Sensitivity of toddler screening: Integrating concurrent and prospective strategies to detect ASD

幼儿筛查的敏感性：整合同步和前瞻性策略来检测 ASD

• 批准号: 10680190
• 负责人: Diana L Robins
• 金额: $ 69.06万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680190
• 关键词: 14 year old; 3 year old; 8 year old; Academy; Address; Age; American; Benefits and Risks; Characteristics; Child; Childhood; Classification; Clinical; Communities; Complement; Data; Detection; Diagnosis; Disparate; Early Diagnosis; Early Intervention; Education; Enrollment; Evaluation; Female; Goals; Health; Literature; Masks; Measures; Medical Records; Methods; Minority; Outcome; Parents; Participant; Pattern; Pediatrics; Positioning Attribute; Prevalence; Primary Care; Prospective Studies; Provider; Readiness; Recommendation; Records; Reporting; Research; Resources; Risk; Sampling; School-Age Population; Screening procedure; Secure; Sensitivity and Specificity; Signal Transduction; Site; Standardization; Symptoms; Testing; Time; Toddler; United States Preventative Services Task Force; Visit; Well Child Visits; aged; autism spectrum disorder; autistic children; checkup examination; clinical diagnosis; clinically significant; cohort; cost; disorder risk; disparity reduction; early screening; follow-up; improved; male; primary care setting; prospective; psychiatric comorbidity; public health relevance; screening; tv watching; validation studies; web portal

Screening for autism spectrum disorder (ASD) during well-child pediatric check-ups reduces the age of diagnosis, allowing more time for critical early intervention. Furthermore, universal screening mitigates disparities in the age of diagnosis for minorities, and has been demonstrated to be feasible in community- based primary care settings. However, limited follow-up of toddlers who screened negative is a notable gap in the literature that contributed to the United States Preventive Services Task Force’s (USPSTF) determination of insufficient evidence to recommend universal ASD screening at present. Follow-up of children who are not identified at risk is cost- and labor-intensive, but is critical to determine the sensitivity of toddler ASD screening. This study will be among the first to use rigorous prospective detection strategies in a large, low-risk sample that previously had concurrent detection. The goal of the proposed study is to find missed cases by rescreening children who were not identified with ASD during the course of three prior screening studies that administered the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up during toddler well child visits. This includes those who screened negative as toddlers, as well as children who screened positive but either were lost to follow-up or were evaluated and not diagnosed with ASD. The specific aims are to measure prospective sensitivity using rigorous case confirmation for potential missed cases. We will identify patterns in toddler screening outcomes for these missed cases; we predict that children whose first screen was younger and those who did not complete multiple screens are more likely to be missed cases compared to those screened at older toddler visits and rescreened by age three. Finally, we will examine whether missed cases are more likely to have milder ASD symptoms, greater likelihood of psychiatric comorbidities, and be female compared to children who demonstrated risk as toddlers but were not diagnosed with ASD until they were older. Although these characteristics have been hypothesized, rigorous evidence is lacking to demonstrate differences between children with ASD missed by toddler screening. The majority of the multi-site sample (total n = 8,751) screened negative at one or more pediatric visits between 1 and 3 years old (n = 8,091). In addition, we will rescreen children who screened positive but did not attend the evaluation (n = 426), which often signals lack of parent concern, and children evaluated and classified as nonASD (n = 234), who may have developed clinically significant ASD symptoms as they aged. Parents will be invited to enroll and rescreen their child, now 7-14 years old, using a secure web-based portal. All at risk children, and a random sample of low-risk cases, will be invited for a comprehensive, research-reliable evaluation; final ASD outcomes will be used to calculate prospective sensitivity, which will be compared to literature reporting sensitivity based on record review strategies. Results of this proposed study will directly address a gap identified by the USPSTF, and will address the Interagency Autism Coordinating Committee’s Question 1 about early detection of ASD.

在健康儿童儿科检查期间筛查自闭症谱系障碍（ASD）可以降低儿童的年龄。 诊断，为关键的早期干预留出更多时间。此外，普遍筛查减轻了 少数民族诊断年龄的差异，并已被证明是可行的，在社区- 基于初级保健设置。然而，对筛查阴性的幼儿的有限随访是一个值得注意的差距， 有助于美国预防服务工作组（USPSTF）确定 目前没有足够的证据推荐普遍的ASD筛查。未成年儿童的后续行动 确定有风险的ASD筛查是成本和劳动密集型的，但对于确定幼儿ASD筛查的敏感性至关重要。 这项研究将是第一个在大规模低风险样本中使用严格的前瞻性检测策略的研究 之前有过并发检测这项研究的目的是通过以下方法找到遗漏的病例： 重新筛选在三项先前的筛查研究中未被确定为ASD的儿童， 在幼儿健康儿童的随访期间， 探访这包括那些在蹒跚学步时筛查结果为阴性的人，以及筛查结果为阳性但 失访或接受评估但未诊断为ASD。具体目标是衡量 前瞻性敏感性，使用严格的病例确认潜在的遗漏病例。我们会找出 这些遗漏病例的幼儿筛查结果;我们预测，首次筛查年龄较小的儿童 那些没有完成多次筛查的人比那些没有完成多次筛查的人更有可能被遗漏。 在较大的幼儿访问时进行筛查，并在三岁时重新筛查。最后，我们将研究是否遗漏的情况下， 更有可能有较轻的ASD症状，更有可能患有精神病合并症，并且是女性 相比之下，那些在蹒跚学步时就表现出患自闭症风险，但直到24岁才被诊断为自闭症的儿童， 老了虽然这些特征已经被假设，但缺乏严格的证据来证明 儿童筛查漏诊的ASD儿童之间的差异。大多数多地点抽样（总数 n = 8，751）在1至3岁之间的一次或多次儿科访视中筛查为阴性（n = 8，091）。此外，本发明还提供了一种方法， 我们将重新筛选筛查阳性但未参加评估的儿童（n = 426），这通常表明 缺乏父母的关心，儿童评估和分类为非ASD（n = 234），谁可能已经发展 随着年龄的增长，他们会出现临床上显著的ASD症状。家长将被邀请登记和重新筛选他们的孩子，现在 7-14年，使用一个安全的基于网络的门户网站.所有的高危儿童，和低风险病例的随机样本， 将被邀请进行全面的，可靠的研究评估;最终ASD结果将用于计算 前瞻性敏感性，将与基于记录审查的文献报告敏感性进行比较 战略布局这项拟议研究的结果将直接解决USPSTF确定的差距，并将 解决机构间自闭症协调委员会关于早期发现ASD的问题1。