A Multimedia Screening System for Early ASD Identification in Diverse Populations

用于不同人群早期 ASD 识别的多媒体筛查系统

• 批准号: 8893574
• 负责人: KATARZYNA CHAWARSKA
• 金额: $ 24.98万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-17 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8893574
• 关键词: 8 year old; Administrator; Age; Age of Onset; Agreement; Algorithms; Attention; Autistic Disorder; Behavior; Caring; Child; Childhood; Clinic; Clinical; Collaborations; Collection; Communities; Complex; Data; Detection; Development; Developmental Delay Disorders; Developmental Disabilities; Devices; Diagnosis; Diagnostic; Differential Diagnosis; Early Intervention; Early identification; Early treatment; Electronics; Evaluation; Failure; Feedback; Focus Groups; Future; Generations; Goals; Guidelines; Hand; Hospitals; Human Resources; Language; Life; Measures; Medical; Modeling; Multimedia; Nature; Outcome; Paper; Parents; Participant; Phenotype; Physicians; Population; Population Heterogeneity; Predictive Value; Preparation; Primary Care Physician; Primary Health Care; Process; Property; Provider; Psychometrics; Questionnaires; Recommendation; Records; Recruitment Activity; Research; Resources; Risk; Sampling; Services; Solutions; Specificity; Statistical Models; Surveys; Symptoms; Syndrome; System; Systems Integration; Tablets; Technology; Testing; Text; Time; Toddler; Translating; Validation; Visit; Visual; Work; autism spectrum disorder; base; clinical care; clinical phenotype; collaborative environment; cost; data exchange; digital; early awareness; follow-up; health record; high risk; indexing; information gathering; instrument; literacy; novel; population based; primary care setting; public health relevance; response; screening; socioeconomics; tool; usability

 DESCRIPTION (provided by applicant): Although we now have the tools and expertise to diagnose autism spectrum disorders (ASD) reliably in the 2nd year of life, most children are still diagnosed after their 4th birthday and, in under-resourced, ethnically diverse communities, as late as 8 years of age. These gaps highlight our failure to translate state-of-the art screening and diagnostic practices into practical solutions for identifying the most vulnerable children across socioeconomic strata. This disconnect is highly concerning given that early implementation of treatment leads to more positive outcomes. Factors contributing to the gaps include the limited awareness of early signs of ASD amongst parents and professionals, limited feasibility of deploying traditional paper-and-pencil screeners in primary care centers, and difficulties accessing appropriate services. In low-resource communities, these problems are further compounded by lack of supportive environments and language and literacy issues. This study aims to pilot a solution to surmount some of these challenges through the development of a new generation, tablet-based screening system comprised of two parts: (1) A novel video-based screener (Yale Adaptive Multimedia Screener, YAMS) based on early syndrome expression data collected over a decade at the Yale Toddler Developmental Disabilities Clinic (YTDDC) (Aim 1). By using simple spoken language, this screener will circumvent literacy-related issues. By providing visual examples, it will add clarity to concepts that may be complex for new parents. The screener will be adaptive, with questions contingent on prior responses, thus maintaining diagnostic precision within a time-efficient system highly acceptable by parents and staff; (2) Digital implementation of the M-CHAT-R/F, with automatic scoring for increased efficiency and with high-level interpretations and recommendations to increase physician utility. This adaptation will provide an established measure to augment our research goals and to serve as a comparison system for the YAMS (Aim 3). To gauge the utility and feasibility of our approach (Aim 2), we will test YAMS through collaborations with community primary care centers serving low-resource and ethnically diverse populations. 200 parents will be recruited to participate at their child's 18- or 24-month well-care visit. All who screen positive on the M-CHAT- R/F and/or our YAMS (N~20) will be invited for expert follow-up assessment at the YTDDC. Data from this community screening sample will be augmented by a clinic-based sample of 18-24 month-old toddlers with diagnoses of ASD (N=70), developmental delay (DD, N=20), or typical development (N=70). The combination of these two samples will provide preliminary validation of the usability, utility, and potential of our screener. Our study represens a cohesive, unified approach that leverages the full capabilities of modern, low-cost, hand-held technologies to move us towards the goal of early universal screening for ASD. Our unique focus combines attention to not just the development of the screening system itself, but also the usability of the system in diverse settings and the integration of the screener as a facilitating agent of the clinical care process.

 描述（由申请人提供）：虽然我们现在拥有在生命的第二年可靠地诊断自闭症谱系障碍 (ASD) 的工具和专业知识，但大多数儿童在 4 岁生日后仍然被诊断出来，而且是在资源贫乏、种族多元化的社区中这些差距凸显了我们未能将最先进的筛查和诊断实践转化为实际的解决方案，以识别社会经济阶层中最脆弱的儿童，因为早期实施了治疗，这种脱节令人高度关注。线索造成差距的因素包括家长和专业人员对 ASD 早期症状的认识有限、在初级保健中心部署传统纸笔筛查仪的可行性有限以及在资源匮乏的情况下难以获得适当的服务。由于缺乏支持性环境以及语言和读写能力问题，这些问题进一步复杂化。本研究旨在通过开发新一代基于平板电脑的筛查系统来试行克服其中一些挑战的解决方案，该系统由两部分组成：（ 1）基于视频的新颖筛查仪（耶鲁自适应多媒体筛查仪，YAMS）基于耶鲁幼儿发育障碍诊所（YTDDC）十多年来收集的早期综合症表达数据（目标 1）。提供视觉示例，这将使新父母可能复杂的概念更加清晰。筛选器将具有适应性，问题取决于先前的反应，从而在父母和工作人员高度接受的高效系统内保持诊断精度； (2) M-CHAT-R/F 的数字化实施，通过自动评分来提高效率，并通过高水平的解释和建议来提高医生的效用。这种改编将为增强我们的研究目标并充当我们的研究目标提供既定措施。 YAMS 的比较系统（目标 3） 为了评估我们的方法（目标 2）的实用性和可行性，我们将通过与服务于资源匮乏和种族多元化人群的社区初级保健中心合作来测试 YAMS。参加在孩子 18 或 24 个月的护理就诊时，所有在 M-CHAT-R/F 和/或我们的 YAMS (N~20) 上筛查呈阳性的人都将被邀请在 YTDDC 进行专家后续评估。来自该社区筛查样本的数据将通过基于临床的 18-24 个月大幼儿样本进行扩充，这些幼儿被诊断为自闭症谱系障碍 (N=70)、发育迟缓 (DD，N=20) 或典型发育（N=70）。这两个样本的结合将初步验证我们的筛选器的可用性、实用性和潜力。我们独特的重点不仅关注筛查系统本身的开发，还关注系统在不同环境中的可用性以及筛查仪的集成作为促进。临床护理代理人过程。