How Useful Are the Parent-Completed Ages and Stages Questionnaires for Screening of Motor Problems in Preschoolers with High-Functioning Autism?

Background:  

Comorbidity is common in autism spectrum disorders (hereafter “autism”). For instance: up to 79% of individuals with autism, including those with intellectual disabilities, have concurrent motor problems (Lai, Lombardo, & Baron-Cohen, 2014). Mild motor problems, which are not attributable to medical conditions such as cerebral palsy, are often seen in children with high-functioning autism (HFA). Unfortunately, motor skills of children with HFA are habitually not a priority for early assessment and intervention teams who may focus primarily on social-communication and behavioural concerns (Lloyd, MacDonald, & Lord, 2013). Developmental screening with a broadband screen that is appropriate for parents may help to identify those children who are in need of further profound motor evaluation. 

Objectives:  

To determine the usefulness of the Ages and Stages Questionnaires (ASQ-2) for screening gross and fine motor problems in preschoolers with HFA in the clinical setting of an autism diagnostic center. 

Methods:  

Participants:

39 children with HFA between 22 and 54 months of age (mean chronological age 39.5m, SD 8.5m) with an IQ above 70 (mean mental age 39.8m, SD 11.3m) were diagnosed in University Autism Clinics (Flanders, Belgium) according to DSM-IV-TR diagnostic criteria for autism confirmed by ADOS-G-classification.
Screening: Parents filled in the gross and fine motor domain section of the Ages and Stages Questionnaires-second edition (ASQ-2) (Squires, Bricker, & Potter, 1999). To take into account the different cut-off scores of the ASQ-2 questionnaires, gross and fine motor scores were expressed as a difference score between the raw and cut-off score.
Motor evaluation: Gross and fine motor development were measured with the use of the locomotion and visual-motor integration subtests of the Peabody Developmental Motor Scale-second edition (PDMS-2). PDM-2 standard scores below 7 were considered as indicating motor problems (Folio & Fewell, 2000).

Results:  

In this sample, the prevalence of gross motor problems (49%) was higher than of fine motor problems (26%). Specificity analyses revealed an acceptable likelihood of correct identification of children without gross and fine motor problems (specificity of 90%, respectively 93%). However, sensitivity analyses revealed the likelihood of underscreening of motor problems in this population. Only a minority of children with gross motor problems (sensitivity of 32%) and half of the children with fine motor problems (sensitivity of 50%) were correctly identified according to the ASQ-2. 

Conclusions:  

The capacity of the broadband parental-based ASQ-2 screener to identify children with motor problems appears to be limited. The gross and fine motor domains of the ASQ-2 are not sufficient to identify mild motor problems in high-functioning children with autism in the context of an autism diagnostic center. For further research we suggest to verify how useful the Ages and Stages Questionnaires-third edition (ASQ-3) are for this purpose.