Exploration of early screening model for infants with autism spectrum disorders

CONG Yan; XU Xia; WANG Hao; WANG Dong; YU Lu-ting; DONG Chen-qing; JIANG Li; ZHENG Ting-ting; JI Jia-yi

doi:10.11852/zgetbjzz2021-1307

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Chinese Journal of Child Health Care ›› 2022, Vol. 30 ›› Issue (6) : 689-693. DOI: 10.11852/zgetbjzz2021-1307

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Exploration of early screening model for infants with autism spectrum disorders

CONG Yan,XU Xia, WANG Hao, WANG Dong, YU Lu-ting, DONG Chen-qing, JIANG Li, ZHENG Ting-ting, JI Jia-yi

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Abstract

Objective To evaluate the screening efficacy of autism spectrum disorder (ASD) by the Bayley Scales of Infant Development-Ⅰ(BSID Ⅰ) combined with Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT-R/F), in order to provide clinical basis for early ASD screening in primary child care system.Methods Infants aged 6 to 12 months, who participated in Early Developmental Risk and Abnormality Screening Program for 0 - 3 Years Old Children in Yiwu Maternal and Child Health Hospital using BSID Ⅰ evaluation from January to December 2019 were enrolled in this for a prospective cohort study.BSID Ⅰ were conducted in the children with positive autism alert indexin Autism Diagnosis and Rehabilitation Guide issued by the Ministry of Health in 2010.Infants with abnormal mental development index (MDI) and psychomotor development index (PDI) (MDI or PDI<80) were followed up. M-CHAT-R/F assessment was performed at 18 months of age, then further diagnosis of ASD was made based on DSM-5 by a specialist.Results Totally 3 096 cases were included in the study, of whom 535 cases with positive autism alert index and421 cases (13.60%) had abnormal BSID Ⅰ results. At 18 months of age, a total of 38 (9.97%) children were screened positive by M-CHAT-R/F evaluation, and 16 children were finally diagnosed with ASD. When taking BSID Ⅰ MDI<80 as a predictor, its proportion was significantly different between ASD group and non-ASD group (χ²=10.28, P<0.01). The positive predictive value of BSID Ⅰ for ASD screening was 0.076, which increased to 0.42 when combined with M-CHAT-R/F.Conclusions BSID Ⅰ combined with M-CHAT-R/F can improve the positive predictive value of ASD screening in infants. It is suggested that m-CHAT-R /F screening at 18 months of age should be performed in infants with BSID Ⅰ MDI<80, thus to provide a new method for early screening of ASD.

Key words

Bayley Scales of Infant development-Ⅰ / Modified Checklist for Autism in Toddlers,Revised,with Follow-up / Autism Spectrum Disorder / positive predictive value / infants

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CONG Yan,XU Xia, WANG Hao, WANG Dong, YU Lu-ting, DONG Chen-qing, JIANG Li, ZHENG Ting-ting, JI Jia-yi. Exploration of early screening model for infants with autism spectrum disorders[J]. Chinese Journal of Child Health Care. 2022, 30(6): 689-693 https://doi.org/10.11852/zgetbjzz2021-1307

