Detection of Ignored Autism Spectrum Disorder By Simple External Observation in Kindergarten: A Proof of Concept Study

Background:

Kindergarten is a privileged opportunity to observe children’s behavior in a natural context. This possibility allows for detecting signs of derangement in motor and neuropsychological development not otherwise previously observed.

Our group has developed a standardized protocol with a checklist containing over 284 items for carefully detecting delay in the acquisition of a given capacity according to age related international developmental nomograms.

Objectives:

The aim of this study is to assess the feasibility and effectiveness in the screening of ASD by simply observing child behavior while at Kindergarten.

Methods:

The protocol included two different tests:

• The Denver Developmental Screening Test (Denver test)is a 41 item test for screening development of infants and preschool-aged children; items cover four general functions: personal social (e.g. smiling), fine motor adaptive (e.g. grasping and drawing), language (e.g. combining words), and gross motor (e.g. walking). Test age range 0-6.
• The Adaptive Behavior Assessment System – Second edition (ABAS – II) containing 216 items is a global and normative assessment scale of behavior that measures daily life skills. The project protocol provides for teacher/caregivers questionnaires regarding subjects aged 2-5. It investigates 10 adaptive areas: Communication, Preschool/School skills, self-Control, Playing/leisure, Socializing, Self-Care, Home Care/School, Environmental Use, Health and Safety, Work.

Expert psychomotor and education therapists with the supervision of a senior neuro-pediatrician (MN), observed and interacted with 62 children, aged 36 - 65 months, attending the “Istituto Comprensivo Don Milani” in Tavernerio (Como, Italy) during two sessions and after obtaining written informed consent.

Seven out of 62 children were found to be affected by neuro-psychiatric disorders (ASD; Down syndrome; delay of psychomotor development; Cerebral Palsy; developmental disorder; hyperactivity)

Our staff was pleasantly accepted in the classroom and was able to collect all the information required. The school teachers learned basic skills to heighten their observation capabilities in child behavior as a result of interacting with our professional staff.

Results:

In the 55 children without previous diagnoses of neuro-psychiatric disorders, the application of the Denver test and ABAS scales pointed out the presence of 7 and 12 cases respectively with at least one (range 1 - 6) item not corresponding to chronological age. The integration of this information with the experience and skills of our staff resulted in the recognition of possible undetected developmental disorders and the subsequent invitation to parents to bring the children in question to a neurodevelopmental diagnostic unit.

In one of these cases, an Autism Spectrum Disorder (ASD) diagnosis was made.

In one of two other cases, parents did not continue with the diagnosis, in the other, a pediatric psychiatrist did not confirm the presence of language developmental delay (table 1).

Conclusions:

This experience shows that structured external observation in a kindergarten is a feasible and promising approach for the screening and the early detection of neurodevelopmental disorders. ABAS II seems to provide increased sensitivity in detecting suspicious cases.