In recent years, there has been an increasing interest in the diagnosis of Autism Spectrum Disorders (ASD) in infants (children younger than 3 years). Research has shown that well-trained clinicians can diagnose ASD reliably in children from 18-24 months on. However, the diagnosis of this age group is complex. First, because the presentation of ASD symptoms can be substantially different than that of an older child with ASD. Second, because the distinction between typical development - which does show a lot of variation at this age - and atypical developmental is difficult. Third, because some characteristics of ASD (such as less social responsiveness, delayed development of language, and repetitive behaviors) also may occur in other developmental disorders and syndromes.
Once diagnosed, early intervention is considered important for infants with ASD, since it may lead to better short- and long-term outcomes. Such programs focus mainly on fostering early social communication, especially joint attention and symbolic play. In order to measure the effect of early intervention programs, there is a need for an instrument that can measure the level of this social communicative functioning. Such an instrument could also be used in diagnostics, since early social communicative problems, including joint attention problems, are one of the most distinctive features in infants with ASD.
The objective of this study was to develop a questionnaire that can be easily used to measure early social communicative behavior in infants in a reliable and valid way.
The items for the Early Social Communicative Behavior Questionnaire (ESCBQ) are based on 1) extensive research of literature on both typical and atypical development of early social communicative behavior in infants, 2) existing (international) instruments concerning this topic, and 3) clinical expertise with young children with ASD. There are 108 dichotomous questions formulated: concerning the first year of life, eye contact, social interest, reaction to name, emotions, attachment, sharing pleasure, taking turns, looking, following gaze, following a pointing finger, pointing, showing, giving, playing, interaction games, imitation, gestures, and language.
It takes 20 minutes to fill in the questionnaire. In order to explore the psychometric properties of the ESCBQ, 1200 parents of typically developing children aged 0-6 years filled in the questionnaire.
The total score of the ESCBQ shows a steady increase with age, with a plateau at 30 months. The internal consistency, based on inter-item reliability, is good (Cronbach’s alpha=.97). Also the test-retest reliability (second measurement after 1 week) is good (N=43, Wilcoxon Signed Rank test, M1=93.19 vs. M2=95.63, r=.91, p=.001). A Principal component analysis conveyed four factor scores, with the first factor ‘pretending and language’ explaining 31% of the variance. The other three factors concern pointing, attention shifting and following gaze. These four factors coincide with what is expected from literature. A Mokken scale analysis reveals five scales (ScaleH=.39-.94, 4 scales >.55; Rho=.51-.99). Further analyses are underway.
The ESCBQ is a new test with good psychometric properties.
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