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A Pilot Study of a Screening Model to Triage Toddlers Referred for Autism Spectrum Disorder (ASD) to a Tertiary Care Center (TRC) Using a New Level 2 ASD Screening Test
Toddlers referred for concerns of ASD to be evaluated by ASD experts, wait an average of 6 months before being evaluated delaying diagnosis in those with true ASD and treatment.
Objectives:
To evaluate a screening model to expedite autism evaluations in toddlers in a TRC by trained speech pathologists and a developmental pediatrician (SP-DP)
Methods:
The Rapid Interactive screening Test for Autism in Toddlers (RITA-T) is a new Level 2 ASD screening test in toddlers. It includes 9 activities that evaluate social communication skills in toddlers in less than 10 minutes. We have established its scoring algorithm, manual, developed a training protocol and demonstrated its discriminative properties in specifically identifying toddlers with ASD. Over five weeks, toddlers under 39 months of age waiting to be evaluated, were administered first the MCHAT and the RITA-T by the SP-DP. They were then assigned to 3 different risk groups based on their respective scores. Another team of clinicians administered the following tests and provided diagnoses of ASD or Non-ASD accordingly: Low Risk: DSM 5 checklist and the Vineland Adaptive Behavior Scales (VABS); Medium Risk: DSM 5, VABS and the ADOS; High Risk: DSM 5 and a developmental evaluation.
Results:
Twenty-two toddlers (82% boys) were evaluated. Mean age was 29.8 months (17-39 months). 18% were low risk, 41% were in each medium and high risk groups. ASD diagnoses were 0%, 67% and 100% in the 3 groups respectively. In total, 15 (68%) had a diagnosis of ASD. The RITA-T total score, DSM-5 criteria checked, and the MCHAT critical items failed were significantly different between the ASD and Non-ASD groups (ANOVA, p<0.01) and between the 3 risk groups (ANOVA, p<0.01). There were no significant differences on the VABS. The RITA-T was significantly correlated with the DSM & MCHAT measures (Pearson corr=0.49, p<0.01).
Conclusions:
The RITA-T is useful in a screening protocol in expediting autism evaluations of toddlers in a TRC. Testing of the RITA-T and of this paradigm continues.