The Feasibility and Validity of Autism Spectrum Disorder Screening Instrument: Behavior Development Screening for Toddlers (BeDevel)—A Pilot Study

Abstract

Although early screening is critical for individuals with autism spectrum disorder (ASD) in order to receive early intervention and improve function later in life, screening is often delayed. Limitations of existing screening instruments, and the need for a culturally appropriate early screening tool in Korean children, led us to develop Behavior Development Screening for Toddlers (BeDevel). The BeDevel assessment consists of two parts: BeDevel‐Interview, a structured interview measure for parents/primary caregivers; and BeDevel‐Play, a play‐based semi‐structured observational measure in children. To examine the feasibility and validity of BeDevel, 155 children (N = 75 ASD, N = 55 typical development, N = 25 developmentally delayed) aged 18–42 months (M = 31.54 months, SD = 7.60) were examined through parent‐reported screening questionnaires, BeDevel, and standard diagnostic assessments. When BeDevel items were analyzed using Cohen's kappa statistics, most items in BeDevel‐Interview and all items in BeDevel‐Play were reasonably consistent with diagnoses. We identified primary items, which were significantly interacted with actual diagnosis in the chi‐squared test (P < 0.05, range = 0.000–0.032). Using cutoff numbers of items determined using the receiver operating characteristics curve, BeDevel showed satisfactory levels of sensitivity (83.33%–100%), specificity (81.25%–100%), positive predictive values (80.65%–100%), and negative predictive values (83.87%–100%), as well as high internal consistency (Cronbach's α = 0.866–959). The agreement between BeDevel and most other screening/diagnostic instruments was moderate (k = 0.419–1.000). These results suggest that BeDevel can be a useful instrument for early screening of ASD. Autism Res 2019, 12: 1112–1128. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Although early screening is critical for individuals with autism spectrum disorder (ASD) in order to receive early intervention and improve function later in life, screening is often delayed. Limitations of existing screening instruments and the need for a culturally appropriate early screening tool in Korean children led us to develop Behavior Development Screening for Toddlers (BeDevel). The BeDevel assessment consists of two parts: BeDevel‐Interview, a structured interview measure for parents/primary caregivers; and BeDevel‐Play, a play‐based, semi‐structured observational measure in children. In order to test the feasibility and validity of BeDevel, we analyzed preliminary data of total 155 children aged 18–42 months, examined through parent‐reported screening questionnaires, BeDevel, and standard diagnostic assessments. When individual items were analyzed, responses of all BeDevel‐Interview items and of most BeDevel‐Play items well matched actual diagnoses, and we identified primary items, which were particularly useful in differentiating between the ASD group and the non‐ASD group. With the optimal screening criteria determined, the BeDevel was able to identify individuals...

How Do Children with Autism Spectrum Disorder Encode and Reproduce Visuospatial Stimuli?: Investigation into Visuospatial Processing Abilities and Styles

“…Although the SRS has not been standardized in Korea, Cronbach's α value of the Korean translation of SRS-2 was reported to be 0.96. 38…”

Short caregiver interview and play observation for early screening of autism spectrum disorder: Behavior development screening for toddlers (BeDevel)

“…However, such efforts can be complicated by factors such as variability in ASD symptoms and developmental heterogeneity, regression, and shortage of appropriate screening instruments (Huerta & Lord, 2012;Pierce et al, 2019). For instance, although ASD symptoms present differently across different ages (Bong et al, 2019), the majority of representative screening instruments, including the modified checklist for autism in toddlers, revised (M-CHAT-R) and the social communication questionnaire (SCQ), have only one version for all ages (García-Primo et al, 2014). The social attention and communication study (SACS) is a useful and valid clinicianrated checklist for age-specific risk behaviors in ASD, which can be implemented in children younger than 24 months (Barbaro & Dissanayake, 2010).…”

“…To address these issues, Bong et al (2019) developed the behavior development screening for toddlers (BeDevel), a level-2 ASD screening instrument with a high diagnostic predictive value that accounts for a range of characteristics. BeDevel is an early screening instrument for ASD risk behaviors that can be used in toddlers below 42 months of age.…”

“…BeDevel is an early screening instrument for ASD risk behaviors that can be used in toddlers below 42 months of age. As a dual procedure, it includes caregiver interviews (BeDevel-Interview: BeDevel-I) and semi-structured observations (BeDevel-Play: BeDevel-P) (See Bong et al (2019) for detailed descriptions of all items included in BeDevel-I/ P). BeDevel, which takes 10-15 minutes to administer, targets five age groups (i.e., 9~11, 12~17, 18~23, 24~35, and 36~42 months) with activities and question items based on expected developmental milestones.…”

“…The decision to include children as young as 9 months old was made based on the Korean infant and toddler routine check-ups and the American Academy of Pediatrics' guideline, which recommends young children to be screened for developmental delays during doctor visits at 9-, 18-, and 30-months (Centers for Disease Control and Prevention, 2020). However, due to the small sample size in 9-11 and 12-17 months groups, the validation analyses in Bong et al (2019) were limited to 18~23, 24~35, and 36~42 months groups. The pilot study examined the validity and reliability of BeDevel in 155 toddlers with and without ASD and showed satisfactory levels of sensitivity (83.33/100%), specificity (81.25/100%), positive predictive values (PPV; 80.65-100%), negative predictive values (NPV; 83.87-100%), and internal consistency (Cronbach's α = 0.87-96)0.6 The levels of agreement between BeDevel and other widely used screening/diagnostic assessments were moderate (k = 0.42-1.00).…”