A Community Screening Program to Detect 1-Year-Old Infants at Risk of Pdd's: Preliminary Results

Background: Despite recent studies suggest that autism early signs can be detected in children before their second year of life, only few of them have been performed on large samples of community infants, at their first birthday. In the present study, we used two screening programs, at 12 and 18 months, each of them combining a parent-report instrument with a task the child has been submitted to by the paediatrician.

Objectives: To identify children at risk of PDDs in a community-based sample through the application of the presented screening protocol.

Methods: A preliminary ongoing sample is composed of 180 children recruited in a primary care setting. The first screening program consists in its turn of two different levels. At first level: a) parents fill out First Year Inventory (FYI); b) paediatricians carry out the “response to name” task during medical well-child visits. At second level, children who failed “response to name” and/or met a score above the cut-off in Social-Communication Domain and/or in Sensory-Regulatory Functions Domain and/or in Total score at FYI were evaluated by an expert child psychiatrist with AOSI (Bryson, Zwaigenbaum, McDermott et al., 2007) and ADOS. Chronological (or corrected in preterm) age of 12 months (within the week before or after the baby’s first birthday), absence of severe sensory or motor impairments and absence of identified genetic disorders were the inclusion criteria. The second screening program was realized at 18 months of age through a) the filling out by parents of Modified Checklist for Autism in Toddlers (M-CHAT) b) the “joint attention” task administered by paediatrician.

Results: Among the 180 children partecipating in first level screening, 8 were considered at risk (in particular: 3 of them failed both tasks, while the remaining 5 passed the response to name task, but went beyond the fixed cut-off at the FYI). The AOSI and ADOS scales were employed as second level screening instruments on all 8 subjects, in order to reduce false positive. Only one child failed both the instruments and was therefore referred to a diagnostic and therapeutic assessment. The remaining 7 children will undergo a neuropsychiatric evaluation at 15 months of age to monitor chiefly the socio-communicative skills. In order to minimize the false negative results, all the 180 children of the sample will be re-evaluated at 18 months (second screening program) and finally at their third year of life.

Conclusions: This double screening program could be a promising instrument to detect children at risk for PDD, but larger samples are necessary in order to define its most effective use.