Improving and Streamlining Screening and Diagnosis of ASD at 18-24 Months of Age

描述(由申请人提供)：迫切需要改进自闭症谱系障碍(ASD)的早期发现，因为研究表明，早期干预可以最大限度地提高儿童的预后。美国儿科学会建议，所有儿童在18个月和24个月时都应该使用ASD专用筛查工具进行筛查。然而，目前还没有一种经过充分验证的ASD特定筛查方法可用于18-24个月的儿科环境中，因此迫切需要在这些年轻年龄使用经过验证的筛查工具。本研究项目旨在研究以下筛查和评估措施：1)针对12-36个月儿童的自闭症和沟通障碍早期筛查工具(ESAC)；2)临床环境下自闭症红旗的系统观察(SORF-Clinic)；3)家庭环境自闭症红旗的系统观察(SORF-Home)；以及新开发的针对30个月以下儿童的自闭症诊断观察计划(ADOS)幼儿模块。共有600名18-24个月大的儿童将参与这项研究，其中200名儿童已经接受了评估，400名儿童从佛罗里达州和密歇根州的不同人群中招募了新的儿童：1)低风险样本：从普通人群样本中通过宽带筛查器筛查通信延迟的儿童；以及2)高风险样本：转诊为疑似自闭症或其他发育迟缓的儿童。最好的估计临床诊断将作为比较其他工具的金标准。本研究项目将针对以下具体目标：目的1.研究ESAC、SORF和ADOS幼儿的临界点，并评估与最佳估计诊断相关的敏感度和特异度；目的2.使用因子分析研究ESAC、SORF和ADOS幼儿测量的结构的潜在维度，以确定测量的因素数量以及每个因素具有强和弱负荷的条目；目的3.检查ESAC、SORF和ADOS幼儿个体条目和条目组合的准确性，以研究简化筛查、评估和诊断过程的方法。这项研究的预期结果将对这一领域具有重要意义，因为它记录了一套有希望的幼儿筛查和评估措施的准确性，这些措施最大限度地发挥了家庭在改善ASD早期发现方面的作用。将自闭症在家中日常活动中表现出的症状与在临床环境中表现出来的症状进行比较，对于与蹒跚学步的儿童家庭就自闭症的早期危险信号和早期诊断的紧迫性以及开发更有效的筛查方法达成共识，将具有重要意义。这些发现将为研究人员提供识别和研究较年轻ASD儿童的方法，从而推动科学进步，这可能会影响遗传、生物医学和干预研究。通过改进和简化18至24个月大儿童ASD的早期筛查和诊断，这项研究的发现将对更早地获得干预措施具有重要意义。 公共卫生相关性：这项研究的预期结果将对该领域具有重要意义，因为它记录了一套有希望的幼儿筛查和评估措施的准确性，这些措施最大限度地发挥了家庭在改善ASD早期发现方面的作用。将自闭症在家中日常活动中表现出的症状与在临床环境中表现出来的症状进行比较，对于与蹒跚学步的儿童家庭就自闭症的早期危险信号和早期诊断的紧迫性以及开发更有效的筛查方法达成共识，将具有重要意义。这些发现将为研究人员提供识别和研究较年轻ASD儿童的方法，从而推动科学进步，这可能会影响遗传、生物医学和干预研究。通过改进和简化18至24个月大儿童ASD的早期筛查和诊断，这项研究的发现将对更早地获得干预措施具有重要意义。

DESCRIPTION (provided by applicant): There is a pressing need to improve early detection of autism spectrum disorders (ASD) because research indicates that earlier intervention maximizes children's outcomes. The American Academy of Pediatrics recommends that all children be screened with an ASD-specific screening tool at 18- and 24- months. However, there currently is not a well-validated ASD-specific screener for use at 18-24 months in pediatric settings, making the need for validated screening tools at these young ages urgent. This research project is designed to study the following screening and evaluation measures: 1) the Early Screening for Autism and Communication Disorders (ESAC), a new autism-specific parent report screening tool for children 12-36 months; 2) the Systematic Observation of Red Flags of ASD for a clinical setting (SORF-Clinic), 3) the Systematic Observation of Red Flags of ASD for a home setting (SORF-Home), and the Autism Diagnostic Observation Schedule (ADOS) Toddler Module newly developed for children under 30 months of age. A total of 600 children from 18-24 months of age will participate in this study, 200 who have already been evaluated and 400 new children recruited from diverse populations in Florida and Michigan: 1) low risk sample: children who screen positive on a broadband screener for communication delays from a general population sample; and 2) high risk sample: children referred for suspected ASD or other developmental delays. A best estimate clinical diagnosis will be made as the gold standard to compare the other tools. This research project will address the following specific aims: Aim 1. To study cutoff points and estimate sensitivity and specificity for the ESAC, SORF, and ADOS-Toddler in relation to a best estimate diagnosis; Aim 2. To study the underlying dimensions of the constructs measured with the ESAC, SORF, and ADOS-Toddler using factor analysis to determine the number of factors measured and which items have strong and weak loadings with each factor; Aim 3. To examine the accuracy of individual items and combination of items on the ESAC, SORF, and ADOS-Toddler to study methods to streamline the screening, evaluation, and diagnostic process. The expected outcomes of this study will have significance for the field by documenting the accuracy of a set of promising screening and evaluation measures for toddlers that maximizes the role of families to improve early detection of ASD. The comparison of autism symptoms displayed at home in everyday activities with those displayed in clinical settings will have important implications for building consensus with families of toddlers about early red flags of ASD and the urgency of early diagnosis and for developing more effective screening methods. These findings will advance science by providing researchers methods for identifying and hence studying children with ASD at younger ages, which could impact genetic, biomedical, and intervention research. By improving and streamlining early screening and diagnosis of ASD in 18 to 24 month old children, the findings of this study will have important implications for earlier access to intervention. PUBLIC HEALTH RELEVANCE: The expected outcomes of this study will have significance for the field by documenting the accuracy of a set of promising screening and evaluation measures for toddlers that maximizes the role of families to improve early detection of ASD. The comparison of autism symptoms displayed at home in everyday activities with those displayed in clinical settings will have important implications for building consensus with families of toddlers about early red flags of ASD and the urgency of early diagnosis and for developing more effective screening methods. These findings will advance science by providing researchers methods for identifying and hence studying children with ASD at younger ages, which could impact genetic, biomedical, and intervention research. By improving and streamlining early screening and diagnosis of ASD in 18 to 24 month old children, the findings of this study will have important implications for earlier access to intervention.