A Multimedia Screening System to Predict ASD Symptoms in Diverse Community Settings: Preliminary Convergent and Concurrent Validity

Background:

Earlier identification of ASD leads to earlier, more effective treatment. Many infants and toddlers with ASD would not be identified, however, without formal screening (Miller et al., 2011). ASD-specific screening, increasingly routine in well-child pediatric visits (Arunyanart et al., 2012), may benefit from new generations of tools that improve accuracy in the youngest children and decrease time burden. Furthermore, disparities exist in screening accessibility in racially- and economically-diverse populations (Herlihy et al., 2011). Electronic multimedia applications can provide remote administration of video illustrations to improve clarity, usability, and accessibility across diverse cultural and socioeconomic groups. The Yale Adaptive Multimedia Screeners (YAMS-One and YAMS-Toddler) were developed to fill these needs.

Objectives:

To evaluate preliminary convergent and concurrent validity in a pilot of the YAMS system in multiple community pediatric primary care sites.

Methods:

200 families from three urban community pediatric locations and 48 families attending a research clinic participated by completing age-appropriate versions of the YAMS via iPad: 1) the YAMS-One (for 10-16-month-olds; n=51 community infants, M_age=14m) along with a text-only version of the Communication and Symbolic Behavior Scales Infant-Toddler Checklist (CSBS-ITC; Wetherby & Prizant, 2002); or 2) the YAMS-Toddler (for 17-33-month-olds; 149 community toddlers, 48 research clinic toddlers, M_age=26m) accompanied by a text-only version of the M-CHAT-Revised/Follow-Up (Robins et al., 2014). Children in the research clinic sample were concurrently administered the ADOS-2 Toddler Module. The community sample was racially- and ethnically-diverse (88% non-white, 44% Hispanic) with a range of SES backgrounds: 51% of mothers had a high school degree or less. The research clinic sample was less diverse (20% non-white; 22% Hispanic) and more highly-educated (87% of mothers had a college degree or more). We used Pearson’s r to examine associations between the YAMS-One/CSBS-ITC scores and the YAMS-Toddler/M-CHAT-R/F scores, respectively, to test preliminary convergent validity. To examine concurrent validity, Pearson’s r measured the relationship between YAMS-Toddler scores and ADOS-Toddler Social Affect scores.

Results:

Pearson correlations showed high positive correspondence between YAMS-Toddler scores and M-CHAT-R/F final scores in both community (r(149)=.617, p<.001) and research clinic samples (r(48)=.825, p<.001). YAMS-One scores were marginally associated with CSBS-ITC Composite Scores, including Social Composite (r(51)=-.245, p=.08) and Symbolic Composite (r(51)=-.248, p=.08) but not Speech Composite (p=.66) in the community sample. In the research clinic sample, there was a significant correlation between YAMS-Toddler scores and ADOS SA scores (r(46)=.662, p<.001).

Conclusions:

Results suggest good convergent and concurrent validity for YAMS-Toddler in both diverse community samples and research clinic samples. YAMS-One (infant version), was only modestly associated with CSBS-ITC scores. The latter is a broadband screener for social-communication delays, while the YAMS-One taps into attention and emotion regulation constructs as well as social communication, all of which may characterize prodromal symptoms of ASD around the first birthday. Longitudinal follow-up will yield information on the predictive power of the YAMS-One for later autism severity. The YAMS system shows promise as a valid ASD screener that capitalizes on modern technology to enable more efficient screening, using video supports to broaden accessibility across socioeconomic and cultural barriers.