The Utility of Parent Completed Questionnaires in Age-Specific Protocols Designed to Identify Children at Risk for Autism Spectrum Disorders at an Early Age

Background: Despite increased awareness, many children are still not diagnosed with Autism Spectrum Disorders (ASD) until they are four or older, when the syndrome has been clearly established. Since early intervention has been proved to alter the course of symptoms and the severity of the disorder, numerous lines of research have been focusing on ways to anticipate the age of diagnosis. As the diagnosis of autism is currently based on the observation of the child’s behaviour, the development of age-specific protocols for early diagnosis might help clinicians in the process of identifying children at risk for ASD at an earlier age.

Objectives: This study investigated the utility of parent completed questionnaires in identifying toddlers at risk for ASD, as part of a larger ongoing project on the validation of age-specific protocols, specifically designed to identify and diagnose children with ASD at an early age.

Methods: Three groups of children were enrolled in this study and followed longitudinally from 12 to 24 months of age: 30 siblings of children with a diagnosis of ASD; 30 clinically referred children, who were receiving medical attention at a local hospital; 30 typically developing children recruited at local kindergartens. Parents of all three groups were administered a set of age-specific questionnaires (FYI, ITSEA, QUIT, PSI, EMQ, CDI, QBUL, M-CHAT, CBCL, SCQ, RBS-R, Sensory Profile), and children underwent clinical assessment with the Autism Diagnostic Observation Schedule –ADOS and the Griffiths Developmental Scales – GMDS-ER. Parent ratings across groups were compared using an ANOVA with Bonferroni's post hoc tests, and correlation and regression analyses were performed to evaluate to what extent they predicted diagnostic outcome.

Results: The analyses that have been performed so far indicate that some questionnaires might be particularly helpful in clinical decision-making. For example, the Competence domain of the ITSEA at 12 months significantly differentiated all three groups (p≤.01) and significantly correlated with clinical outcomes (p≤.05), with higher scores being more frequently associated with lower cognitive functioning and higher scores on the ADOS at 24 months. The Withdrawn scale of the CBCL at 18 months significantly differentiated siblings with an ASD outcome both from typically developing toddlers and siblings with a familial risk but no ASD outcome (p≤.05). Regression analysis showed that higher scores on the Withdrawn scale predicted an outcome of ASD (p≤.003).

Conclusions: These preliminary results suggest that some subscales of broadband questionnaires investigating the acquisition of interpersonal and social-communication competences may be used in clinical practice to guide clinicians in the challenging task of performing an early diagnosis of ASD. This result appears consistent with findings from previous studies, which show that between 12 and 24 months red flags should be looked for in gaps in the acquisition of normal evolutionary skills, rather than in the presence of specific behavioural symptoms.