Evaluation des Screeninginstruments „Autism Mental Status Examination“

Background

Diagnostic procedures for autism spectrum disorders (ASD) include a thorough patient history, a clinical evaluation and the use of specific assessment tools, such as the autism diagnostic observation schedule (ADOS). For initial screening other instruments, such as questionnaires addressing the parents as well as affected children also exist. The autism mental status examination (AMSE) was developed to provide clinicians with a short, structured instrument to collate impressions after a clinical exploration. First studies from the USA showed a sensitivity and specificity which were satisfactory for a screening instrument with a cut-off score of 5.

Aim

The specificity and sensitivity of the German-speaking version of the AMSE for detection of ASD were investigated in a psychiatry cohort of children and adolescents.

Material and methods

This article reports the findings of a pilot study on the first use of the German version of the AMSE in 21 children who were evaluated for ASDs.

Results

The findings show a promising overlap with the ADOS and a satisfactory statistically significant correlation of 0.43.

Conclusion

The German version of the AMSE seems to be a promising screening instrument for ASDs; however, it cannot replace specific diagnostic tools.     

An Abbreviated Screening Instrument for Autism Spectrum Disorders

The reliability and validity of the Parent's Observations of Social Interactions (POSI), a new, seven‐item screening instrument for autism spectrum disorders (ASD), is examined in two substudies. In Study 1, parents of 217 children (18–48 months) evaluated at a developmental clinic completed intake questionnaires that included the POSI and the Modified Checklist for Autism in Toddlers (M‐CHAT) checklist. POSI and M‐CHAT scores were compared to clinical evaluation results to assess reliability and validity. In Study 2, parents of 232 children (16–36 months) from both primary care and subspecialty settings completed the POSI, the M‐CHAT, and a report of their child's diagnoses. POSI and M‐CHAT scores were compared to reported diagnoses to assess reliability and validity. In both studies, the POSI demonstrated adequate internal reliability (Cronbach α = 0.83 and 0.86, respectively). In Study 1, POSI sensitivity (89%) was higher than that for the M‐CHAT (71%; p < .05); specificities were not significantly different (POSI: 54%, M‐CHAT: 62%). In Study 2, sensitivity (83%) compared favorably to that for the M‐CHAT (50%), although specificity was lower (75 vs. 84%). Despite its brevity, the POSI demonstrated good internal reliability and comparable sensitivity/specificity to the M‐CHAT checklist in two independent populations. If results are reproduced in larger, more diverse samples, the POSI may provide an efficient method for ASD screening in young children.     

The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program

ObjectiveChildren born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation.MethodChildren aged 18–36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the “at risk” range on either tool were referred for a full diagnostic ASD evaluation.ResultsSixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated “at risk” for ASD. Nine (13 %) scored “at risk” on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %).ConclusionThe ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.     

自闭症谱系障碍的早期筛查工具

基于35项实证研究, 遵循诊断准确性研究的质量评估(QUADAS-2)的循证程序对自闭症谱系早期预警特征筛查工具开展质量评估, 包括婴儿阶段(10个筛查工具, 159388人)、幼儿阶段(14项筛查工具, 11712人), 旨在为自闭症谱系风险的早期识别提供全面的理解。结果表明：幼儿阶段的筛查工具的分类准确性要高于婴儿阶段, 在婴儿阶段达到良好水平的筛查工具有M-CHAT-R/F、PDQ-1; 在幼儿阶段达到优秀水平的筛查工具有OERA、TIDOS。其中, “改良的幼儿自闭症检查表-有修订的后续随访” (M-CHAT-R/F)是目前最具潜力的自闭症谱系风险筛查工具之一。最后, 我们探讨了应用QUADAS-2评估研究质量的局限性, 强调需要规范工具的质量评估标准与进一步验证研究的必要性。     

Underutilization of Genetics Services for Autism: The Importance of Parental Awareness and Provider Recommendation

Reasons for the underutilization of genetics services by families of children with autism spectrum disorders (ASD) are not well understood. We report the identification of factors associated with this underuse. Survey-based study of parents and/or guardians of children with ASD. One hundred fifty-five families completed the questionnaire. Thirty-one of 155 (20%) children had seen a genetics professional. Forty-nine of 154 (32%) children had undergone genetic testing. Parents whose child saw a genetics professional were more likely to 1) Have a primary provider refer for or suggest a genetics evaluation 2) Have asked for a referral, and/or 3) Know another person with a genetic cause of ASD. amilies of children with ASD who have not received genetics services are less aware of their availability and utility. They are also less likely to have their provider recommend a clinical genetics evaluation. Efforts should be taken to increase awareness of both health providers and parents regarding the usefulness of genetics services for ASD.     

