The Early Start Saga Model: Community-Based Health Check-Ups for Screening Infants and Toddlers with Autism Spectrum Disorder in Japan

Thursday, May 17, 2012
Sheraton Hall (Sheraton Centre Toronto)
3:00 PM
T. Haramaki1 and T. Kuroki2, (1)Graduate School of Cuture and Education, Saga University, Saga City, Japan, (2)Clinical Research Division, National Hospital Organization Hizen Psychiatric Center, Saga, Japan
Background: Recently, it is recommended that screening of autism should be incorporated into routine medical practice for 2 year-old or younger children. The Early Start Saga Model, a community-based project for detecting and supporting children with autism spectrum disorder (ASD) at the earliest life stage in Saga Prefecture, Japan, launched in 2002 and has achieved a favorable outcome such as high rates (over 95%) of use of municipal health check-ups at the age of 1.5 and 3 years after birth. It consists of two steps of screening. The first step is to check development of children and to serve an open consultation for their mothers regarding child rearing, and to screen any diseases and developmental abnormalities by pediatricians. The second step is to detect children with high risk of ASD. To conduct the second step, public health nurses in the local community have been trained to perform a semi-structured interview with a mother using a questionnaire for ASD screening, which has been originally developed according to critical measures in research on early developmental milestones; e.g. joint attention, social smiles and other items, as shown in M-CHAT and Red Flags. The inter-rater reliability has been established.

Objectives: To validate community-based health check-ups for screening infants and toddlers with ASD, the rate of children with high risk of ASD was analyzed.

Methods: All data were collected from public health departments of all cities and counties in Saga Prefecture from 2008 to 2010 and analyzed statistically on the basis of the community birth-cohort survey.

Results: Among the children who visited health check-ups in each community, children with high risk of ASD were screened at the rate of from 11.1% to 17.1% in every year. The boy: girl ratio was 1.5 – 1.9: 1. Children followed up after screening examination eventually received definite diagnosis of ASD at a relatively high rate (appr. 30%).

Conclusions: The screening system of community-based health check-ups by public health nurses may be effective for detecting children with high risk of ASD. Further studies are needed to elucidate cumulative prevalence of ASD among high-risk children.

| More