Objectives: The major objective of this ongoing study of the FIRST WORDS® Project is to implement a developmental surveillance system to estimate the prevalence of ASD in toddlers using a community-based screening of a general population sample. Methods: Children were first screened with a broadband parent-report surveillance checklist, the Infant-Toddler Checklist (ITC), through healthcare providers between 9 and 18 months of age. Two autism-specific screening tools were used for children with a positive broadband screen— the Early Screening for Autism and Communication Disorders (ESAC) based on parent report and the Systematic Observation of Red Flags of ASD (SORF) based on an interactive videotaped behavior sample. A diagnostic evaluation to confirm or rule out ASD was completed at 18-24 and 30-36 months of age.
Results: Based on screening of 4,186 children, 49 children have been diagnosed with ASD at 18-24 months of age. We anticipate that this is a conservative estimate because more children may be diagnosed with ASD at 30-36 months of age or older. The accuracy of the broadband and autism-specific screeners will be reported in relation to parent concern. Stability of diagnosis from the 2nd to the 3rd year will be reported for children who reach 30-36 months of age.
Conclusions: These findings document the effectiveness of a developmental surveillance system to screen for ASD in a general population sample of toddlers using a broadband screener followed by two autism-specific screeners. Barriers that impede and strategies that improve parent participation and follow-up in screening and diagnosis of ASD at 18-24 months of age will be discussed.
Funding Sources: CDC, NIH/NIDCD, USDOE