The Utility of a Social Emotional Questionnaire in Identifying Autism Symptomatology in Toddlers with Autism Spectrum Disorder

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that, among other things, can result in deficits in social emotional functioning (APA, 2013). The Ages and Stages Questionnaire: Social Emotional (ASQ:SE) is a social emotional screening instrument for children 1 through 72 months of age, but has rarely been used as a screener in children suspected of having ASD. Since the ASQ:SE screens for difficulties in self-regulation, compliance, communication, adaptive behaviors, autonomy, affect and interaction with people, it may be an ideal adjunct to more commonly used screening tools for ASD to ensure that we are comprehensively understanding the profiles of individual children with ASD.

Objectives: The current study seeks to examine the ability of the ASQ:SE to accurately screen for ASD symptomatology in toddlers 16-43 months who have been referred for an ASD evaluation.

Methods: Participants included 130 toddlers (103 males) who were participating in a larger research study examining the efficacy of eye-tracking technology in distinguishing children with ASD from those without. Of the 130 toddlers, 116 (93 males) received an ASD diagnosis and the others displayed no clinical concerns. Caregivers completed the ASQ:SE as well as the M-CHAT-R prior to their appointment. Each participant was also assessed with the Mullen Scales of Early Learning (Mullen) and the Autism Diagnostic Observation Schedule, 2^nd Edition (ADOS-2).

Results: The ASQ:SE was strongly correlated with scores on the M-CHAT-R (r(128) = .479, p < .0001). Total scores from the ASQ:SE were significantly negatively correlated with all assessed domains of the Mullen (p < .05). Additionally, on the ADOS-2, Social Affect, Restricted/Repetitive Behaviors, and total scores were all significantly positively correlated (p < .05). See Table 2. 91.4% of children who were identified as having ASD failed the ASQ:SE, whereas 85.3% failed the M-CHAT-R. Of the 17 children who did not fail the M-CHAT-R, the ASQ:SE identified 10 of them who ended up with the ASD diagnosis. No differences were found between the children who failed the ASQ:SE and the children that did not. Characteristics, including behavioral patterns, of toddlers who passed the screening tools despite having an ASD diagnosis will be examined.

Conclusions: Social emotional screening tools can be helpful additions to identifying children with ASD. In combination with ASD specific screening tools, such as the M-CHAT-R, almost 94% of children, who had an ASD diagnosis were identified. The ASQ:SE was able to identify an additional 8% of children that the M-CHAT-R would have missed if used in isolation. The children assessed in this study were those whose parents or other professionals already had a concern about ASD, and thus, it is interesting that screening tools did not identify all children. Children who did not fail the ASQ:SE did not differ in their presentation when compared to children who failed it. This study shows results that indicate that the ASQ:SE could be a useful complement to identifying children with ASD within a diagnostic work up. Limitations including age restrictions on the M-CHAT-R will be discussed.