International comparisons of autism spectrum disorder behaviors in preschoolers rated by parents and caregivers/teachers.
Four rare CBCL items—strange behavior, rocking, unresponsive to affection, withdrawn—spot ASD risk worldwide, and parents give steadier ratings than teachers.
01Research in Context
What this study did
Parents and teachers in 18 countries filled out the CBCL/1½-5 on preschoolers.
The team looked at which items best flagged possible autism.
They compared parent scores with teacher scores across cultures.
What they found
Four items showed low rates everywhere: strange behavior, rocking, not cuddly, and withdrawn.
Parents gave steadier ratings than teachers across all nations.
These four rare items may be the best red flags for ASD screening.
How this fits with other research
Flapper et al. (2013) saw the same three ASD factors in 18-month-olds, so the pattern starts early.
Embregts (2000) found the CBCL shaky for kids with mild ID; check for ID before trusting the same form.
Moss et al. (2009) used parent-rated CSI-4 to split ASD from ADHD in older kids; parent eyes still matter.
Why it matters
Use the four low-rate items first when you screen preschoolers.
If the child has ID, add another tool; the CBCL alone may mislead.
Parents give steadier data than teachers, so start with mom or dad when time is short.
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Add the four low-rate items to your intake checklist and ask the parent first.
02At a glance
03Original abstract
This study tested international similarities and differences in scores on a scale comprising 12 items identified by international mental health experts as being very consistent with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) category of autism spectrum disorder. Participants were 19,850 preschoolers in 24 societies rated by parents on the Child Behavior Checklist for Ages 1½-5; 10,521 preschoolers from 15 societies rated by caregivers/teachers on the Caregiver-Teacher Report Form, and 7380 children from 13 societies rated by both types of informant. Rank ordering of the items with respect to base rates and mean ratings was more similar across societies for parent ratings than caregiver/teacher ratings, especially with respect to the items tapping restricted interests and repetitive behaviors. Items 80. Strange behavior; 63. Repeatedly rocks head or body; 67. Seems unresponsive to affection; and 98. Withdrawn, doesn't get involved with others had low base rates in these population samples across societies and types of informants, suggesting that they may be particularly discriminating for identifying autism spectrum disorder in young children. Cross-informant agreement was stronger for the items tapping social communication and interaction problems than restricted interests and repetitive behaviors. The findings support the feasibility of international use of the scale for autism spectrum disorder screening in population samples.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361319839151