the START app includes a brief questionnaire for primary caregivers as well as a provision for video-recording a parent/caregiver-child play session.…”

Section: Toolsmentioning

confidence: 99%

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Using mobile health technology to assess childhood autism in low-resource community settings in India : an innovation to address the detection gap

Dubey

Bishain

Dasgupta

et al. 2021

Preprint

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Autism Spectrum Disorders, hereafter referred to as autism, emerge early and persist throughout life, contributing significantly to global years lived with disability. Typically, an autism diagnosis depends on clinical assessments by highly trained professionals. This high resource demand poses a challenge in resource-limited areas where skilled personnel are scarce and awareness of neurodevelopmental disorder symptoms is low. We have developed and tested a novel app, START, that can be administered by non-specialists to assess several domains of the autistic phenotype (social, sensory, motor functioning) through direct observation and parent report. N=131 children (2-7 years old; 48 autistic, 43 intellectually disabled, and 40 typically developing) from low-resource settings in the Delhi-NCR region, India were assessed using START in home settings by non-specialist health workers. We observed a consistent pattern of differences between typically and atypically developing children in all three domains assessed. The two groups of children with neurodevelopmental disorders manifested lower social preference, higher sensory sensitivity, and lower fine-motor accuracy compared to their typically developing counterparts. Parent-report further distinguished autistic from non-autistic children. Machine-learning analysis combining all START-derived measures demonstrated 78% classification accuracy for the three groups (ASD, ID, TD). Qualitative analysis of the interviews with health workers and families (N= 15) of the participants suggest high acceptability and feasibility of the app. These results provide proof of principle for START, and demonstrate the potential of a scalable, mobile tool for assessing neurodevelopmental disorders in low-resource settings.

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Section: Parent/caregiver-report and Interaction Measuressupporting

confidence: 85%

Section: Toolsmentioning

confidence: 99%

Using mobile health technology to assess childhood autism in low-resource community settings in India : an innovation to address the detection gap

Dubey

Bishain

Dasgupta

et al. 2021

Preprint

Self Cite

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“…Careful structured and patient objective status, coupled with an analysis and explanation of behavior, and backed by history, provides a sound base for ASD diagnosis [ 1 ]. Diagnosis based on a structured questionnaire and observation similar to ours has also been applied by other authors [ 14 , 20 ]. In many countries, diagnosis of ASD is made only by experienced pediatricians, pediatric neurologists, clinical psychologists, and other specialists [ 1 ], which saves time and resources and allows early initiation of therapeutic intervention, even when diagnosis is uncertain [ 9 ].…”

Section: Discussionmentioning

confidence: 92%

“…A review of the worldwide practice showed that ASD is presently diagnosed by multidisciplinary teams or by skilled individual specialists—pediatricians, developmental pediatricians, child psychiatrists, psychologists, or others—depending on the healthcare system and the resources of each country [ 1 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria

et al. 2021

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Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional study of 192 children aged 13 months to 17 years 11 months (average 4 years 9 months), investigated in an outpatient and hospital setting from January 2015 to June 2018 by a semi-structured history and clinical examination, and diagnosed with ASD by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results: Behavioral peculiarities were detected in the history of the first two years of life in 74.8% of the subjects. The first developmental abnormalities were noticed by the parents at ages from 8 to 36 months (mean 15.6 months) and were predominantly in speech (in 94.6%) and non-verbal communication (11.3%). Developmental regression was reported in 42.1% of the patients occurring between the ages of 6 and 50 months (mean 17.9 months), affecting most commonly speech (88.4% of cases), non-verbal communication (29.2%), and behavior (12.8%). By history, the first manifestations of ASD were noticed at ages from 8 months to 84 months (mean 18.5 months), and were disorders of expressive speech (in 66.7% of cases), receptive speech (in 45.8%), non-verbal communication (35.4%), behavior (27.6%), play (8.9%), socialization (5.7%), and joint attention (2.1%). The most common motive for specialized consultation was delay in language development—in 84.6% of children. The age of ASD diagnosis varied between 12 and 132 months (mean 39.7 months), and the time period between first ASD manifestations and diagnosis was in the range of 0 to 79 months (mean 23.3 months). Many symptoms of abnormal social communication, unnoticed by parents, were detected objectively in more than 95% of the cases—absent or rare spontaneous or reciprocal smile; lack of sharing of interest or affect; abnormal eye contact; lack of finger pointing; lack of gaze to a pointed object; poor facial expressions; lack of imaginary play, etc. Conclusions: Almost two years are needed for diagnosing abnormal development in other domains besides speech in ASD patients. Diagnosis before the age of three years can be achieved by focusing parents’ and pediatricians’ attention on social communication and behavior in patients with speech delay or developmental regression.

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“…In all three settings the quality of services is strengthened by the use of formal assessment tools measuring activity and participation in children with a focus on family perspectives during goal setting. India has taken the lead in adopting or creating developmental assessment tools in multiple languages using culturally appropriate material in the South Asian region [31]. Zaman et al invented the famous Ten Questions screen, one of the earliest disability measures developed in Bangladesh [32].…”

Section: Strengthsmentioning

confidence: 99%

Early Interventions for Infants at Risk for Developmental Impairment: The South Asian Perspective

et al. 2021

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Majority of under-five children with developmental disabilities live in low-and middle-income countries (LMIC). A considerable proportion of disabilities results from perinatal adversities. The neonatal and infant mortality rates in India, Bangladesh, and Sri Lanka have improved over the last two decades, implying survival of infants at risk for developmental impairments. The need to thrive beyond survival is a well-recognized concept and it is imperative to establish high-risk infant follow-up (HRIF) programmes to capture these infants within the first 1000 d of life. Many challenges are present within the LMICs to identify infants at risk and to ensure early intervention (EI) during the window of optimal neural plasticity. However, it is essential to acknowledge the strengths within such systems to understand the impact of these programmes and packages on the activity and participation of these infants and their families. The International Classification of Functioning, Health and Disability for Children and Youth (ICF-CY) version is a holistic framework that will enable the families, clinicians, and policymakers to measure the impact of these interventions. Though all three countries have national policies to reach for high-risk infants, there is lack of published evidence on the successful implementation of such strategies. Therefore, it is timely to establish universally accessible, culturally appropriate and sustainable HRIF programmes. It is also recommended to measure the outcomes of such programmes based on the ICF-CY to understand the impact on the activity and participation of children in South Asia. KeywordsSouth Asia • High-risk infant follow-up • Early intervention • International classification of functioning • Disability and health for children and youth * Samanmali P. Sumanasena

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Development and validation of DSM-5 based diagnostic tool for children with Autism Spectrum Disorder

Cited by 26 publications

References 16 publications

Using mobile health technology to assess childhood autism in low-resource community settings in India : an innovation to address the detection gap

Using mobile health technology to assess childhood autism in low-resource community settings in India : an innovation to address the detection gap

The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria

Early Interventions for Infants at Risk for Developmental Impairment: The South Asian Perspective

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