Improving the early screening procedure for autism spectrum disorder in young children: Experience from a community‐based model in shanghai

Abstract

Most children with autism spectrum disorder (ASD) are not diagnosed until the age of 4, thus missing the opportunity for early intervention. The objective of this study was to investigate the feasibility of an early screening program for ASD applied during well-child visits in a community-based sample. The study lasted for 4 years and was divided into two stages. Stage I involved the implementation of the basic screening model in 2014. Toddlers received level 1 screening via section A of the Chinese-validated version of the Checklist for Autism in Toddlers (CHAT-23) during 18- and 24-month well-child visits in Xuhui District, Shanghai, China. Screen-positive children were referred to receive section B of the CHAT-23 for level 2 screening, and those still screen-positive were referred to undergo diagnosis and evaluation. Stage II involved the implementation of the improved screening model from 2015 to 2017 with the following modifications: (a) an added observational component in level 1 screening; (b) telephone follow-ups with the screen-positive families; and (c) dissemination of information on ASD to families. The results showed that 42 of 22,247 screened children were diagnosed with ASD. The ASD diagnosis rates were 0.1% in Stage I and 0.21% in Stage II. The screen-positive rate and the show rate of referral for level 1 screening increased by 76.92% and 58.43%, respectively, in Stage II compared to Stage I. Our results suggest that with appropriate logistic support, this two-level screening model is feasible and effective for the early screening of ASD during well-child visits. Autism Res 2018, 11: 1206-1217. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Difficulty in the timely identification of autism spectrum disorder (ASD) results in missed opportunities for many ASD children to receive early intervention. In this study, we established an early screening model for ASD among children aged 18-24 months in the community by relying on the three-level child healthcare system in China. The results showed that this model can effectively identify and diagnose ASD in children at an early age and thus enable early intervention.

A systematic review of screening tools for the detection of autism spectrum disorder in mainland China and surrounding regions

“…Key journals were also monitored after this date, until submission of the manuscript. This led to the identification of two additional studies (C. Li et al, 2018;Sun et al, 2019). Keywords were identified based on our research aims (see Table 1).…”

“…Huang et al, 2016;Liu & Xu, 2015;Sun et al, 2015;Wong et al, 2018;Wu, Chiang, Hou, Chu, & Liu, 2018;Zhou et al, 2015). One study (4.5%) (C. Li et al, 2018) used the CHAT-23 as both a Level 1 screening tool (CHAT-23-A, consisting of the parent report section of the M-CHAT) and Level 2 screening tool (CHAT-23-B, consisting of the observational section of the CHAT). The Level 1 screening tool was applied at 18-to 24-month well-child visits, with children who screened positive referred for Level 2 screening on the same day.…”

“…Children were either from low-risk, community-based cohorts (12 studies; n = 188,881 children, aged 4 months-12 years) (Bu et al, 2017;J. Huang et al, 2017;Jiang et al, 2015;Jin et al, 2018;C. Li et al, 2018;Q.…”

“…Wang et al, 2017;. Three studies reported children who had been first identified at risk of ASD in a local Maternity and Child Health Care Hospital setting who were then transferred to a specialized clinical for a final diagnosis, which was completed by a pediatrician (C. Li et al, 2018;Liu & Xu, 2015;Sun et al, 2015). Two studies validated screening tools (CAST and ASRS; Sun et al, 2015;Zhou et al, 2015) in local autism rehabilitation centers, special schools, and primary schools, using clinical samples with existing diagnoses.…”

A Pilot Investigation of the Social Attention and Communication Surveillance (SACS) Tool for the Early Identification of Autism in Tianjin, China (SACS-C)

“…A recent systematic review jointly undertaken by Australian and Chinese scholars (24) reported that whilst screening tools currently used in China have reasonable psychometric properties for identifying autism in clinical populations, there appear to be no studies undertaken with community-based samples. They stressed the need to align the screening and diagnostic systems in Mainland China with best practice in autism screening and diagnosis (25)(26)(27)(28)(29). Prioritizing the need for community-based screening in the general population with psychometrically and culturally validated tools is needed together with follow-up of children deemed at high-likelihood of autism at the community level so that they are assessed and diagnosed by a specialized multidisciplinary clinical team (24).…”