Implementation of ASD screening in a community setting serving high-risk preschool children

平均而言，自闭症谱系障碍（ASD）的诊断发生在四岁生日之后， 干预机会。许多患有ASD的儿童被转介到州早期干预机构， 发育迟缓，但除非他们的ASD被确定，干预服务通常是低强度的， 并不针对他们的核心ASD症状。然而，实施筛查以检测ASD姿势， 巨大的后勤挑战。这可能导致不准确或改变的管理，这可能会阻碍 成功检测。虽然在ASD领域中准确和可靠的早期检测程序的重要性 被广泛承认，到目前为止还没有研究检查过程序保真度的问题（即，坚持 在ASD筛查中的规定方案）。另一个关键的研究差距涉及ASD的近端结果 早期检测程序，例如筛查结果与自闭症转诊和特定干预的关系 服务由于早期筛查的最终目标是促进及时获得适当的干预 方案，至关重要的是要检查转诊率和儿童的服务， 屏幕正。拟议的项目旨在解决这些关键差距， 知识，重点是实施修订的幼儿自闭症检查表修订版 在一个大的城市高危学龄前样本的背景下，随访（M-CHAT-R/F）。大多数研究 在儿科健康儿童检查期间使用M-CHAT和M-CHAT-R/F筛查的儿童（例如， Chlebowski等人，2013年），虽然有几项研究已经检查了高风险工具的性能， 幼儿和学龄前儿童（例如，Charman等人，2015; Snow & Lecavalier，2008）。总的来说，灵敏度 当将M-CHAT施用于有发育迟缓风险的学龄前儿童样品时， 尽管特异性范围从差到足够。为了测试研究的问题，我们将提取 入学，多学科评估（MDE），和服务/安置数据从埃尔文特殊教育早期 发展成功（种子），该机构提供干预服务，以3-5岁的儿童， 宾夕法尼亚州费城县SEEDS估计，2015年1月至12月，有5,000名儿童接受了筛查。的 第一个目标将通过检查准确性和 完成数据随时间变化。将检查不准确和缺失的数据是否存在障碍和偏见。的 第二个目的是检查筛查的近端结果，即M-CHAT-R/F之间的关系， 分数和MDE结果，自闭症评估结果，以及为儿童提供的服务 SEEDS计划。这项研究将是第一个检查在高风险环境中筛查程序的保真度。 识别障碍或系统性偏差可能会为更成功的筛查提供替代方法， 改善自闭症儿童的护理。这项研究还使用了一种新的方法， 近端结果，这将增加对早期干预机构筛查作用的理解。

On average, diagnoses of autism spectrum disorder (ASD) occur after the fourth birthday, missing critical early intervention opportunities. Many children with ASD are referred to state early intervention agencies for possible developmental delay, but unless their ASD is identified, intervention services are generally low intensity and not specific to their core ASD symptoms. However, implementation of screening to detect ASD poses considerable logistical challenges. This can result in inaccurate or altered administration, which may hinder successful detection. While the importance of accurate and reliable early detection procedures in the ASD field is widely acknowledged, no study thus far has examined the issue of procedural fidelity (i.e., adherence to the prescribed protocol) in ASD screening. Another critical research gap concerns the proximal outcomes of ASD early detection procedures, such as how screening results relate to autism referrals and specific intervention services. As the ultimate goal of early screening is to facilitate timely access to appropriate intervention programs, it is critically important to examine the rates of referral and uptake of services for children who screen positive. The proposed project aims to address these critical gaps and increase scientific knowledge, focusing on the implementation of the Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) in the context of a large urban high-risk preschool sample. Most research using the M-CHAT and the M-CHAT-R/F screened children during pediatric well-child check-ups (e.g., Chlebowski et al., 2013), although several studies have examined the performance of the tool with high-risk toddlers and preschoolers (e.g., Charman et al., 2015; Snow & Lecavalier, 2008). Overall, sensitivity is adequate when the M-CHAT is administered to samples of preschoolers at risk for developmental delay, although specificity ranges from poor to adequate. In order to test the study research questions we will extract intake, multidisciplinary evaluation (MDE), and service/placement data from Elwyn Special Education for Early Developmental Success (SEEDS), the agency providing intervention services to children age 3-5 in Philadelphia County, PA. SEEDS estimates that 5,000 children were screened January-December 2015. The first aim will examine the procedural fidelity of the M-CHAT-R/F implementation, by examining accuracy and completion data over time. Both inaccurate and missing data will be examined for barriers and biases. The second aim will examine the proximal outcomes of screening, namely the relationship between M-CHAT-R/F scores and MDE results, autism evaluation results, and services and placements offered to children in the SEEDS program. This study will be the first to examine fidelity of screening procedures in a high-risk setting. Identification of barriers or systematic bias may inform alternate approaches to more successful screening, improving care of children with ASD. This study also uses a novel approach to relate screening results to proximal outcomes, which will increase understanding of the role of screening in early intervention agencies.