Screening for Autism Spectrum Disorder: A Measurement Agreement Study

Friday, May 13, 2016: 5:30 PM-7:00 PM
Hall A (Baltimore Convention Center)
D. Kamara1, K. M. Walton1 and A. N. Witwer2, (1)The Ohio State University, Columbus, OH, (2)The Ohio State University, Gahanna, OH
Background:  Children with Autism Spectrum Disorder (ASD) often show developmental delays prior to their diagnosis of ASD (Zwaigenbaum et al., 2009). Autism screening for children with developmental delay (DD) can help identify children that are in need of autism-specific services. The Modified Checklist for Autism, Revised with Follow-up (M-CHAT-R/F; Robins et al., 2014) is a widely accepted screening tool for autism in toddlers. In addition to the M-CHAT-R/F, there are also measures in place for identifying problems with behavior problems and social-emotional competence (i.e. social-emotional functioning). Some of these social-emotional screening tools, including the Ages and Stages: Social-Emotional (ASQ:SE; Squires, Bricker, & Twombly, 2002), the Brief Infant Toddler Social Emotional Assessment (BITSEA; Briggs-Gowan & Carter, 2006), and the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000), are also used as screening tools for autism and are commonly given in early intervention settings. The ASQ:SE contains items that are meant to flag for autism, but has not yet been validated as an autism-specific screening tool. Despite this, in a survey of birth to three providers, the ASQ:SE was reported to be the most commonly administered screening tool for ASD (Shaw & Hatton, 2009). The BITSEA also includes items that are meant to flag for ASD.  An Autism score derived from these items has demonstrated promise in identifying children with ASD (Kruizinga et al., 2014). The CBCL has a pervasive developmental problems (PDP) scale that can be used to identify children with ASD. A recent meta-analysis suggests that the CBCL PDP scale may be sensitive, but not specific at identifying ASD (Hampton & Strand, 2015). Given the varied use of these tools in community settings, it is worthwhile to know how much these measures agree with each other in terms of identifying children with DD who are at-risk of ASD. 

Objectives:  To examine the agreement between the M-CHAT-R/F, the BITSEA Autism score, the CBCL PDP scale, and the ASQ:SE in classifying children as at-risk for ASD in a sample of toddlers with developmental delay.

Methods:  Participants were young children between the ages of 18-36 months, and their parents, enrolled in early intervention services in Ohio. Parents completed a packet of questionnaires on their child’s social-emotional functioning. All measures were completed within one month of each other. Agreement was calculated based on dichotomous risk outcomes (at-risk or not at-risk) with Cohen’s Kappa, which corrects for chance agreement. Each social-emotional screening tool was compared individually to the M-CHAT-R/F.

Results:  Preliminary results suggest moderate to substantial agreement between measures. So far, the CBCL PDP scale appears to have the strongest agreement with the M-CHAT-R/F. Data collection is ongoing. We expect to have results from approximately 50 children and parents by IMFAR.

Conclusions:  Within a population of toddlers with developmental delays, the social-emotional screening tools, particularly the CBCL PDP scale had good agreement with the M-CHAT-R/F. These results suggest that these tools may be appropriate for screening children with developmental delays for ASD. Further research needs to examine the sensitivity and specificity of these measures.