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      Screening for autism spectrum disorders: state of the art in Europe

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          Abstract

          A large number of studies have reported on the validity of autism spectrum disorder (ASD) screening procedures. An overall understanding of these studies’ findings cannot be based solely on the level of internal validity of each, since screening instruments might perform differently according to certain factors in different settings. Europe has led the field with the development of the first screening tool and first prospective screening study of autism. This paper seeks to provide an overview of ASD screening studies and ongoing programmes across Europe, and identify variables that have influenced the outcomes of such studies. Results show that, to date, over 70,000 children have been screened in Europe using 18 different screening procedures. Differences among findings across studies have enabled us to identify ten factors that may influence screening results. Although it is impossible to draw firm conclusions as to which screening procedure is most effective, this analysis might facilitate the choice of a screening method that best fits a specific scenario, and this, in turn, may eventually improve early ASD detection procedures.

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          Most cited references89

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          Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder.

          Advances in the fields of cognitive and affective developmental neuroscience, developmental psychopathology, neurobiology, genetics, and applied behavior analysis have contributed to a more optimistic outcome for individuals with autism spectrum disorder (ASD). These advances have led to new methods for early detection and more effective treatments. For the first time, prevention of ASD is plausible. Prevention will entail detecting infants at risk before the full syndrome is present and implementing treatments designed to alter the course of early behavioral and brain development. This article describes a developmental model of risk, risk processes, symptom emergence, and adaptation in ASD that offers a framework for understanding early brain plasticity in ASD and its role in prevention of the disorder.
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            Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F).

            This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT. Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated. The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis. The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.
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              The Autism Spectrum Quotient: Children's Version (AQ-Child).

              The Autism Spectrum Quotient-Children's Version (AQ-Child) is a parent-report questionnaire that aims to quantify autistic traits in children 4-11 years old. The range of scores on the AQ-Child is 0-150. It was administered to children with an autism spectrum condition (ASC) (n = 540) and a general population sample (n = 1,225). Results showed a significant difference in scores between those with an ASC diagnosis and the general population. Receiver-operating-characteristic analyses showed that using a cut-off score of 76, the AQ-Child has high sensitivity (95%) and specificity (95%). The AQ-Child showed good test-retest reliability and high internal consistency. Factor analysis provided support for four of the five AQ-Child design subscales. Future studies should evaluate how the AQ-C performs in population screening.
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                Author and article information

                Contributors
                pgarciaprimo@isciii.es
                Journal
                Eur Child Adolesc Psychiatry
                Eur Child Adolesc Psychiatry
                European Child & Adolescent Psychiatry
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1018-8827
                1435-165X
                10 June 2014
                10 June 2014
                2014
                : 23
                : 11
                : 1005-1021
                Affiliations
                [ ]Institute of Rare Diseases Research (Instituto de Investigación de Enfermedades Raras, IIER), Carlos III Institute of Health, Consortium for Biomedical Research in Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras-CIBERER), Madrid, Spain
                [ ]Department of Educational Sciences, Utrecht University, Utrecht, The Netherlands
                [ ]Department of Psychology, King’s College London’s Institute of Psychiatry, London, England
                [ ]Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
                [ ]Laboratoire Octogone, EA 4156, Université de Toulouse le Mirail, Toulouse, France
                [ ]Department of Child Neurology and Psychiatry, IRCCS Stella Maris Foundation, Pisa, Italy
                [ ]Department of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland
                [ ]Department of Child and Adolescent Psychiatry, University Medical Centre, Utrecht, The Netherlands
                [ ]Faculty of Education, University Institute of Community Integration (Instituto Universitario de Integración en la Comunidad-INICO), University of Salamanca, Salamanca, Spain
                [ ]Institute of Rare Diseases Research (Instituto de Investigación de Enfermedades Raras, IIER), Carlos III Institute of Health, Madrid, Spain
                [ ]Instituto de Salud Carlos III, IIER-Pab 11, Monforte de Lemos, 5, 28029 Madrid, Spain
                Article
                555
                10.1007/s00787-014-0555-6
                4229652
                24913785
                e5f60509-e2bd-477f-9cbb-49e73b21cbbe
                © The Author(s) 2014

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                : 3 December 2013
                : 31 March 2014
                Categories
                Review
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2014

                Clinical Psychology & Psychiatry
                autism,screening,methods,early,detection,review,europe
                Clinical Psychology & Psychiatry
                autism, screening, methods, early, detection, review, europe

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