A Comparative Study of Verbal Autistic Children on Language Skills Using the CCC-2 - Brazilian Version

Background: Social communication problems is a core group of symptoms for the diagnostic definition of autism spectrum disorders (ASD). In low or middle developed regions of the world, frequently it is difficult to find speech therapists and other speech specialists with adequate clinical experience in ASD, in order to provide screening or assessment of language problems or even for identify ASD children correctly. Consequently, caregivers self administered questionnaires or inventories for language symptoms could be an useful and practical way to perform screening for ASD in verbal competent children.

Objectives: To investigate comparatively the performance of CCC-2 on verbal ASD children in the subscales and global assessment for social communication problems and its potential for application as screening instrument for ASD

Methods: The study design was an observational, cross sectional, comparative case-control study design with two groups. The case group (N=20) was composed by verbal ASD children from four to sixteen years of age. The control group (N=20) was composed by typically developed children of the same age profile and sex distribution and free of behavioral or language problems. ASD children and their caregivers were recruited from the Child Psychiatry Outpatient Clinic of the University Hospital at the School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil. We use the Brazilian version of CCC-2 (Children’s Communicative Checklist – second edition), originally developed by Bishop (1998) and translated from english to Brazilian portuguese by Costa and colleagues (2013). The diagnosis of ASD was performed according to the current DSM-5 (American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders – Fifth edition) criteria by a team of trained child psychiatrists, according to the standardized clinical protocol of the Child Psychiatric Outpatient Clinic.

Results: No statistically significant difference was found regarding socioeconomic variables as well regarding educational level of parents. The GCC (General Communication Composite) Standard score of the ASD group reached a lower mean value (M = 82.35; SD = 13.34) in comparison with the control group (M = 105.1; SD = 7.98). The difference of means was statistically significant (F = 42.83; p < 0.001). The ROC analysis identified a cutoff point for the GCC score of ≤ 95 with 85% sensitivity and 90% specificity (AUC = 0.936; p < 0.001). When using the GCC Percentile Rank, we found a mean score for the ASD group of 19.30 (SD = 19.63) and of 62.05 (SD = 18.50) for the control group. The difference of the mean GCC Percentile Ranks between the two groups was statistically significant (F = 50.25; p < 0.001). The ROC analysis for the GCC Percentile Rank identified a cutoff point at percentile ≤ 37, with 85% sensitivity and 90% specificity (AUC = 0.936; p < 0.001).

Conclusions: The results demonstrate a good discriminating performance of the CCC-2 Brazilian version for the screening and high suspicion for the identification of verbal ASD children.