Early Screening for Autism Spectrum Disorders (ASD) in Two-Year-Old Children with Visual Impairment and Longitudinal Outcomes

Poster Presentation
Thursday, May 2, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
N. J. Dale1, E. Sakkalou2, M. De Haan3 and A. Salt4, (1)Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom, (2)UCL Great Ormond Street Institute of Child Health, London, United Kingdom, (3)UCL Institute of Child Health, London, United Kingdom, (4)Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
Background: Children with congenital profound or severe visual impairment (VI) are at high risk of ASD and social-communication difficulties (prevalence of ASD ~30%). Existing tools used to measure socio-communicative development and ASD are highly vision-dependent and not valid for children with VI. We recently validated a novel visual impairment social-communication observational schedule (VISCOS), drawing on principles of ADOS but specifically designed for 4-7 year olds with VI. We developed initial validation against expert clinician formulation and have identified children who are at high risk of ASD. A proportion of children who participated in the VISCOS at 4-7 years, also participated at 2-years-old in standard behavioural items and social ‘presses’ to elicit social and communicative behaviours and coded using the Social Communication Schedule (SCS-2), which was non vision-dependent. The SCS-2 includes a Social-Communicative ability Scale (SCS) and a Negative Behavioural Screener (NBS) of repetitive and restricted behaviours.

Objectives: To carry out longitudinal analyses between the SCS-2 and clinician and VISCOS outcomes, to establish construct validity between tools. To examine whether the SCS-2 could act as a potential early screener to identify children at-risk of ASD.

Methods: Preliminary data from 39 children at 24 months (M=25.51, SD=2.36) with VI from the longitudinal OPTIMUM project were rated using the SCS (high scores indicated better social communicative abilities) and a negative behaviour screener (NBS – higher scores indicated more negative behaviours), whilst engaging in social and independent play tasks. The same children participated in the VISCOS assessments at 4-7 years (M=64.04, SD=8.12) - DAiSY study.

Results: A Kruskal-Wallis test examined differences in the 3 clinician categories (Non-ASD, Borderline, ASD) and SCS and NBS. A significant difference was found between groups on SCS scores, with a difference present between the Non-ASD group and the ASD group χ2(2)=8.2, p=0.17; children in the ASD group (N = 6; M=16.83 SD=9.13) scored lower SCS scores than children in the Non-ASD group (N= 28; M=26.14 SD=5.75). A Mann-Whitney U-test comparing the combined ASD+Borderline group to the Non-ASD group found the ASD+Borderline group scoring lower (N=11; M=18.63 SD=7.47) on SCS than the Non-ASD group (N=28; M=26.14 SD=5.75), U=63.00 p=.004. No significant findings were found for the NBS. A ROC analysis on VISCOS scores based on the clinician formulation groups had revealed excellent predictive discriminant validity (AUC=0.92), with a sensitivity/specificity of 0.86 for clinician ratings and identified a VISCOS threshold score for High Risk for ASD (≥13.5) or Low Risk for ASD (<13.5). Using this cut-off (at or above 13.5 indicating difficulties) the two groups did not differ significantly on SCS scores (ASD+Borderline N=13; M=23.31, SD = 7.12 vs Non-ASD N=20; M=26.40, SD = 6.01) U= 94.00 p = .184. Despite the nonsignificant p value, a Cohen’s d effect size of 0.475 suggested a medium effect.

Conclusions: The SCS-2 scores at 2 years showed significant differentiation of the clinician diagnostic categories (drawing on the VISCOS tool) at 4-7 years. Findings suggest that this ‘early stage’ tool may provide a potential screener for early signs of ASD in children with VI.