Smart Early Screening for Autism and Communication Disorders in Primary Care

描述（由申请人提供）：迫切需要建立社区的能力，以遵循美国儿科学会的指导方针，在18和24个月时筛查所有儿童的ASD（约翰逊和迈尔斯，2007），因为研究表明，早期干预可以最大限度地提高结果。作为对PA-10 - 158的回应，这项调查的首要目的是验证自闭症和沟通障碍早期筛查的新自动在线版本-"智能ESAC"的有效性，该版本使用智能技术从10个关于沟通延迟的宽带问题无缝过渡到20个自闭症特定问题，这些问题适用于在初始宽带屏幕上显示阳性的儿童。Smart ESAC被设计为一个通用的屏幕，用于12个月和18个月大的沟通延迟和ASD。我们将通过佛罗里达狭长地带的社区初级保健提供者（PCP）对智能ESAC的有效性进行大规模的纵向研究，该地区提供小型城市和农村医疗保健环境以及种族，民族和社会经济水平的多样性。我们还将研究家庭参与筛查和诊断，以改善健康差距。我们将招募多达32名PCP，他们将对8，424名12个月大的婴儿进行筛查，并在该项目的5年内纵向跟踪这些儿童。我们将邀请家庭参加对所有儿童的诊断评估， 筛选阳性和随机选择的儿童与阴性筛选，以检测约842名儿童与沟通延迟和约84名儿童与ASD。这项纵向研究将针对以下具体目标：目标1。研究12个月和18个月时Smart ESAC在预测12个月和18个月时自闭症的沟通延迟或红旗以及在预测18 - 24个月和30 - 36个月时ASD的最佳估计诊断方面的既定临界点并估计灵敏度、特异性和区分度;目的2.使用因素分析和项目反应理论研究Smart ESAC测量的各个项目和结构的基本维度，以确定因素的数量和因素内的差异项目功能，最终预测诊断结果;以及目标3。查明社区环境中阻碍筛查和转诊过程的障碍，以及有助于改善这一过程的文化敏感战略。拟议研究的预期成果将通过记录一种新的有前途的婴儿和幼儿通用自动筛查工具的准确性，对沟通障碍和ASD的早期检测产生重大影响。本研究还将通过基于动机访谈和以家庭为中心的策略开发手动参与干预来影响家庭参与社区筛查过程。调查结果还将有助于在初级保健中确定的最大和最年轻的婴儿和幼儿样本之一，有可能将筛查沟通延迟和ASD的年龄降低到12个月，这将对早期获得干预措施和社区环境中的立即实施产生重要影响。

DESCRIPTION (provided by applicant): There is a pressing need to build the capacity of communities to follow the guidelines of the American Academy of Pediatrics to screen all children for ASD at 18 and 24 months (Johnson & Myers, 2007) as research indicates that earlier intervention maximizes outcomes. In response to PA-10-158, the overarching purpose of this investigation is to validate the effectiveness of a new automated online version of the Early Screening for Autism and Communication Disorders- the "Smart ESAC," that uses smart technology to seamlessly transition from 10 broadband questions about communication delay to 20 autism-specific questions for children who screen positive on the initial broadband screen. The Smart ESAC is designed as a universal screen for communication delays and ASD at 12 and 18 months of age. We will conduct a large-scale longitudinal study of the validity of the Smart ESAC through community primary care providers (PCPs) in the Florida panhandle, which offers small urban and rural healthcare settings and diversity in race, ethnicity, and socioeconomic level. We will also study family engagement in screening and diagnosis to improve health disparities. We will recruit up to 32 PCPs who will implement screening with 8,424 infants at 12 months of age and follow these children longitudinally over the 5 years of this project. We will invite families to participate in diagnostic evaluations for all children who screen positive and randomly selected children with a negative screen to detect about 842 children with communication delays and about 84 children with ASD. This longitudinal study will address the following specific aims: Aim 1. To study the established cutoff points and estimate sensitivity, specificity, and discrimination for the Smart ESAC at 12 and 18 months in predicting communication delay or red flags for autism at 12 and 18 months, and in predicting distally a best-estimate diagnosis of ASD at 18-24 and 30-36 months; Aim 2. To study individual items and underlying dimensions of the constructs measured by the Smart ESAC using factor analysis and item response theory to determine the number of factors and differential item function within factors, to ultimately predict diagnostic outcome; and Aim 3. To identify barriers in community settings that impede the screening and referral process and culturally sensitive strategies that function to improve this process. The expected outcomes of the proposed research will have a significant impact on early detection of communication disorders and ASD through documentation of the accuracy of a new promising universal automated screening tool for infants and toddlers. This study will also impact family engagement in community screening processes through the development of a manualized engagement intervention based on Motivational Interviewing and family-centered strategies. Findings will also contribute one of the largest and youngest samples of infants and toddlers identified in primary care, with the potential of lowering the age to screen for communication delay and ASD to 12 months, which will have important implications for earlier access to intervention and immediate implementation in community settings.