A Multimedia Screening System for Early ASD Identification in Diverse Populations

用于不同人群早期 ASD 识别的多媒体筛查系统

• 批准号: 8893574
• 负责人: KATARZYNA CHAWARSKA
• 金额: $ 24.98万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-17 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8893574
• 关键词: 8 year old; Administrator; Age; Age of Onset; Agreement; Algorithms; Attention; Autistic Disorder; Behavior; Caring; Child; Childhood; Clinic; Clinical; Collaborations; Collection; Communities; Complex; Data; Detection; Development; Developmental Delay Disorders; Developmental Disabilities; Devices; Diagnosis; Diagnostic; Differential Diagnosis; Early Intervention; Early identification; Early treatment; Electronics; Evaluation; Failure; Feedback; Focus Groups; Future; Generations; Goals; Guidelines; Hand; Hospitals; Human Resources; Language; Life; Measures; Medical; Modeling; Multimedia; Nature; Outcome; Paper; Parents; Participant; Phenotype; Physicians; Population; Population Heterogeneity; Predictive Value; Preparation; Primary Care Physician; Primary Health Care; Process; Property; Provider; Psychometrics; Questionnaires; Recommendation; Records; Recruitment Activity; Research; Resources; Risk; Sampling; Services; Solutions; Specificity; Statistical Models; Surveys; Symptoms; Syndrome; System; Systems Integration; Tablets; Technology; Testing; Text; Time; Toddler; Translating; Validation; Visit; Visual; Work; autism spectrum disorder; base; clinical care; clinical phenotype; collaborative environment; cost; data exchange; digital; early awareness; follow-up; health record; high risk; indexing; information gathering; instrument; literacy; novel; population based; primary care setting; public health relevance; response; screening; socioeconomics; tool; usability

 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.

 描述（由申请人提供）：虽然我们现在有工具和专业知识来诊断自闭症谱系障碍（ASD）在生命的第二年可靠，大多数儿童仍然在他们的4岁生日后被诊断出来，在资源不足，种族多样化的社区，迟至8岁。这些差距突出表明，我们未能将最先进的筛查和诊断实践转化为实际解决方案，以确定社会经济阶层中最脆弱的儿童。这种脱节是非常令人关切的，因为早期实施治疗会带来更积极的结果。造成差距的因素包括父母和专业人员对ASD早期迹象的认识有限，在初级保健中心部署传统纸笔筛查的可行性有限，以及难以获得适当的服务。在资源贫乏的社区，这些问题因缺乏支持性环境以及语言和识字问题而进一步加剧。 本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，以克服其中一些挑战，该系统由两部分组成：（1）基于耶鲁幼儿发育障碍诊所（YTDDC）十多年收集的早期综合征表达数据的新型视频筛查仪（Yale Adaptive Multimedia Screener，YAMS）（目标1）。通过使用简单的口语，这一筛选将绕过与识字有关的问题。通过提供直观的例子，它将增加清晰的概念，可能是复杂的新父母。筛选器将是自适应的，问题取决于先前的回答，从而在家长和工作人员高度接受的时间效率系统内保持诊断精度;（2）M-CHAT-R/F的数字化实施，自动评分以提高效率，并提供高水平的解释和建议，以提高医生的效用。这种适应将提供一个既定的措施，以扩大我们的研究目标，并作为一个比较系统的YAMS（目标3）。为了衡量我们方法（目标2）的实用性和可行性，我们将通过与为资源匮乏和种族多元化人群提供服务的社区初级保健中心合作来测试YAMS。将招募200名父母参加他们孩子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YAMS（N~20）上筛选为阳性的人将被邀请在YTDDC进行专家随访评估。来自该社区筛查样本的数据将通过诊断为ASD（N=70）、发育迟缓（DD，N=20）或典型发育（N=70）的18-24个月大幼儿的基于诊所的样本进行扩充。这两个样本的组合将为我们筛选器的可用性、实用性和潜力提供初步验证。我们的研究代表了一种凝聚力，统一的方法，利用现代，低成本，手持技术的全部功能，使我们朝着ASD早期普遍筛查的目标迈进。我们独特的关注点不仅关注筛查系统本身的开发，还关注系统在不同环境中的可用性，以及将筛查仪整合为临床护理过程的促进剂。