Improving the early screening procedure for autism spectrum disorder in young children: Experience from a community-based model in shanghai.
A five-minute play observation plus a follow-up call doubled autism finds at routine 18-month check-ups.
01Research in Context
What this study did
Doctors in Shanghai added two simple steps to the usual toddler autism check. First, a nurse watched each child play for five minutes. Next, the clinic called families who screened positive to book the next visit.
They ran the new two-step model for one year at 36 community clinics. All children had their regular 18-month check-up.
What they found
The extra watch-and-call steps doubled the number of toddlers found with autism. More families also showed up for the full evaluation after the phone reminder.
How this fits with other research
Kamio et al. (2014) saw that the plain M-CHAT caught only half of autism cases at 18-month visits. Chunyang’s team kept the same visit time but added a quick play check and a call, pushing detection up sharply.
Leung et al. (2014) got lots of positive screens (about 3 in 10) but most families never followed up. The Shanghai model shows a short phone call closes that gap.
Marlow et al. (2019) reviewed low-cost tools for low-income countries and picked short parent questionnaires like CHAT-23. This study proves you can boost those same tools with tiny staff actions instead of new tests.
Why it matters
You do not need new forms or pricey tech to find more toddlers with autism. Ask a nurse or RBT to watch the child stack blocks or look for name calling during the visit, then have front desk call within a week if the screen is positive. Those two moves can double your catch rate and get families back through the door.
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02At a glance
03Original abstract
Most children with autism spectrum disorder (ASD) are not diagnosed until the age of 4, thus missing the opportunity for early intervention. The objective of this study was to investigate the feasibility of an early screening program for ASD applied during well-child visits in a community-based sample. The study lasted for 4 years and was divided into two stages. Stage I involved the implementation of the basic screening model in 2014. Toddlers received level 1 screening via section A of the Chinese-validated version of the Checklist for Autism in Toddlers (CHAT-23) during 18- and 24-month well-child visits in Xuhui District, Shanghai, China. Screen-positive children were referred to receive section B of the CHAT-23 for level 2 screening, and those still screen-positive were referred to undergo diagnosis and evaluation. Stage II involved the implementation of the improved screening model from 2015 to 2017 with the following modifications: (a) an added observational component in level 1 screening; (b) telephone follow-ups with the screen-positive families; and (c) dissemination of information on ASD to families. The results showed that 42 of 22,247 screened children were diagnosed with ASD. The ASD diagnosis rates were 0.1% in Stage I and 0.21% in Stage II. The screen-positive rate and the show rate of referral for level 1 screening increased by 76.92% and 58.43%, respectively, in Stage II compared to Stage I. Our results suggest that with appropriate logistic support, this two-level screening model is feasible and effective for the early screening of ASD during well-child visits. Autism Res 2018, 11: 1206-1217. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Difficulty in the timely identification of autism spectrum disorder (ASD) results in missed opportunities for many ASD children to receive early intervention. In this study, we established an early screening model for ASD among children aged 18-24 months in the community by relying on the three-level child healthcare system in China. The results showed that this model can effectively identify and diagnose ASD in children at an early age and thus enable early intervention.
Autism research : official journal of the International Society for Autism Research, 2018 · doi:10.1002/aur.1984