17105
Video-Guided Self Report of ASD Indicators
Existing ASD screeners have modest sensitivity and positive predictive value and often require follow-up questions or screening. Evidence is emerging that video examples of child development patterns activate parents’ evaluative thinking about their child’s developmental well-being (Sices et al., 2008). We examined the promise of a video-supported tool to assist parents in recognizing signs of ASD in their child (ASD Video-Guided Self-Report; AVSR).
Objectives:
Evaluate whether the AVSR distinguishes children grouped based on their parents’ stated concerns about ASD or prior ASD diagnosis.
Evaluate the sensitivity, specificity, and positive predictive value of the AVSR.
Methods:
This study included four groups of children (ages 12-60 months) based on parent report of concern about the child/prior ASD assessment: No concern (n=32; mean age=30 months); Concern about delay but not ASD (Concern-Other; n=15; mean age 32 months); Suspect ASD but no assessment yet (ASD-Suspected; n=37; mean age=33 months); ASD diagnosis based on prior assessment (ASD-Diagnosed; n=32; mean age 43 months). Group differences were assessed on the AVSR, ADOS, and developmental quotient (Mullen Scales of Early Learning Early Learning Composite). Nonparametric tests with bonferroni corrections were used due to unequal variance and/or unequal distribution of scores across the groups. Receiver Operating Characteristic (ROC) analyses were then conducted to evaluate the sensitivity and specificity of the AVSR in detecting ASDs and to determine an appropriate cut-off for classifying participants as having an ASD or not.
Results:
Kruskal-Wallis one-way analysis of variance by ranks identified significant differences between groups (p=0.004) across all AVSR scales, with parents in the No Concern group reporting significantly less impairment on all five AVSR scales than parents in the ASD-Suspected and ASD-Diagnosed groups. Those in the Concern-Other group also reported significantly less impairment than those in the ASD-Diagnosed group with respect to Routine Flexibility and Unusual Movement and reported significantly less impairment than those in both ASD groups on Imagination and Play. Similar analyses also identified significantly higher performance on the Mullen Early Learning Composite in the No Concern group compared to the ASD groups (H(3)=45.25, p<0.001).
The ROC analyses established a cut-off score of 55 on the AVSR to best classify participants as ASD or Non-ASD (based on ADOS and expert clinical judgment) with the area under the curve at 0.8556. This cut-off produced a high sensitivity (93.3%), specificity (77.8%), and positive predictive value (82.4%). There were no false positives in the No Concern group. One false positive was in the Concern-Other group. Nearly 1/3 of the ASD-Suspected group scored 55 on the AVSR, but were not diagnosed with ASD by the clinical expert. These children met ADOS criteria for ASD and/or had other delays. There was one false negative in each group.
Conclusions:
With video support, parents show a high level of ability to identify whether or not their child is showing ASD symptoms. The AVSR shows promise for use at home or in settings where ASD risk is evaluated in children ages one to five years.