Identifying Children with Autism Spectrum Disorder at 18 Months in a General Population Sample

Abstract

Background Previous research on clinical and high-risk samples suggests that signs of autism spectrum disorder (ASD) can be detected between one and two years of age. We investigated signs of ASD at 18 months in a population-based sample and the association with later ASD diagnosis. Methods The study sample includes 52 026 children born 2003 through 2008, and is a subset of children that participated in the Norwegian Mother and Child Cohort (MoBa), a population-based longitudinal study, and the Autism Birth Cohort (ABC), a sub-study on ASD. Parents completed all 23 items from the Modified Checklist for Autism in Toddlers (M-CHAT) at 18 months. Results The M-CHAT 6-critical-item criterion and the 23-item criterion had a specificity of 97.9% and 92.7% and a sensitivity of 20.8% and 34.1%, respectively. In the 173 children diagnosed with ASD to date, 60 children (34.7%) scored above the cut-off on either of the screening criteria. The items with the highest likelihood ratios were “interest in other children”, “show objects to others”, and “response to name”. Conclusion Even though one third of the children who later received an ASD diagnosis were identified through M-CHAT items, the majority scored below cut-off on the screening criteria at 18 months. The results imply that it might not be possible to detect all children with ASD at this age.

The Early Diagnosis of Preschool Children with Autism Spectrum Disorder in Norway: a Study of Diagnostic Age and Its Associated Factors

“…The results show that most of these children in the southeastern region of Norway are diagnosed at a mean age of 46.4 months. This is in line with other international studies (8,17,(26)(27), and it is considerably later than research has indicated it possible (4,15). The study also explored the possible factors that affect the diagnostic age of children with ASD.…”

“…On the basis of this knowledge of early behavioral symptoms related to the core areas of social interaction, social communication, and restricted and repetitive patterns of behavior, interests, and activities, it is generally accepted that children with ASD may reliably be diagnosed as early as 24 months of age and, for certain children, no later than 36 months of age (4,(8)(9)(10). However, this may not the case for all affected children, especially those with less severe symptoms (11).…”

Instrumentos para Rastreamento de Sinais Precoces do Autismo: Revisão Sistemática

“…Outro instrumento Nível 1 é o Modified Checklist for Autism in Toddlers -M-CHAT, que parece ser mais adequado para detectar os sinais do autismo a partir dos 24 meses de idade Stenberg et al, 2014). Pandey et al (2008) recomendam que, em um processo de identificação precoce, a decisão clínica deve considerar a baixa especificidade do M-CHAT no rastreamento de crianças entre 16-23 meses de idade.…”

“…Pandey et al (2008) recomendam que, em um processo de identificação precoce, a decisão clínica deve considerar a baixa especificidade do M-CHAT no rastreamento de crianças entre 16-23 meses de idade. Segundo Stenberg et al (2014) Com relação ao ADEC, foram encontrados cinco estudos que buscam evidências de validade e precisão, indicando que esse instrumento possui propriedades psicométricas adequadas e validade convergente com o M-CHAT (Tabela 4). O ADEC mostrou ser efetivo para detectar os sinais do autismo em crianças entre 12 e 36 meses de idade (Hedley, Young, Angelica, Gallegos, & Marcin Salazar, 2010; Os instrumentos Nível 1 utilizam o formato questionário, com tamanho variando entre nove-63 itens (M = 24; DP = 17), indicando ser esse formato o mais adequado para uso na população geral e que possui os pais ou cuidadores como respondentes.…”

“…Alguns estudos de evidências de validade apontaram para resultados inadequados (Inada et al, 2011;Kleinman et al, 2008;Robins, 2008), o mesmo ocorrendo em estudos de aplicação dele (Oosterling et al, 2009;Pandey et al, 2008;Perera, Wijewardena, & Aluthwelage, 2009;Stenberg et al, 2014). Perera et al (2009) consideram que uma das razões para a baixa sensibilidade (0,25) do M-CHAT encontrada no Sri-Lanka talvez seja a diferença cultural e social.…”