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A new screening programme for autism in a general population of Swedish toddlers
Gudrun Nygren1, Eva Sandberg, Fredrik Gillstedt
1Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden. gudrun.nygren@gnc.gu.se
Insights
Early autism screening using the M-CHAT and JA-OBS tools in 2.5-year-olds demonstrated a 90% positive predictive value for autism spectrum disorder (ASD). This combined approach shows promise for routine early detection in child health programs.
Area of Science:
- Developmental Pediatrics
- Child Psychology
- Public Health Screening
Background:
- Early diagnosis of autism spectrum disorder (ASD) is critical for effective intervention.
- Routine screening in early childhood can significantly improve the chances of early ASD diagnosis.
- Understanding the early signs of autism is essential for timely recognition.
Purpose of the Study:
- To evaluate the efficacy of screening instruments in predicting clinical diagnoses of ASD in young children.
- To assess the utility of a combined screening approach for early autism detection.
- To determine the positive predictive value (PPV) of specific screening tools in a general population.
Main Methods:
- A general population screening was conducted on 2.5-year-old children in Gothenburg, Sweden.
- Screening utilized the Modified Checklist for Autism in Children (M-CHAT) and a trained nurse's observation of joint attention abilities (JA-OBS).
- Children with initial screening "suspicion" underwent detailed clinical assessment for ASD diagnosis.
Main Results:
- Out of 3999 children screened, 64 raised "definitive" suspicion of ASD.
- Of the 54 children assessed, 48 received a confirmed ASD diagnosis.
- The combined M-CHAT and JA-OBS screening achieved a 90% positive predictive value (PPV).
Conclusions:
- The combination of M-CHAT and JA-OBS shows significant promise for the early detection of autism spectrum disorder.
- Integrating these screening tools into routine child health center developmental programs can optimize early diagnosis.
- Trained medical staff are essential for effective implementation and early detection of ASD, regardless of age.
Abstract:
The evidence from early intervention studies of autism has emphasised the need for early diagnosis. Insight into the early presentation of autism is crucial for early recognition, and routine screening can optimise the possibility for early diagnosis. General population screening was conducted for 2.5-year-old children at child health centres in Gothenburg, Sweden, and the efficacy of the screening instruments in predicting a clinical diagnosis of autism was studied. The tools used for autism screening comprised the Modified Checklist for Autism in Children (M-CHAT) and an observation made by trained nurses of the child's joint attention abilities (JA-OBS). From the new screening procedure a "definitive" suspicion of autism spectrum disorder (ASD) was raised in 64 individuals in the study population of 3999 young children. Fifty-four of these were clinically assessed in detail. Forty-eight children had a confirmed diagnosis of ASD, three had severe language disorder, and three (6%) were classified as having typical development. The Positive predictive Value (PPV) for the combination of M-CHAT and the JA-OBS was 90%. The combination of instruments used showed promise for early detection of autism as a routine in the developmental programme at child health centres. Trained medical staff is a basic requirement and enables earlier detection and the use of screening tools beyond routine population screening regardless of the age at which a suspicion of autism is raised.
