Early Detection of Autism Spectrum Disorder

描述(由申请人提供)：对患有自闭症的儿童进行早期发现和干预可带来更好的结果(例如，Dawson等人，2010年)。干预依赖于准确的识别；因此，早期筛查和诊断至关重要(Filipek等人，1999年)。改良的幼儿自闭症检查表(M-ChAT)已成为16-30岁儿童最广泛使用的自闭症早期筛查工具。然而，尽管M-Chat和其他筛查工具已经提供了10年或更长时间，而且全民筛查已经得到了国家组织的认可，但美国ASD诊断的中位年龄仍然是4岁或更大。在四年或四年后确诊的儿童错过了厄尔关键干预的可能性。此外，没有筛查人员可以检测到每个孩子；因此，医生对儿童发育的监测是必不可少的，这包括将行为观察与筛查、父母关注和病史信息相结合。因此，虽然有效的筛查需要强大的筛查工具，但仅有强大的筛查工具是不够的。有效的筛查政策 必须考虑以下问题：筛查应在何时进行，如何在持续的发育监测背景下最好地实施筛查，以及哪些儿童、家庭、医生和实践因素影响筛查和监测的成功。这项拟议的研究建立在开创性的M-Chat工作基础上，该工作为有效的筛查奠定了基础。这项研究将调查三个关键问题：(1)开始筛查的最佳年龄是什么年龄(12、15、 或18个月)？(2)能否通过简短、有重点的干预来提高医生监测的准确性？(3)在儿童/家庭层面(例如，种族/民族、社会经济地位、性别)和在儿童/家庭层面上，与有效的自闭症筛查和监测存在差异的因素是什么？ 医生/执业水平(医生信念和自我效能感、执业地点和患者人口统计数据)？共有12,000名幼儿接受ASD筛查，这项研究将检查这三个目标中的变量如何影响ASD检测的年龄和准确性，使该团队能够确定未来干预的目标，以缩小差距，促进所有儿童的早期和准确诊断。在早期ASD筛查中所做的大部分工作来自为这项拟议的研究组建的团队，来自不同地理区域的大样本儿童将使这些结果立即得到推广。这项拟议的研究将回答有关ASD早期筛查的关键遗留问题，从而影响全国儿童的早期健康监测，并有助于确保ASD早期检测的承诺能够成为现实。

DESCRIPTION (provided by applicant): Early detection and intervention for children with ASD leads to better outcomes (e.g., Dawson et al., 2010). Intervention depends on accurate identification; therefore, early screening and diagnosis are crucial (Filipek et al., 1999). The Modified Checklist for Autism in Toddlers (M-CHAT) has become the most widely used early autism screening tool for children 16-30 mos. However, though the M-CHAT and other screening instruments have been available for 10 years or more, and universal screening has been endorsed by national organizations, the median age of ASD diagnosis in the U.S. is still four years or older. Children diagnosed at four years or later miss the possibility of crucial earl intervention. Furthermore, no screener can detect every child; therefore, physician surveillance of children's development, which involves integrating behavioral observation with screening, parent concern, and history information, is essential. Therefore, although a strong screening tool is necessary for effective screening, it is not sufficient on its own. Effective screening policies must consider issues such as when screening should occur, how best to implement screening in the context of ongoing developmental surveillance, and what child, family, physician, and practice factors influence the success of screening and surveillance. The proposed study builds on the seminal M-CHAT work, which did the foundational work for an effective screener. This study will investigate three key questions: (1) what is the best age to initiate screening (12, 15, or 18 mos)? (2) Can accuracy of physician surveillance be improved with a brief, focused intervention? (3) What are the factors associated with disparity in effective ASD screening and surveillance at the child/family level (e.g., race/ethnicity, socioeconomic status, sex) and at the physician/practice level (physician beliefs and self-efficacy, practice location, and patient demographics)? With a total of 12,000 toddlers screened for ASD, this study will examine how the variables in these three aims influence age and accuracy of ASD detection, allowing this team to identify targets for future intervention to reduce disparities and facilitate early and accurate diagnosis for all children. Much of the work done in early ASD screening comes from the team assembled for this proposed study, and the large sample of children from diverse geographic areas will make these results immediately generalizable. The proposed study will answer key remaining questions about early ASD screening, thereby impacting the early health monitoring of children across the nation, and helping ensure that the promise of early ASD detection can become a reality.