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)的诊断发生在四岁之后，错过了危急的早期 干预机会。许多患有自闭症的儿童被转介到州早期干预机构进行可能的治疗 发育迟缓，但除非发现他们的自闭症，否则干预服务通常强度低， 不是针对他们的ASD核心症状。然而，实施筛选以检测ASD姿势 相当大的后勤挑战。这可能会导致给药不准确或改变，这可能会阻碍 检测成功。虽然准确可靠的ASD早期检测程序在ASD领域的重要性 被广泛承认，但到目前为止还没有研究检查程序保真度的问题(即，遵守 指定方案)进行ASD筛查。另一个关键的研究空白涉及ASD的近期结局 早期检测程序，例如筛查结果与自闭症转介和特定干预的关系 服务。因为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儿童转介和接受服务的比率，这些儿童 筛查结果为阳性。拟议的项目旨在解决这些关键差距，并提高科学 知识，重点是实施修订后的幼儿自闭症检查表 在一个大的城市高危学龄前儿童样本的背景下，进行了后续行动(M-Chat-R/F)。大多数研究 使用M-Chat和M-Chat-R/F在儿科健康儿童体检期间筛查儿童(例如， ChleBowski等人，2013)，尽管几项研究已经检查了该工具的高风险性能 幼儿和学龄前儿童(例如，Charman等人，2015；Snow&Lecavalier，2008)。总体而言，敏感性是 当M-Chat应用于有发育迟缓风险的学龄前儿童样本时， 尽管特异性从差到足不等。为了检验学习研究问题，我们将提取 Elwyn特殊教育的招生、多学科评估(MDE)和服务/安置数据 发展成功(SEED)，为3-5岁儿童提供干预服务的机构 宾夕法尼亚州费城Seed估计，2015年1月至12月期间，有5000名儿童接受了筛查。这个 第一个目标将检查M-Chat-R/F实施的程序保真度，通过检查准确性和 随时间推移的完成数据。不准确和缺失的数据都将被检查障碍和偏见。这个 第二个目的是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。这项研究将第一次检查在高风险环境下筛查程序的保真度。 障碍或系统性偏差的识别可以为更成功的筛查提供替代方法， 改善对患有自闭症儿童的护理。这项研究还使用了一种新的方法将筛查结果与 近期结果，这将增加对筛查在早期干预机构中的作用的理解。

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.