Validation of the Electronic Modified Checklist for Autism in Toddlers, Revised with Follow-Up: A Nonrandomized Controlled Trial.

OBJECTIVE: To examine the classification rates and screening properties, including sensitivity and specificity, of the web-based Modified Checklist for Autism in Toddler, Revised with Follow-Up (M-CHAT-R/F) compared with paper-phone administration, and to determine the extent to which electronic M-CHAT-R/F streamlines screening, increases screening fidelity, increases diagnostic evaluation participation, and decreases waiting time from screening to evaluation compared with paper-phone modality. STUDY DESIGN: Primary-care practices in urban and suburban settings administered either the web-based or paper-phone M-CHAT-R/F using a prospective nonrandomized control design. Toddlers (n = 17 900) were screened between 2009 and 2016 at routine well-child check-ups. Toddlers who screened at risk on the M-CHAT-R/F were invited to complete diagnostic evaluations; 176 children were diagnosed with autism. The χ2, Fisher exact, and t-tests, as well as regression and screening properties, were used to compare outcome distributions, screening properties, and implementation by modality. RESULTS: Classification rates of the initial M-CHAT-R into low, medium, and high risk were significantly different across modalities with very small effect sizes. Sensitivity and specificity were high across both modalities. For children in the medium-risk range, the web-based modality had a greater rate of predicting risk for autism after Follow-Up compared with the paper-phone modality, and the web eliminated delay between initial screen and Follow-Up. The web-based modality showed increased screening fidelity, no data loss, and similar rates of evaluation attendance and time to evaluation from Follow-Up administration. CONCLUSIONS: The web-based M-CHAT-R/F is a valid tool for universal autism screening. Systems-level decisions should balance the increased feasibility of the electronic administration with the increase in Follow-Up accuracy provided by skilled clinician interview.

Associations between autistic traits and fractional anisotropy values in white matter tracts in a nonclinical sample of young adults.

Whereas a number of studies have examined relationships among brain activity, social cognitive skills, and autistic traits, fewer studies have evaluated whether structural connections among brain regions relate to these traits and skills. Uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF) are white matter tracts that may underpin the behavioral expression of these skills because they connect regions within or provide sensory information to brain areas implicated in social cognition, and structural differences in these tracts have been associated with autistic traits. We examined relationships among self-reported autistic traits, mentalizing, and water diffusivity in UF and ILF in a nonclinical sample of 24 young adults (mean age = 21.92 years, SD = 4.72 years; 15 women). We measured autistic traits using the Autism-Spectrum Quotient, and we measured mentalizing using the Dynamic Interactive Shapes Clips task. We used Tract-Based Spatial Statistics and randomize to examine relationships among fractional anisotropy (FA) values in bilateral ILF and UF, age, cognitive abilities, autistic traits, and mentalizing. Autistic traits were positively related to FA values in left ILF. No other relationships between FA values and other variables were significant. Results suggest that left ILF may be involved in the expression of autistic traits in individuals without clinical diagnoses.

Using the BASC-2 Parent Rating Scales to Screen for Autism Spectrum Disorder in Toddlers and Preschool-Aged Children.

Early identification of toddlers and preschool-aged children with autism spectrum disorder (ASD) is important for ensuring that these youth receive targeted early intervention services. Identifying young children with ASD is complicated by overlap among symptoms of ASD and other developmental delays. Additionally, youth with ASD have a higher risk of experiencing co-occurring challenging behaviors that are beyond the diagnostic criteria for ASD (e.g., attention difficulties, anxiety). Given this, broadband behavioral assessments that measure symptoms of ASD as well as other behavioral and emotional challenges offer a cost-effective method for screening young children. The present study evaluated the utility of one such assessment, the Behavior Assessment System for Children, Second Edition, Parent Rating Scale-Preschool (BASC-2 PRS-P), for identifying young children with ASD from those with other diagnoses (including other developmental delays) and those without diagnoses. The sample included 224 toddlers and preschoolers (age range: 24-63 months, males n = 153 [68 % total sample]) who screened positive on an ASD-specific screening tool. Results demonstrated that the Developmental Social Disorders (DSD) scale on the BASC-2 PRS-P had adequate sensitivity and specificity values when distinguishing youth with ASD from those without any diagnoses, but not when differentiating between youth with ASD and those with other diagnoses. Similar to other multidimensional behavior rating scales, the BASC-2 PRS-P may be most useful for identifying young children who require comprehensive diagnostic evaluations.