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Screen Accurately Identifies Autism at an Early Age

A promising screening tool that elicits responses from parents about potential communication delays accurately distinguishes infants with autism spectrum disorder (ASD) from those with developmental delay and from typically developing children, new research indicates.

And with additional refinements, the same Early Screening for Autism and Communication Disorders (ESAC) will soon be available as a web-based Smart ESAC tool with questions that parents can answer online and receive findings from a healthcare professional should a child screen positive for ASD.

The study was presented at the International Meeting for Autism Research (IMFAR) 2015.

“The big reason why we need better screens for toddlers is that we are not doing well screening in primary care for developmental delays in general and autism specifically.”

Need for a Better Screen

“The big reason why we need better screens for toddlers is that we are not doing well screening in primary care for developmental delays in general and autism specifically,” Amy Wetherby, PhD, distinguished research professor of clinical sciences, Florida State University Autism Institute, in Tallahassee, told Medscape Medical News.

“We know that of those children who are going to meet eligibility criteria for special education, we are catching only about 20% of them in our early intervention system, so we need a better broadband screen so we can catch these children earlier, and families can then access intervention services earlier as well.”

Initially, investigators used a 47-item ESAC questionnaire, but after screening 450 children, they were able to whittle it down to the current 30-item ESAC screen.

Together with the University of Michigan, Florida State University investigators then screened a large cohort of more than 12,000 children in primary care with a communication screen and then followed up with the 30-item ESAC screen.

They used the same 30-item ESAC screen for a second cohort of children referred to either university for possible ASD.

“Gold-standard” diagnostic evaluations were then carried out in a total of 647 children. Children were categorized into three age groups: those between 12 and 17 months of age; those between 18 and 23 months of age; and those between 24 and 36 months of age.

Depending on the age group, the receiver operating characteristic (ROC) curves ranged from 0.70 to 0.93, indicating that the 30-item ESAC screen had good sensitivity and specificity for distinguishing children with ASD from those with developmental delay as well as from typically developing children. (The ROC is a plot of the true positive rate against the false positive rate for different possible cut points of a diagnostic test.)

“We then took these 30 items and with a new sample of children, we have created what we call the best 10 questions to serve as a broadband screener, and we have developed cut points for these 10 questions so that we would not miss any children with development delay,” Dr Wetherby added.

Again, depending on the age of the child, these best of 10 individual items have shown acceptable sensitivity and specificity as a broadband screen for communication delay and will form the basis of an online broadband screen currently under construction.

“The idea here is to have a combined online screen that screens broadly for communication delay, and if a child passes that 10-item screen, the parent’s done,” Dr Wetherby explained.

However, if that 10-item screen comes out positive, “the parent automatically gets the remaining 20 autism-specific questions, and a report will be generated by the system and will be given to the parent by a healthcare professional,” she added.

Investigators are planning to recruit during the next 5 years primary care providers across Florida who will implement screening in more than 8000 infants aged 12 months.

Infants will be followed longitudinally during a 5-year follow-up period. The intent is to confirm the discriminating power of Smart ESAC at 12 and 18 months in being able to predict communication delay and potential risk for ASD.

It is hoped that the proposed research will be of significant benefit with regard to the early detection of ASD and other communication disorders through universal automated screening and will facilitate early introduction of appropriate intensive interventions for ASD.

In the meantime, the team has developed an online Autism Navigator ( for primary care providers, in which the 30-item ESAC screen will be embedded.

The site will also provide online courses for the primary care provider on the diagnosis and management of children with ASD.

In addition, Autism Navigator will offer a collection of tools for families, one of which is available now, About Autism in Toddlers, so that families can learn about the early signs of autism and what they need to do next.

Dr Wetherby reports no relevant financial relationships.

International Meeting for Autism Research (IMFAR) 2015. Abstract 20579. Presented May 15, 2015.

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