Summary: A new visual-based tool may help to reduce social disparities at a critical point of child development for a more accurate assessment of autism.
Source: University of Pennsylvania
Screening tools for autism spectrum disorder (ASD) often fail to identify ASD among children from low-income families and racial/ethnic minority groups, particularly when English is not the family’s primary language. A new visually-based tool may reduce these disparities at a pivotal point in children’s development.
In Pediatrics, Zuleyha Cidav, David Mandell, and colleagues found that the Developmental Check-In Tool (DCI) can accurately identify ASD risk among young children from families that have low income or speak English as a second language.
Most of the sample was Hispanic, enrolled in Medicaid or uninsured, and from families where English was not the primary language. The DCI is written in both English and Spanish, and it includes 26 pictures in four domains: communication, play, social, and behavior. Each picture includes a brief description.
Consistent with an earlier study, the DCI showed a good ability to distinguish between children with ASD and children without ASD, performing well across all age groups, genders, levels of maternal education, primary language, and racial/ethnic groups included in the study.
The DCI can improve ASD identification among children from families with low literacy or limited English proficiency. Even though ASD can be diagnosed in children as young as 18 months, on average, children in the U.S. receive an ASD diagnosis at age four. Earlier recognition of ASD is critical for early intervention and improved functional outcomes.
While the disparity in ASD diagnoses between Black and white children has improved over time, Hispanic children continue to be diagnosed at a lower rate. The DCI could lead to earlier and more accurate ASD diagnoses for this group.
About this ASD research news
Source: University of Pennsylvania
Contact: Press Office – University of Pennsylvania
Image: The image is credited to University of Pennsylvania
Original Research: Closed access.
“Validation of the Developmental Check-In Tool for Low-Literacy Autism Screening” by Jill F. Harris, Caroline N. Coffield, Yvette M. Janvier, David Mandell and Zuleyha Cidav. Pediatrics
Validation of the Developmental Check-In Tool for Low-Literacy Autism Screening
BACKGROUND: Persistent disparities exist in early identification of autism spectrum disorder (ASD) among children from low-income families who are racial and/or ethnic minorities and where English is not the primary language. Parental literacy and level of maternal education may contribute to disparities. The Developmental Check-In (DCI) is a visually based ASD screening tool created to reduce literacy demands and to be easily administered and scored across settings. In a previous study, the DCI showed acceptable discriminative ability between ASD versus non-ASD in a young, underserved sample at high-risk for ASD. In this study, we tested the DCI among an unselected, general sample of young underserved children.
METHODS: Six hundred twenty-four children ages 24 to 60 months were recruited through Head Start and Early Head Start. Parents completed the DCI, Modified Checklist for Autism in Toddlers, Revised with Follow-Up, and Social Communication Questionnaire. Children scoring positive on any measure received evaluation for ASD. Those screening negative on both Modified Checklist for Autism in Toddlers, Revised with Follow-Up and Social Communication Questionnaire were considered non-ASD.
RESULTS: Parents were primarily Hispanic, reported high school education or less, and had public or no insurance. The DCI demonstrated good discriminative power (area under the curve = 0.80), performing well across all age groups, genders, levels of maternal education, primary language, and included ethnic and racial groups. Item-level analyses indicated that 24 of 26 DCI items discriminated ASD from non-ASD.
CONCLUSIONS: The DCI is a promising ASD screening tool for young, underserved children and may be of particular value in screening for ASD for those with low literacy levels or with limited English proficiency.