Autism spectrum disorder screening in preschools

Abstract

Can non-clinicians spot preschoolers likely to have autism spectrum disorder by observing their everyday peer interaction? We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic “stress test” to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule–2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later (odds ratios = 14.6 and 6.7, respectively). This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder. Lay abstract With professional training and regular opportunities to observe children interacting with their peers, preschool teachers are in a good position to notice children’s autism spectrum disorder symptomatology. Yet even when a preschool teacher suspects that a child may have autism spectrum disorder, fear of false alarm may hold the teacher back from alerting the parents, let alone suggesting them to consider clinical assessment for the child. A valid and convenient screening tool can help preschool teachers make more informed and hence more confident judgment. We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic “stress test” to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule–2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later. This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder.

Autism spectrum disorder screening in Chinese-language preschools

“…Reliability estimates of COS-Teacher and COS-Researcher in this study were comparable to those for the original English COS. Validity of COS-Researcher here closely aligned with prior results. For both the English COS (Au et al, 2021) and Chinese COS here, the Cramer's V measuring the strength of association between the COS-Researcher classification status and subsequent ASD diagnosis was 0.33, with sensitivity and specificity, respectively, around 0.80 and 0.65. Moreover, the AUCs for COS-Researcher in both studies were around 0.80 (p-values < 0.001).…”

“…Cronbach’s alpha was 0.90 for both COS-Teacher and COS-Researcher, indicating good internal reliability. Intraclass correlation coefficients (ICCs; mean-rating ( k = 2), absolute-agreement, two-way random-effects model) for interrater and test–retest reliabilities for COS-Researcher were 0.85 and 0.73, respectively (Koo & Li, 2016) and comparable to those for the English COS (Au et al, 2021).…”

“…COS. The 13-item COS used in Au et al (2021) was translated and back-translated by our Chinese-English bilingual research team. Translation fidelity and quality were checked, and the scale was copyedited by experts in child clinical psychology and developmental psychology.…”

“…Early intervention for children with autism spectrum disorder (ASD) requires early identification. Au et al (2021) developed the 13-item Classroom Observation Scale (COS) as a valid and reliable ASD screening tool for teachers and non-clinically trained observers to make real-time observation of children’s peer interaction (or the lack thereof) in regular preschool classrooms. It focuses on peer interaction because children with ASD often display more noticeable problems (compared to non-ASD children) when they are around peers without adults hovering around to scaffold and instruct (Corbett, Schupp, Simon, Ryan, & Mendoza, 2010).…”

“…Note that social initiation behaviors, relative to social responding (or non-responding) behaviors, might be more readily noticed by teachers and others in a busy preschool classroom. The COS proves to have good psychometric properties and, crucially, strong predictive validity in identifying preschoolers under the age of 4½ years to be more likely than their peers to have ASD diagnosable about 1½ years later (Au et al, 2021).…”