Evaluating the predictive ability of early autism risk screeners: A longitudinal follow up study of developmental progress and diagnostic outcomes

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Justus, Sidni Alanna
Singleton, Jenny L.
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Autism Spectrum Disorder (ASD) is now considered one of the most common developmental disabilities (Newschaffer et al., 2007). Over the past 20+ years, researchers have worked towards identifying early behavioral or physiological predictors of ASD so that early treatment and intervention can be implemented. These efforts include the development of rapid, behavior-based screeners (e.g., Rapid-ABC by Ousley, Arriaga, Abowd, & Morrier, 2013) to supplement or replace the commonly used parent-report methods (e.g., Modified Checklist for Autism in Toddlers) and lengthy behavioral and interview assessments (Autism Diagnostic Observation Schedule; Autism Diagnostic Interview) that are considered the gold-standard for ASD screening and diagnosis. The present study explores how these different means of measuring early infant and toddler social communication and language behavior (i.e., parent-report via the M-CHAT vs. direct observation of behavior via the Rapid-ABC screener) collected at Time 1 correspond with later developmental progress and diagnostic outcomes as reported by parents in a semi-structured interview collected at Time 2. 56 parents of 57 children who previously participated in a study evaluating early infant ASD-risk behaviors when their children were 15-35 months of age participated in a follow-up phone interview about their child’s social communicative development and medical updates over the last 3-7 years. The results of the follow up interview with parents suggested there was fairly good correspondence with later autism diagnosis only for those children who showed Time 1 “at-risk” status from both parent-report and behavioral assessment. However, each individual form of assessment, considered on its own, did not have strong predictive ability in identifying children who went on to have an autism diagnosis. Qualitative interviews with parents revealed that some of the Time 1 “at-risk” children demonstrated other kinds of social or communication concerns, yet still, the correspondences were not tight as some false positives and missed negatives were present. Ultimately, this study did not identify a clear leader among the evaluated tools used for identifying autism risk in infancy and toddlerhood. It does point to the importance of converging data from multiple sources (behavioral assessments as well as parent-report screeners) so that no child who presents some autism-related behaviors is overlooked given the literature demonstrating that early intervention is critical for this population and other developmental disorders. It is possible that with a larger sample, we may have found support for one early risk assessment tool over another. Future infant/toddler studies that include a longitudinal follow up will help address this gap in research on Autism Spectrum Disorder.
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