Sensitivity of toddler screening: Integrating concurrent and prospective strategies to detect ASD

幼儿筛查的敏感性：整合同步和前瞻性策略来检测 ASD

• 批准号: 10680190
• 负责人: Diana L Robins
• 金额: $ 69.06万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680190
• 关键词: 14 year old; 3 year old; 8 year old; Academy; Address; Age; American; Benefits and Risks; Characteristics; Child; Childhood; Classification; Clinical; Communities; Complement; Data; Detection; Diagnosis; Disparate; Early Diagnosis; Early Intervention; Education; Enrollment; Evaluation; Female; Goals; Health; Literature; Masks; Measures; Medical Records; Methods; Minority; Outcome; Parents; Participant; Pattern; Pediatrics; Positioning Attribute; Prevalence; Primary Care; Prospective Studies; Provider; Readiness; Recommendation; Records; Reporting; Research; Resources; Risk; Sampling; School-Age Population; Screening procedure; Secure; Sensitivity and Specificity; Signal Transduction; Site; Standardization; Symptoms; Testing; Time; Toddler; United States Preventative Services Task Force; Visit; Well Child Visits; aged; autism spectrum disorder; autistic children; checkup examination; clinical diagnosis; clinically significant; cohort; cost; disorder risk; disparity reduction; early screening; follow-up; improved; male; primary care setting; prospective; psychiatric comorbidity; public health relevance; screening; tv watching; validation studies; web portal

Screening for autism spectrum disorder (ASD) during well-child pediatric check-ups reduces the age of diagnosis, allowing more time for critical early intervention. Furthermore, universal screening mitigates disparities in the age of diagnosis for minorities, and has been demonstrated to be feasible in community- based primary care settings. However, limited follow-up of toddlers who screened negative is a notable gap in the literature that contributed to the United States Preventive Services Task Force’s (USPSTF) determination of insufficient evidence to recommend universal ASD screening at present. Follow-up of children who are not identified at risk is cost- and labor-intensive, but is critical to determine the sensitivity of toddler ASD screening. This study will be among the first to use rigorous prospective detection strategies in a large, low-risk sample that previously had concurrent detection. The goal of the proposed study is to find missed cases by rescreening children who were not identified with ASD during the course of three prior screening studies that administered the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up during toddler well child visits. This includes those who screened negative as toddlers, as well as children who screened positive but either were lost to follow-up or were evaluated and not diagnosed with ASD. The specific aims are to measure prospective sensitivity using rigorous case confirmation for potential missed cases. We will identify patterns in toddler screening outcomes for these missed cases; we predict that children whose first screen was younger and those who did not complete multiple screens are more likely to be missed cases compared to those screened at older toddler visits and rescreened by age three. Finally, we will examine whether missed cases are more likely to have milder ASD symptoms, greater likelihood of psychiatric comorbidities, and be female compared to children who demonstrated risk as toddlers but were not diagnosed with ASD until they were older. Although these characteristics have been hypothesized, rigorous evidence is lacking to demonstrate differences between children with ASD missed by toddler screening. The majority of the multi-site sample (total n = 8,751) screened negative at one or more pediatric visits between 1 and 3 years old (n = 8,091). In addition, we will rescreen children who screened positive but did not attend the evaluation (n = 426), which often signals lack of parent concern, and children evaluated and classified as nonASD (n = 234), who may have developed clinically significant ASD symptoms as they aged. Parents will be invited to enroll and rescreen their child, now 7-14 years old, using a secure web-based portal. All at risk children, and a random sample of low-risk cases, will be invited for a comprehensive, research-reliable evaluation; final ASD outcomes will be used to calculate prospective sensitivity, which will be compared to literature reporting sensitivity based on record review strategies. Results of this proposed study will directly address a gap identified by the USPSTF, and will address the Interagency Autism Coordinating Committee’s Question 1 about early detection of ASD.

筛查自闭症谱系障碍（ASD）在儿童小儿检查期间 诊断，为重要的早期干预提供更多时间。此外，普遍筛选减轻 少数民族诊断时代的差异，已被证明是在社区中可行的 基于初级保健设置。但是，筛选负面的幼儿的随访有限是显着的差距 为美国预防服务工作组（USPSTF）确定做出贡献的文献 目前不足以推荐通用ASD筛查的证据。不在的儿童跟进 确定处于危险中的是成本和劳动力密集的，但对于确定幼儿ASD筛查的敏感性至关重要。 这项研究将是最早在大型低风险样本中使用严格的前瞻性检测策略的研究之一 以前有并发检测。拟议的研究的目的是通过 在三个先前的筛查研究过程中，未与ASD识别的儿童纠正儿童 管理幼儿自闭症的修改清单，修订，并在蹒跚学步的孩子期间进行跟进 访问。这包括那些筛选为幼儿负面的人，以及筛选阳性但 要么丢失了随访，要么被评估，也未被诊断为ASD。具体目的是衡量 潜在的案例确认潜在的丢失病例。我们将确定模式 这些错过的案件的幼儿筛选结果；我们预计第一个屏幕很年轻的孩子 与那些未完成多个屏幕的人相比，更有可能被遗漏 在较旧的小孩访问中进行筛选，并在三岁时进行审查。最后，我们将检查是否错过案件 更有可能患有Miller ASD症状，更大的精神合并症，并且是女性 与表现出幼儿风险但没有被诊断为ASD的孩子相比 尽管已经假设了这些特征，虽然较旧，但缺乏严格的证据来证明 幼儿筛查错过的ASD儿童之间的差异。大多数多站点样本（总数 n = 8,751）在1到3岁之间的一个或多个儿科探访下进行筛查（n = 8,091）。此外， 我们将重新筛选筛选阳性但没有参加评估的孩子（n = 426），这通常是发出信号的 缺乏父母的关注，对儿童进行评估和归类为nonASD（n = 234），他们可能已经发展 临床意义的ASD症状随着年龄的增长。父母将被邀请入学并重新分校，现在 7-14岁，使用安全的基于Web的门户。所有有风险的儿童，以及随机的低风险病例样本， 将邀请进行全面，可靠的评估；最终的ASD结果将用于计算 前瞻性敏感性将与基于记录审查的文献报告敏感性进行比较 策略。这项拟议研究的结果将直接解决USPSTF确定的差距，并将 解决机构间自闭症协调委员会关于ASD早期发现的问题1。