References

[1] Ts J, Jacob P, Srinath S, et al. Toddlers at risk for autism spectrum disorders from Kerala, India - A community based screening[J]. Asian J Psychiatr,2018,31:10-12.
[2] Carpenter LA,Boan AD, Wahlquist AE, et al. Screening and direct assessment methodology to determine the prevalence of autism spectrum disorders[J]. Ann- Epidemiol, 2016,26(6):395-400.
[3] Zwaigenbaum L, Young GS, Stone WL, et al. Early head growth in infants at risk of autism:A baby siblings research consortium study[J]. J Am Acad Child Adolesc Psychiatry, 2014,53(10):1053-1062.
[4] 中华人民共和国卫生部儿童孤独症诊疗康复指南[S].2010.
[5] 易受蓉,罗学荣,杨志伟,等.贝利婴幼儿发展量表在我国的修订(城市版)[J].中国临床心理学杂志,1993,1(2):71-75.
[6] Luo R, Shi Y, Zhou H, et al. Micronutrient deficiencies and developmental delays among infants:Evidence from a crosssectional survey in rural China[J]. Bmj Open, 2015, 5(10):e008400.
[7] Marlow M,Servili C,Tomlinson M. A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children:Recommendations for use in low- and middle-income countries[J]. Autism Res,2019,12(2):176-199.
[8] 杨玉凤. 创建适合我国儿童孤独症谱系障碍的评估工具和干预方法[J]. 中国儿童保健杂志,2020,28(1):1-2.
[9] Baxter AJ,Brugha TS, Erskine HE,et al. The epidemiology and global burden of autism spectrum disorders[J]. Psychol Med,2015,45(3):601-613.
[10] Levine TA, Alderdice FA, Grunau RE,et al. Prenatal stress and hemodynamics in pregnancy:A systematic review[J]. Arch Womens Ment Health,2016,19(5):721-739.
[11] de Vries PJ. Thinking globally to meet local needs: autism spectrum disorders in Africa and other low-resource environments[J]. Curr Opin Neurol,2016,29(2):130-136.
[12] Morelli DL, Pati S, Butler A,et al. Challenges to implementation of developmental screening in urban primary care: a mixed methods study[J]. BMC Pediatr,2014,21:14-16.
[13] 郭翠华,罗美芳,王旭祥,等. 三甲医院和社区孤独症谱系障碍早期筛查的结果比较[J]. 中国儿童保健杂志,2018,26(4):372-375.
[14] 魏蓉美,刘智妹,张兰,等.孤独症警示指标阳性婴儿筛查及3年随访研究[J].中国儿童保健杂志,2017,25(9):894-896,913.
[15] Heck A,Chroust A,White H,et al.Development of body emotion perception in infancy:From discrimination to recognition[J].Infant Behav Dev,2018,50:42-51.
[16] 蒋秋静,张静.儿童孤独症的早期识别与早期干预[J].中国妇幼卫生杂志,2010,1(4):217-220.
[17] 高磊,苏媛媛,戴炜,等.孤独症谱系障碍的早期危险因素[J].中国人理卫生杂志,2014,28(6):440-444.
[18] Wolke D,Eryigit-Madzwamuse S,Gutbrod T.Very preterm/very low birth weight infants'attachment:Infant and maternal characteristics[J].Arch Dis Child Fetal Neonatal Ed,2014,99(1):70-75.
[19] 胡瑗,张丽娟,朱鑫荣,等. 发育筛查量表联合改良版婴幼儿孤独症筛查量表在孤独症早期筛查中的效果分析[J]. 中国妇幼保健,2020,35(21):4083-4086.
[20] Abo El Elella SS, Tawfik MAM, Abo El Fotoh WMM, et al. Screening for developmental delay in preschool-aged children using parent-completed Ages and Stages Questionnaires: additional insights into child development[J]. Postgrad Med J,2017,93(1104):597-602.
[21] Semrud-Clikeman M, Romero RAA, Prado EL, et al. [Formula: see text]Selecting measures for the neurodevelopmental assessment of children in low- and middle-income countries[J]. Child Neuropsychol,2017,23(7):761-802.
[22] 江澜,严双琴,王晓燕,等.婴儿社会性反应问卷的编制与信效度评价[J]. 中国儿童保健杂志,2014,23(3):231-235.
[23] 孙艳丽,江澜,王晓燕,等.婴儿期社会性反应评估对18月龄孤独症行为预测作用队列研究[J].中国公共卫生,2016,32(11):1463-1466.
[24] Farmer JE, Clark MJ. Identification and evaluation of Missouri's children with autism spectrum disorders: promoting a rapid response[J]. Mo Med, 2008,105(5):384-389.
[25] 万国斌,李雪荣,龚颖萍.婴儿期行为倾向与智力发展的相关性研究[J].中国实用儿科杂志,1997,12(6):339-340.
[26] 罗美芳,肖博,赵晓丽,等.儿童神经心理行为检查量表2016版在孤独症谱系障碍幼儿中的临床应用[J].中国当代儿科杂志,2020,226(5):494-498.
[27] Chlebowski C,Robins DL,Barton ML,et a1. Large-scale use of the modified checklistfor autism in low-risk toddlers[J].Pediatrics,2013,13l(4):ell21-e1127.
[28] Baird G, Charman T, Baron-Cohen S, et a1. A screening instrument for autism at 18 months of age:A 6-year follow-up study[J]. J Am Acad Child Adolesc Psychiatry,2000,39(6):694-702.
[29] Kleinman JM, Robins DL, Ventola PE, et a1. The modified checklist for autism in toddlers:A follow-up study investigating the early detection of autism spectrum disorders[J]. J Autism Dev Disord, 2008, 38(5):827-839.
[30] 韦秋宏,谢小芬,戴婧婧,等. 孤独症筛查量表在早期识别孤独症谱系障碍中的临床价值[J].中国当代儿科杂志,2021,23(4):343-349.
[31] 郑慕时,冯玲英,刘湘云,等. 0~6岁儿童智能发育筛查测验全国城市常模的制定[J]. 中华儿科杂志,1997,35(3):117-120.
[32] Aly Z, Taj F, Ibrahim S. Missed opportunities in surveillance and screeningsystems to detect developmental delay: A developing country perspective[J]. Brain Dev, 2010, 32(2):90-97.
[33] Rogers SJ, Estes A, Lord C, et a1. A multisite randomized controlled two-phase trial of the early start denver model compared to treatment as usual[J].J Am Acad ChildAdolesc Psychiatry,2019,58(9):853-865.
[34] 张勤良,张俊,刘凤琳,等.结构化教学法对孤独症谱系障碍儿童康复效果的影响研究[J].中国儿童保健杂志,2019,27(1):80-83.
[35] Abubakar A, Ssewanyana D, Newton CR. A systematic review of research on autism spectrum disorders in Sub-Saharan Africa[J].Behav Neurol,2016,2016:3501910.
[36] Collins PY, Pringle B, Alexander C,et a1. Global services and support for children with developmental delays and disabilities: Bridging research and policy gaps[J].PLoS Med,2017,14(9):e1002393.
[37] Warren R, Kenny M, Bennett T, et a1. Screening for developmental delay among children aged 1-4 years: a systematic review[J].CMAJ Open,2016,25;4(1):20-27.
[38] Council on Children With Disabilities,Section on Developmental Behavioral Pediatrics,Bright Futures Steering Committee,et al.Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening[J]. Pediatrics,2006,118(1):405-420.