Development of motion processing in children with autism

Recent findings suggest that children with autism may be impaired in the perception of biological motion from moving point-light displays. Some children with autism also have abnormally high motion coherence thresholds. In the current study we tested a group of children with autism and a group of typically developing children aged 5 to 12 years of age on several motion perception tasks, in order to establish the specificity of the biological motion deficit in relation to other visual discrimination skills. The first task required the recognition of biological from scrambled motion. Three quasi-psychophysical tasks then established individual thresholds for the detection of biological motion in dynamic noise, of motion coherence and of form-from-motion. Lastly, individual thresholds for a task of static perception--contour integration (Gabor displays)--were also obtained. Compared to controls, children with autism were particularly impaired in processing biological motion in relation to any developmental measure (chronological or mental age). In contrast, there was some developmental overlap in ability to process other types of visual motion between typically developing children and the children with autism, and evidence of developmental change in both groups. Finally, Gabor display thresholds appeared to develop typically in children with autism.     

Predicting developmental deficiencies at the age of four based on data from the first seven months of life

The study examines very young children with the aim of identifying precursors of developmental problems during the first 7 months of age. Information from screening and observations in the birth clinic, in the first level of health care, and from parents was collected on five different occasions. The information that was included concerning the child and family was defined as either optimal or nonoptimal. At the age of 4 years, a clinical group was identified (11.1% of the total population). Logistic regression analyses were performed to detect risk factors. Twenty‐one precursors were used to create a screening questionnaire that provided useful information (sensitivity = 56.1%, specificity = 98.8%) for predicting developmental problems of the children. The contribution of sociodemographic data was significant; medical information was less significant. The highest prediction rate surprisingly was found in the moderate clinical subgroup (62.1%), compared to the group with more severe problems that had a slightly lower rate (46.7%). The conclusion of the study is that it is possible to detect infants in need of early intervention using a continuous process of observation and screening.     

Are children with autistic spectrum disorders susceptible to contour illusions?

Children with autism have been shown to be less susceptible to Kanisza type contour illusions than children without autism ( Happé, 1996 ). Other authors have suggested that this finding could be explained by the fact that participants with autism were required to make a potentially ambiguous verbal response which may have masked whether or not they actually perceived the illusory contours ( Ropar & Mitchell, 1999 ). The present study tested perception of illusory contours in children with autism using a paradigm that requires participants to make a forced choice about the dimensions of a shape defined by illusory contours. It was reasoned that accuracy of the participant on this task would indicate whether or not children with autism could perceive illusory contours. A total of 18 children with autistic spectrum disorder, 16 children with special educational needs not including autism and 20 typically developing children completed an experimental task which assessed perception of Kanisza‐style rectangles defined by illusory contours. There were no significant differences between the performance of the children with autism and either of the two control groups, suggesting that perception of illusory contours is intact in autism.     

Concurrent Validity of the Strengths and Difficulties Questionnaire in an Indigenous Pre-School Population

The strengths and difficulties questionnaire (SDQ) is a frequently used tool for universal screening of pre-schoolers’ behavioural and emotional problems. However, evidence for its concurrent validity is equivocal and has not been tested in a Māori population. We aimed to evaluate the concurrent validity of the strengths and difficulties questionnaire (SDQ) in Māori pre-schoolers (tamariki), aged 4 and 5. We carried out a prospective study of 225 tamariki (46% female) for whom a recent SDQ was available from the New Zealand Ministry of Health’s Before School Check database. A trained nurse carried out a standardised wellbeing and behavioural assessment for these children. Sensitivity, specificity, positive predictive and negative predictive values were calculated, using optimal total difficulty scale threshold values published for the SDQ (parent version SDQ-P; teacher version SDQ-T). Primary outcome: an assessment-based child referral to Child and Adolescent Mental Health Services or to a Paediatric outpatient service. Secondary outcomes: assessment-based parental referral to a parenting programme and combined referral. The optimal thresholds for child referral were low for the SDQ-P (13) and SDQ-T (7). Child referral SDQ-P: sensitivity 62%, specificity 83%, positive predictive value 0.35, negative predictive value 0.94. Child referral SDQ-T: sensitivity 77%, specificity 78%, positive predictive value 0.31, negative predictive value 0.96. The findings demonstrate optimal threshold values for referral for Māori on the SDQ-P and SDQ-T are much lower when compared to published thresholds (17 vs. 16). Sensitivity values were also low. A surveillance approach for the assessment of psychosocial problems is recommended for pre-schoolers.     

