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Clinical Use of the Infant-Toddler Social and Emotional Assessment in Autism Spectrum Disorder

Thursday, 2 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
E. Mottes, F. Apicella, E. Conti, A. Cosenza, S. Maestro, A. Narzisi, R. Tancredi and F. Muratori, University of Pisa – Stella Maris Scientific Institute, Pisa, Italy

Studies suggest that a diagnosis of ASD can be reliably made in the second year of life being relatively stable over time; at the same time ASD diagnosis of young children can be complex in reason of different presentations and a less specific symptomatology overlapping temperament difficulties, emotional dysregulation, regulatory and attentional problems, cognitive and language delay. As a consequence there is a need for tools to support the characterization and identification of young children with or suspected of an ASD.


To determine the capacity of the ITSEA in identifying toddlers with a diagnosis of ASD.


ITSEA is a parental questionnaire performing a profile composed of 3 areas of Problems (Externalizing, Internalizing and Regulatory processes) and an area of Competencies. Each area is composed by different subscales, and three global item clusters (Maladaptive; Social relatedness and Atypical behaviors) can be obtained. Specifically two out of three item clusters refer to typical autism symptomatology.

Forty subjects (mean age: 32,2 SD:4,4; males: 32, females: 8) were recruited at the ASD division of the Stella Maris Scientific Institute; inclusion criteria were: 1) age between 24 and 36 months; 2) a diagnosis of ASD according to DSM-IV criteria and confirmed by ADOS; 3) no associated medical or neurological illness.

Average scores were compared to the scores of the population of ASD subjects from the original ITSEA validation study.

Statistical comparison (T-test for independent groups) with a group of children with Regulation Disorders of Sensory Processing (REG) according to CD:0-3 was obtained.


Abnormal scores resulted in at least one subscale or cluster in 100% questionnaires. The comparison with the original ITSEA ASD group showed a similar profile. As expected clinical scores were obtained on Social Relatedness and Atypical Item Clusters even if with lower percentages in respect to ITSEA group (44% vs 88% and 53% vs 95%). Competence domain was globally involved in 87% of cases with higher clinical percentages in Attention, Imitation/Play, Empathy and Prosocial Peer Relation subscales. None of the Problems domains were globally abnormal, but a clinical score was found in the Depression/Withdrawal subscale within the Internalizing area (47% vs 70% of the original ITSEA) and higher percentages of abnormal scores resulted in the Aggression/Defiance component within Externalizing Problem and, within Dysregulation domain, in the Negative Emotionality subscale which is related to a temperamental component and to the difficulty in modulating negative emotional response. Higher percentages were found also in Eating subscale. In the comparison with REG group significant differences were found in the Competence Domain (p<.05), in the Withdrawal subscale (p<.01) and in the Atypical Item clusters (p<.05).


The results of this preliminary clinical application suggests a good capacity of the ITSEA in identifying Toddlers with ASD providing a profile in which both specific ASD manifestations (Social Relatedness, Atypical Behaviours, Withdrawal) and a global competencies impairment, temperamental and regulatory components may be highlighted.

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