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Use of the CHILD Behavior Checklist 11/2–5 As a Screening Tool to Identify High-Risk Siblings Who Require Clinical Assessment
Younger siblings of children with autism spectrum disorder (ASD) are at higher risk of developing ASD themselves, therefore their surveillance by community health providers is pivotal in order to determine whether they need referral for further assessments. A variety of standardized tools and screening instruments have been developed to inform clinical decision-making. However, early identification is complex, especially in children who may show sub-clinical ASD symptoms or other developmental problems due to a familial genetic risk.
Objectives:
This study aimed to investigate the utility of a parent completed questionnaire - the Child Behavior Checklist (CBCL 11/2–5) - in identifying toddlers who require further specialist assessment, in a population of siblings at genetic risk for ASD.
Methods:
CBCL profiles of 40 toddlers (18 mos.) at genetic risk for ASD, recruited through a surveillance programme, were compared with those of 40 toddlers with no familiarity for ASD (18-24 mos.) recruited through local kindergartens. Toddlers in the high-risk group underwent clinical assessment with the Autism Diagnostic Observation Schedule -ADOS and a best estimate diagnosis was obtained, in accordance with DSM-5 criteria (Outcomes: 9 ASD; 31 no-ASD). Scores on the CBCL questionnaire were compared within the sibling group, to evaluate possible differences between siblings with and without an ASD diagnosis and correlated with the ADOS clinical assessment (ADOS total score).
Results:
As a group, siblings at risk for ASD did not present significant differences in their CBCL profiles in comparison with the TD group. Subtyping the sibling group on the basis of the clinical diagnosis enabled us to observe that 5 of the CBCL scales significantly differentiated siblings with an ASD outcome from siblings with a familial risk but no ASD outcome (p< .05): Somatic Complaints, Withdrawn, Attention Problems, Internalizing Problems and Autism Spectrum Problems. Indeed, higher scores on these scales were positively correlated with higher ADOS total scores (p< .05) and an outcome of ASD as estimated by clinical judgement (p< .05).
Conclusions:
These preliminary findings suggest the utility of the CBCL scales, in particular, of 5 scales (Somatic Complaints, Withdrawn, Internalizing, Attention problems, and Autism Spectrum Problems) in identifying siblings at genetic risk for ASD who need further specialist assessment for ASD, as early as 18 months of life.