Combining ASD-Specific Screening Tools to Capture Red Flags in 12 Month Old High-Risk Siblings

Thursday, May 12, 2016: 5:30 PM-7:00 PM
Hall A (Baltimore Convention Center)
M. Lewis1, N. R. Brane1, B. Kotlar1, E. J. Wang2 and A. M. Wetherby3, (1)Marcus Autism Center, Atlanta, GA, (2)Pediatrics, Emory University, Atlanta, GA, (3)Florida State University Autism Institute, Tallahassee, FL

The American Academy of Pediatrics recommends screening toddlers for ASD at 18 & 24 months. Closely monitoring children at higher risk (e.g. having a sibling with ASD) is especially critical (CDC, 2014) as approximately 20% of younger siblings are at an increased risk for developing ASD (Ozonoff, 2011), therefore requiring intensified developmental surveillance. By using a combination of screening tools as early as 12 months in a high-risk population with consideration for home and clinic settings, providers may identify subtle delays and ASD specific red flags at an earlier age. According to DSM-5 criteria, persistent deficits in social communication and social interaction occur across multiple contexts. Employing multi-source screening at 12 months may provide comprehensive yet efficient means to initiate earlier ASD intervention for infants deemed high-risk.


To examine how combination of clinical assessment, home observation, parent report and ASD-specific screening can be used in a complementary fashion to detect red flags starting as early as 12 months, ultimately testing a downward extension of current AAP guidelines in a high-risk sample.


High-risk 12-month olds were assessed as part of a federally-funded longitudinal study examining siblings. Assessment batteries included 4 samples of early social behavior with consideration for multiple settings: a communication assessment, a video-recorded home observation, parent report measure, and an ASD-specific screening tool. The CSBS (Wetherby & Prizant, 2001) was used to assess communication development, the Systematic Observation of Red Flags of ASD (SORF; Wetherby & Woods, 2004), an ASD-specific screening tool, was used to rate symptomatology within CSBS and home observations. The Early Screening for Autism and Communication Disorders (ESAC; Wetherby, Woods & Lord, 2012), parent questionnaire, was used to collect information on early social communication and presence of repetitive behaviors. Using previous research collected from ESAC and SORF in 18-24 month-olds, cut-offs were determined, where a positive screen for 12-month siblings on at least 2 of 4 measures led to eligibility for an experimental intervention. Within our study, 17 (20 projected by May 2016) high-risk infants were deemed eligible for intervention based on positive screening utilizing these four measures. Comparisons between measures used to assess qualification for intervention were analyzed using the Chi-Squared test and Wilcoxon Two-Sample test.  


Measures conducted in the clinic by highly trained clinicians were more likely to positively identify early ASD signs than the measure conducted in the home or parental report at the 5% significance level (p<.005). Of 17 infants who qualified for the intervention study 76% (n=12) qualified based on the CSBS and 100% (n=17) qualified based on the clinic SORF compared to 41% based on the ESAC (n=7) and 50% on the home SORF (n=8).


Findings suggest that while the CSBS is examining communication, its structured tasks involving object temptations may reveal subtle social delays in high-risk 12-month olds to a trained clinician. Applying an ASD-screening tool to rate the communication sample of the CSBS, closely examining social behaviors and emerging repetitive behaviors, may expose earlier symptomatology and provide more quantitative assessment of red flags.