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，错过了关键的早期阶段 干预机会。许多患有自闭症谱系障碍的儿童被转介到州早期干预机构寻求可能的帮助 发育迟缓，但除非确定他们的自闭症谱系障碍，否则干预服务的强度通常较低，并且 不特定于他们的核心 ASD 症状。然而，实施筛查来检测 ASD 构成 相当大的后勤挑战。这可能会导致管理不准确或改变，从而可能阻碍 检测成功。虽然 ASD 领域准确可靠的早期检测程序非常重要 众所周知，迄今为止还没有研究探讨过程序忠实度的问题（即遵守 ASD 筛查中规定的方案）。另一个关键的研究空白涉及自闭症谱系障碍的近期结果 早期检测程序，例如筛查结果与自闭症转诊和具体干预有何关系 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 计划中，至关重要的是检查以下儿童的转诊率和服务接受率： 屏幕正极。拟议项目旨在解决这些关键差距并提高科学性 知识，重点关注《幼儿自闭症修订清单》的实施 在大型城市高风险学前班样本的背景下进行跟踪（M-CHAT-R/F）。大多数研究 在儿科儿童健康检查期间使用 M-CHAT 和 M-CHAT-R/F 筛查儿童（例如， Chlebowski 等人，2013），尽管有几项研究已经检验了该工具在高风险情况下的性能 幼儿和学龄前儿童（例如，Charman 等人，2015 年；Snow 和 Lecavalier，2008 年）。总体而言，灵敏度为 当对有发育迟缓风险的学龄前儿童样本进行 M-CHAT 时就足够了， 尽管特异性范围从差到足够。为了测试研究问题，我们将提取 来自埃尔文早期特殊教育的入学率、多学科评估 (MDE) 和服务/安置数据 Developmental Success (SEEDS)，该机构为 3-5 岁儿童提供干预服务 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。 第一个目标将通过检查准确性和 随着时间的推移完成数据。将检查不准确和缺失的数据是否存在障碍和偏见。的 第二个目标将检查筛查的近期结果，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和安置 种子计划。这项研究将是第一个在高风险环境中检验筛查程序保真度的研究。 识别障碍或系统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颖的方法将筛查结果与 近期结果，这将增加对早期干预机构中筛查作用的理解。

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.