Early detection and intervention for children with ASD leads to better outcomes (e.g., Dawson et al., 2010). Intervention depends on accurate identification;therefore, early screening and diagnosis are crucial (Filipek et al., 1999). The Modified Checklist for Autism in Toddlers (M-CHAT) has become the most widely used early autism screening tool for children 16-30 mos. However, though the M-CHAT and other screening instruments have been available for 10 years or more, and universal screening has been endorsed by national organizations, the median age of ASD diagnosis in the U.S. is still four years or older. Children diagnosed at four years or later miss the possibility of crucial earl intervention. Furthermore, no screener can detect every child;therefore, physician surveillance of children's development, which involves integrating behavioral observation with screening, parent concern, and history information, is essential. Therefore, although a strong screening tool is necessary for effective screening, it is not sufficient on its own. Effective screening policies must consider issues such as when screening should occur, how best to implement screening in the context of ongoing developmental surveillance, and what child, family, physician, and practice factors influence the success of screening and surveillance. The proposed study builds on the seminal M-CHAT work, which did the foundational work for an effective screener. This study will investigate three key questions: (1) what is the best age to initiate screening (12, 15, or 18 mos)? (2) Can accuracy of physician surveillance be improved with a brief, focused intervention? (3) What are the factors associated with disparity in effective ASD screening and surveillance at the child/family level (e.g., race/ethnicity, socioeconomic status, sex) and at the physician/practice level (physician beliefs and self-efficacy, practice location, and patient demographics)? With a total of 12,000 toddlers screened for ASD, this study will examine how the variables in these three aims influence age and accuracy of ASD detection, allowing this team to identify targets for future intervention to reduce disparities and facilitate early and accurate diagnosis for all children. Much of the work done in early ASD screening comes from the team assembled for this proposed study, and the large sample of children from diverse geographic areas will make these results immediately generalizable. The proposed study will answer key remaining questions about early ASD screening, thereby impacting the early health monitoring of children across the nation, and helping ensure that the promise of early ASD detection can become a reality.

Public Health Relevance

The proposed study will establish the evidence to optimize early ASD autism screening. We will screen 12,000 children across three diverse geographic areas to answer critical questions about (1) the optimal schedule to screen for ASD, (2) physician training to improve integration of ongoing developmental surveillance with ASD-specific screening, and (3) child/family and physician factors that contribute to disparities in screening and surveillance.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
2R01HD039961-11A1
Application #
8834563
Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
Kau, Alice S
Project Start
2000-12-01
Project End
2019-05-31
Budget Start
2014-09-25
Budget End
2015-05-31
Support Year
11
Fiscal Year
2014
Total Cost
$668,397
Indirect Cost
$120,905
Name
Drexel University
Department
None
Type
Organized Research Units
DUNS #
002604817
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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Taylor, Cora M; Vehorn, Alison; Noble, Hylan et al. (2014) Brief report: can metrics of reporting bias enhance early autism screening measures? J Autism Dev Disord 44:2375-80
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Herlihy, Lauren E; Brooks, Bianca; Dumont-Mathieu, Thyde et al. (2014) Standardized screening facilitates timely diagnosis of autism spectrum disorders in a diverse sample of low-risk toddlers. J Dev Behav Pediatr 35:85-92
Mayo, Jessica; Chlebowski, Colby; Fein, Deborah A et al. (2013) Age of first words predicts cognitive ability and adaptive skills in children with ASD. J Autism Dev Disord 43:253-64
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Chlebowski, Colby; Green, James A; Barton, Marianne L et al. (2010) Using the childhood autism rating scale to diagnose autism spectrum disorders. J Autism Dev Disord 40:787-99
Kleinman, Jamie M; Ventola, Pamela E; Pandey, Juhi et al. (2008) Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord 38:606-15
Elder, Lauren M; Dawson, Geraldine; Toth, Karen et al. (2008) Head circumference as an early predictor of autism symptoms in younger siblings of children with autism spectrum disorder. J Autism Dev Disord 38:1104-11
Kleinman, Jamie M; Robins, Diana L; Ventola, Pamela E et al. (2008) The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord 38:827-39

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