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Implementation of A European Protocol for Autism Prevalence

Thursday, 2 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
A. M. Boilson1, A. Staines1, A. Ramirez2 and M. R. Sweeney3, (1)School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland, (2)The Hope Foundation, Scarriff, Ireland, (3)School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
Background:  No national prevalence data exists on rates of autism spectrum disorder (ASD) in Ireland.  ASD prevalence estimation is complex due to  the complexity of case definition and many different protocols have been used in Europe making comparisons difficult. The European Protocol for Autism Prevalence (EPAP) was funded by DG-SANCO to develop a standard protocol for estimating the prevalence of ASD in Europe.          

Objectives:  To operationalize the European protocol in Ireland and examine the score distribution of the Social Communication Questionnaire (SCQ: Rutter et al., 2003) in a school based population. 

Methods:  A protocol was developed to screen children for ASD in a school based setting in Ireland. We screened (n =8,168) children aged 6-11 years, in national (n = 7951, 97%) and special education (n = 217, 3%) schools in three urban regions Galway, Waterford and Cork using the SCQ. A study booklet completed by parents of eligible children capture demographics, and developmental  history. Psychological assessments were reviewed and abstracted at psychological services for children with parent reported diagnosed learning disabilities. Clinical data abstracted for children with a confirmed diagnosis of ASD included: cognitive, speech and language, occupational therapy and gold standard ADOS, ADI-R assessments. A validation study of the SCQ was undertaken among a sample of (n = 300) children (6%) of the total population screened who obtained scores in the normal range, and all those who had scored 12 and over.         

Results:  Completed study booklet returns (excluding incomplete data) from parents for eligible children were as follows: national (n = 5433, 68%) special education schools (n = 72, 33%). The distribution of SCQ scores was highly skewed towards lower scores, 91.6% of children scored in the normal range SCQ Total Score < 12. The Mean score was (4.65) (SD = 4.75) (median = 3.0). There were statistically significant differences in scores by gender (t(5380) = 7.513, p < 0.001); age (F(2, 5457)  = 3.582, p = 0.028) and nationality (t(956.017) = - 3.676, p < 0.001).  Parents of children who reported diagnosed disorders obtained the highest scores (Mean = 9.12, SD = 7.73) children with no parent reported developmental difficulties (Mean = 3.88,SD = 3.78). Children identified for second stage screening were those scoring 12-14 (n = 225, 4%) and over 15 (n = 231, 4%) on the SCQ.

Conclusions:  Implementation of this protocol demonstrates the feasibility of screening children for autism spectrum disorder in an education based setting owing to the overall high response rate (67%) which compares favourably with previous school based studies (29%) (Baron-Cohen et al, 2009).  In the current study parent reported diagnosis were validated from multiple clinical sources.  The distribution and range of scores was similar to the findings from previous sample community based studies (Chander et al., 2007; Mulligan et al., 2009). Analysis of the results of this study is ongoing.

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