A Multimedia Screening System for Early ASD Identification in Diverse Populations

 描述(由申请人提供)：尽管我们现在有工具和专业知识在2岁时可靠地诊断自闭症谱系障碍(ASD)，但大多数儿童在他们4岁生日后仍被诊断出来，在资源不足的种族多元化社区，直到8岁。这些差距突出表明，我们未能将最先进的筛查和诊断做法转化为实际解决办法，以确定社会经济阶层中最脆弱的儿童。鉴于及早实施治疗会带来更积极的结果，这种脱节令人高度关切。造成差距的因素包括父母和专业人员对自闭症早期迹象的认识有限，在初级保健中心部署传统的纸和铅笔筛查器的可行性有限，以及难以获得适当的服务。在资源匮乏的社区，缺乏支持性环境以及语言和识字问题进一步加剧了这些问题。这项研究旨在通过开发新一代基于平板电脑的筛查系统来试验一种解决方案，以克服其中的一些挑战，该系统由两部分组成：(1)基于耶鲁大学幼儿发育障碍诊所(YTDDC)十年来收集的早期症状表现数据的新型视频筛查(Yale Adapted Multimedia Screener，YAMS)(目标1)。通过使用简单的口语，这个筛选器将绕过与识字相关的问题。通过提供直观的例子，它将使可能对新父母来说复杂的概念变得更加清晰。筛查器将具有自适应性，问题取决于先前的反应，从而在家长和工作人员高度接受的省时系统内保持诊断精度；(2)M-Chat-R/F的数字化实施，具有自动评分功能，以提高效率，并具有高级解释和建议，以提高医生的实用价值。这一适应将提供一种既定的措施，以扩大我们的研究目标，并作为山药的比较系统(目标3)。为了衡量我们的方法(目标2)的实用性和可行性，我们将通过与服务于低资源和种族多样化人口的社区初级保健中心的合作来测试山药。将招募200名父母参加他们孩子为期18个月或24个月的良好护理访问。所有在M-Chat-R/F和/或我们的山药(N~20)上筛查呈阳性的人将被邀请在YTDDC进行专家后续评估。这个社区筛查样本的数据将被一个基于临床的18-24个月大的幼儿样本扩大，这些儿童被诊断为自闭症(N=70)、发育迟缓(DD，N=20)或典型发育(N=70)。这两个示例的组合将提供对我们的筛选器的可用性、实用性和潜力的初步验证。我们的研究代表了一种具有凝聚力的、统一的方法，它利用现代、低成本、手持技术的全部能力来推动我们实现ASD早期普遍筛查的目标。我们的独特关注点不仅包括筛查系统本身的开发，还包括系统在不同环境中的可用性以及筛选器作为临床护理过程促进剂的集成。

 DESCRIPTION (provided by applicant): Although we now have the tools and expertise to diagnose autism spectrum disorders (ASD) reliably in the 2nd year of life, most children are still diagnosed after their 4th birthday and, in under-resourced, ethnically diverse communities, as late as 8 years of age. These gaps highlight our failure to translate state-of-the art screening and diagnostic practices into practical solutions for identifying the most vulnerable children across socioeconomic strata. This disconnect is highly concerning given that early implementation of treatment leads to more positive outcomes. Factors contributing to the gaps include the limited awareness of early signs of ASD amongst parents and professionals, limited feasibility of deploying traditional paper-and-pencil screeners in primary care centers, and difficulties accessing appropriate services. In low-resource communities, these problems are further compounded by lack of supportive environments and language and literacy issues. This study aims to pilot a solution to surmount some of these challenges through the development of a new generation, tablet-based screening system comprised of two parts: (1) A novel video-based screener (Yale Adaptive Multimedia Screener, YAMS) based on early syndrome expression data collected over a decade at the Yale Toddler Developmental Disabilities Clinic (YTDDC) (Aim 1). By using simple spoken language, this screener will circumvent literacy-related issues. By providing visual examples, it will add clarity to concepts that may be complex for new parents. The screener will be adaptive, with questions contingent on prior responses, thus maintaining diagnostic precision within a time-efficient system highly acceptable by parents and staff; (2) Digital implementation of the M-CHAT-R/F, with automatic scoring for increased efficiency and with high-level interpretations and recommendations to increase physician utility. This adaptation will provide an established measure to augment our research goals and to serve as a comparison system for the YAMS (Aim 3). To gauge the utility and feasibility of our approach (Aim 2), we will test YAMS through collaborations with community primary care centers serving low-resource and ethnically diverse populations. 200 parents will be recruited to participate at their child's 18- or 24-month well-care visit. All who screen positive on the M-CHAT- R/F and/or our YAMS (N~20) will be invited for expert follow-up assessment at the YTDDC. Data from this community screening sample will be augmented by a clinic-based sample of 18-24 month-old toddlers with diagnoses of ASD (N=70), developmental delay (DD, N=20), or typical development (N=70). The combination of these two samples will provide preliminary validation of the usability, utility, and potential of our screener. Our study represens a cohesive, unified approach that leverages the full capabilities of modern, low-cost, hand-held technologies to move us towards the goal of early universal screening for ASD. Our unique focus combines attention to not just the development of the screening system itself, but also the usability of the system in diverse settings and the integration of the screener as a facilitating agent of the clinical care process.