Parental Perceptions of Services Provided for Children with Autism in Jordan

Providing formal support for children with autism and their parents is important and mandatory to improve children’s abilities and enhance the capabilities of parents. The present study attempted to investigate the perceptions of parents of children with autism regarding the services provided in Jordan. A questionnaire consisting of five sections was designed and distributed to a sample of 60 parents of children with autism (5–18 years old) among four special education institutions in Jordan. The questionnaire addressed five domains: demographics, type and number of received services, methods and difficulties of obtaining services, parents’ satisfaction, and parents’ perceived needed services. The results revealed that the service delivery system with which parents interacted was composed of multiple places and providers, but had several difficulties. Parents participating in this study expressed an average satisfaction with the received services. Issues pertaining to the cost of services, parents-professional partnerships, and overall quality of services were seen by parents as sources of low satisfaction. On the other hand, parents expressed the need for early intervention, family counseling, and community awareness services. Further suggestions and implications are presented in the study.     

Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the Structured Clinical Interview for DSM-IV-TR Personality Disorders (SCID-II)

This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective analyses of 495 SCID-II interviews. The psychometric properties were studied in a prospective validation study in a random sample of Dutch adult psychiatric outpatients, using the SCID-II interview as the gold standard. First, all patients completed the short questionnaire. One week later, they were interviewed with the full SCID-II. After another week, the short questionnaire was readministered. According to the scores obtained with the full SCID-II, 97 patients (50%) had a personality disorder. The set of 10 SCID-II items correctly classified 78% of all participants. The sensitivity, specificity, and positive and negative power were 0.78, 0.78, 0.78, and 0.78, respectively. The results based on the retrospectively obtained data were rather similar to those obtained in the prospective validation study. Therefore, it is concluded that the set of 10 SCID-II items can be useful as a quick self-report personality disorder screen in a population of psychiatric outpatients.     

Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool

Methods for detecting depression in fathers after the birth of their child are scarce. The Edinburgh Postnatal Depression Scale (EPDS), used to screen mothers for postpartum depression (PPD), lacks somatization and externalizing items. This potentially decreases its sensitivity in detecting depression in fathers, as many men actually express depression with somatization or externalizing symptoms. The present study assessed depressive symptoms in fathers of children 0–18 months old, and evaluated whether addressing both typical depression and externalizing, so‐called “depressive equivalent” symptoms, might be more suitable for such assessment. The Beck Depression Inventory‐II (BDI‐II), EPDS, and Gotland Male Depression Scale (GMDS) were responded to by 447 Swedish fathers online. Among participants, 27% reported depressive symptoms above the BDI‐II cut‐off suggestive of depression. Most fathers reported both traditional and depressive equivalent symptoms and a subgroup expressed exclusively depressive equivalent symptoms. Consistently, a scale combining items from the EPDS and GMDS showed higher sensitivity than the EPDS alone in identifying fathers with elevated depressive symptoms, at equal levels of specificity. Our findings suggest that a combination of EPDS and depressive equivalent symptom items results in a more suitable instrument for screening for depression in fathers during the postnatal period.     

A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD)

Borderline personality disorder (BPD) is a common psychiatric disorder that is often overlooked in treatment settings. This report describes the validation of a new self-report screening measure for DSM-IV BPD--the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Two hundred subjects with treatment histories whose ages ranged from 18 to 59 filled out the MSI-BPD. Each subject was then interviewed, blind to MSI-BPD results, with the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). Of these 200 subjects, 139 (69.5%) met DSM-IV criteria for BPD as assessed by the BPD module of the DIPD-IV and the remaining 61 subjects (30.5%) did not. Using logistic regression analyses, an MSI-BPD cutoff of 7 or more of the measure's 10 items was judged to be the best cutoff. This was so because it yielded both good sensitivity (.81; percentage of correctly identified cases) and specificity (.85; percentage of correctly identified noncases) for the diagnosis of DSM-IV BPD. For younger subjects, diagnostic efficiency was even greater. For example, sensitivity was .90 and specificity was .93 at a cutoff of 7 for the 63 subjects who were 25 years old or younger. The results of this study suggest that the MSI-BPD may be a useful screening instrument for the presence of DSM-IV borderline personality disorder.     

Examination of the screening properties of the personality diagnostic questionnaire 4+ (PDQ-4+) in a prison population

There is a high prevalence of personality disorder in most prison populations. Many pass through the system undiagnosed. A screening instrument would improve identification. This study examined the screening properties of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) in prisoners convicted of violent and sexual offenses. A sample of British prisoners completed the self-report PDQ-4+ and were interviewed using the Structured Clinical Interview for DSM-IV Axis II disorders. When used to generate a total score, the PDQ-4+ had an acceptable overall accuracy as measured by the area under the Receiver Operating Characteristics (ROC) curve. The PDQ-4+ appears to have the properties suitable for use as a screening instrument, particularly when screening for the presence or absence of personality disorder rather than for individual personality disorder categories. A graph is presented from which choices of cut-off score for different combinations of sensitivity and specificity can be made. A cut off total score of 25 or above yielded near optimal sensitivity and specificity. The suggested cut off score for this population is lower than that previously suggested.     

