Web-Based Training In Early Autism Screening with the STAT: Results From a Pilot Study

Background: Early identification of autism is a critical first step toward providing the specialized intervention services that are associated with significant gains in learning and behavior.  Yet there is a considerable delay between the average age of initial parent concerns (16-20 months) and the age at which children receive a definitive diagnosis (3-4 years).  This delay is due in part to a lack of familiarity with the early behavioral manifestations of autism by community service providers.  The Screening Tool for Autism in Toddlers and Young Children (STAT) (Stone et al., 2004; 2008) is a level 2 screening tool specifically developed to help community service providers identify early behavioral features of autism, thus facilitating earlier referral and treatment.  Because of the interactive format of the STAT and the subtlety of the early social-communication markers of autism, training is necessary to ensure appropriate administration and interpretation.  Although STAT training workshops are available, the limited number of trainers and training locations can impede access. One way to increase accessibility to this training is through interactive, multi-media, web-based technologies.

Objectives:  To develop and evaluate the efficacy and acceptability of a web-based, multi-media, interactive tutorial for community service providers on the administration and scoring of the STAT.

Methods:  Thirty community health care professionals from 3 geographic areas (Madison, WI; Nashville, TN; and Atlanta, GA) participated.  Professional backgrounds included psychologists, pediatricians, speech-language pathologists, research assistants, nurses, and occupational therapists. The average length of time working in their current occupation was 11.4 years (range 1-36 years, mode = 2 years).  Roughly 1/3 reported having little or no training on autism assessment. 

The STAT consists of 12 play-based items that evaluate behaviors in four social-communicative domains: Play, Requesting, Directing Attention, and Motor Imitation.  The STAT Training Tutorial contains a general overview on the structure of the STAT; general administration conventions; item-specific content, concepts, and scoring conventions; and a 25-item pre-and post-test to assess understanding. Completion of the tutorial takes about 3 hours. Participants first completed the pre-test, then completed the STAT tutorial at their own pace, and then completed the post-test and a user satisfaction questionnaire.

Results:  

Mean scores on STAT concepts improved after taking the tutorial, from 15.7 (SD=2.2) at pre-test to 21.4 (SD=1.8) at post-test (mean change = 5.7 (SD=2.7), t(29) = 11.5, p < .001. At pre-test, only 1 person (3%) obtained correct scores on at least 80% of the items (our a priori cutoff for a ‘pass’), compared to 22 (73%) at post-test, c²(1)=31.09, p < .001.  The majority of trainees “agreed” or “strongly agreed” with statements indicating they enjoyed taking the tutorial; thought it was well organized, relevant, interesting, and useful; thought the time allotted to each section was about right; and felt it was easy to understand and operate.

Conclusions:  The STAT Training Tutorial was successful in increasing community providers’ knowledge of STAT concepts, administration, and scoring, and was rated highly in user satisfaction.  As such, the tutorial promises to be an effective educational tool for promoting early identification of autism.