International Meeting for Autism Research: Validation of the Autism Spectrum Screening Scale (ASSQ), Mandarin Chinese Version

Validation of the Autism Spectrum Screening Scale (ASSQ), Mandarin Chinese Version

Thursday, May 20, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
9:00 AM
Y. Guo , Institute of Mental Health, Peking University Health Science Center, Beijing, China
Y. Tang , Human Genetics, Emory University, Atlanta, GA
C. E. Rice , Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
L. C. Lee , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
Y. F. Wang , Institute of Mental Health, Peking University Health Science Center, Beijing, China
J. Cubells , Human Genetics, Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
Background: International studies of Autism Spectrum Disorders (ASDs) require development of linguistically and culturally appropriate screening and diagnostic instruments. The Autism Spectrum Screening Scale (ASSQ) is a 27-item checklist originally developed in Sweden and published in English for assessments of Asperger syndrome and other high-functioning ASDs. The utility in Chinese-speaking populations has yet to be established.

Objectives: As a first step in establishing the validity of a Mandarin Chinese translation of the ASSQ, this study screened children in several psychiatric diagnostic groups, as well as unaffected children using the Chinese ASSQ.

Methods: The ASSQ was initially translated by two native-speaking experts (Y-LT, Y-QG) and pilot data were collected.  We then recruited children diagnosed with ASD, attention deficit/hyperactivity disorder (ADHD), childhood-onset schizophrenia (SCZ) (DSM-IV diagnoses made independently by two senior psychiatrists) from the Institute of Mental Health, Peking University, and children attending a public school in Beijing. Their parents were asked to complete the ASSQ. As part of the pilot phase, the instrument was further refined through back-translation making minor changes that two native-speaking experts (Y-LT and L-CL) and two English-speaking experts (CR, JFC) felt would make the translation more culturally appropriate while maintaining the clinical meaning of the items. Procedures were approved by the Ethics Committee of the Sixth Hospital, Peking University Health Science Center.

Results: Data from the parents of 94 children with ASD (mean age: 81+/142 months), 45 with ADHD (110+/-27 months), 26 with SCZ (166+/-36 months), and 20 unaffected control (104+/-13 months) were collected. The total scores of ASSQ in children with ASD, ADHD, SCZ, and unaffected controls were 25.4+/-9.0, 10.1+/-6.4, 12.1+/9.3, and 4.3+/-5.0 respectively. Total ASSQ scores of children with ASD were significantly higher than in any other group (all p<0.0001). Receiver-Operating Characteristic (ROC) analysis showed the area under curve was 0.982, with a cutoff score of 11 having the maximum sensitivity (0.98) and specificity (0.90).

Conclusions: Our pilot data of the Chinese translation of the ASSQ successfully differentiated clinically diagnosed ASD from unaffected controls. A total score of 11 as the cut-off score has the highest sensitivity and specificity (ASD vs unaffected controls). While children with other clinical psychiatric diagnoses had higher scores than the affected controls, children with ASD had significantly higher scores compared to any group. Our results suggest the Chinese ASSQ may be a useful component of a strategy for screening for ASD in situations where time consuming expert evaluation is not practical. Work is under way to replicate and extend the results reported here.

CDC disclaimer:  The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

See more of: Communication
See more of: Autism Symptoms