Screening language skills at 2;0

Early screening of children at risk for language difficulties is challenging. This study aimed to analyze the specificity and sensitivity of two screening methods at 2;0 years of age. In addition, the matter of what kind of information the use of word combinations and parental concern provide for screening was analyzed. The subjects were 78 children. The screening methods used were the Finnish versions of the short-form version of the MacArthur Communicative Development Inventories (FinCDI-SF) and the Communication and Symbolic Behavior Scales, Developmental Profile, Infant-Toddler Checklist (FinCSBS). The specificity and sensitivity of the screening methods were analyzed based on result of the Reynell Developmental Language Scales III. Both screening methods had high specificity but only moderate sensitivity. The use of word combinations and parental concern provided relevant information on early language development. The results imply that it is important to take into consideration receptive language development in early screening.     

Psychometric properties of the Movement Assessment Battery for Children‐Checklist as a screening instrument for children with a developmental co‐ordination disorder

Background: The Checklist of the Movement Assessment Battery for Children (MABC) was developed to screen children for movement difficulties in the school situation. However, the psychometric properties of the Checklist have not been investigated in detail. Aim: The psychometric properties of the M‐ABC Checklist were investigated including its usefulness as a screening instrument. Samples: A group of 120 children, 6 to 11 years old, randomly selected from mainstream schools and a group of 64 children, 6 to 9 years old, referred for assessment of their motor functioning. Methods: A reliability analysis was performed to investigate whether the 48 items of the Checklist measure the same construct. Construct validity was investigated by means of a factor analysis. And lastly, the sensitivity, specificity and positive predictive value of the Checklist were investigated by comparing the performance of children on both the Test and Checklist of the M‐ABC. Results: The items of the Checklist measure the same construct. Seven factors were obtained after factor analysis, revealing that the Checklist measures a broad range of motor skills. The Checklist met the standards for sensitivity in all age groups, except in the 8‐year‐old group, where too many children with motor problems were not detected. With the exception of the 6‐year‐old children, specificity was poor. The positive predictive value was acceptable, except for the 7‐year‐old children. Conclusion: the Checklist proved to meet standards for reliability and most aspects of validity. Its use by teachers for screening children with movement difficulties can be recommended.     

Relations between Parenting Stress,Parenting Style,and Child Executive Functioning for Children with ADHD or Autism

Relations among parenting stress, parenting style, and child executive functioning for children with disabilities are not easily teased apart. The current study explored these relations among 82 children and adolescents age 7–18: 21 with attention deficit/hyperactivity disorder, 33 with autism spectrum disorder, and 28 typically developing. Results indicated that children with attention deficit/hyperactivity disorder or autism spectrum disorder had more executive functioning deficits, and their parents reported more parenting stress and a greater use of permissive parenting, compared to typically developing children. In general, increased parenting stress was associated with greater use of authoritarian and permissive parenting styles, as well as more problems with behavior regulation for children. Authoritarian and permissive parenting styles were associated with poorer child executive functioning. Child diagnostic group (attention deficit/hyperactivity disorder, autism spectrum disorder, typically developing) moderated relations between parent stress and child functioning, and between parenting style and child functioning. Implications for intervention with families of children with disabilities are discussed.     

Autism spectrum conditions among children and adolescents: A new profiling tool

There is considerable debate about the sociocognitive features of autism spectrum conditions (ASC), and a tool for profiling the sociocognitive profiles of children and adolescents with ASC is needed. The aim of this research was to evaluate the psychometric properties of a new questionnaire—The Australian Scale for Autism Spectrum Conditions (ASASC). Three hundred twenty‐two parents of children on the ASC spectrum, including autistic disorder (n = 76), Asperger's disorder (n = 188), and pervasive developmental disorder not otherwise specified (n = 21), and a clinical group of children with subclinical ASC features and no ASC diagnosis (n = 37). Measures include an initial scale measuring eight potential dimensions of ASC, a related screening tool for autism, and two previously validated social skills questionnaires. The questionnaires were administered online. The ASASC was factor‐analysed, internal and test–retest reliabilities (for a randomly selected 84 parents) were calculated, and preliminary tests of convergent and divergent validity were conducted. The resulting measure (44 items) contained five coherent and reliable dimensions: understand and express emotion, fact orientation, sensory sensitivity, social communication, and rigidity. The questionnaire had good test–retest reliability and convergent/divergent validity. The ASASC enables profiles of ASC symptomatology that should be useful in adjusting interventions to individual needs.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.