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Predictive properties of the A-TAC inventory when screening for childhood-onset neurodevelopmental problems in a
Tomas Larson1, Sebastian Lundström, Thomas Nilsson
1Department of Clinical Sciences, Lund University, Malmö (TL; HA), Lund (MR), Sweden. tomas.larson@med.lu.se.
Insights
The Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC) effectively screens for neurodevelopmental problems (NDPs) in children. This longitudinal study confirms A-TAC
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Epidemiology
Background:
- Accurate identification of childhood neurodevelopmental problems (NDPs) is crucial for research and clinical practice.
- Screening instruments aid in prioritizing comprehensive assessments and monitoring at-risk populations.
- The Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC) was developed for efficient NDP screening.
Purpose of the Study:
- To evaluate the prospective and psychometric properties of the A-TAC instrument.
- To assess A-TAC's utility in a population-based, epidemiological setting.
- To examine A-TAC's validity in identifying children with neurodevelopmental problems.
Main Methods:
- Utilized data from the Swedish Child and Adolescent Twin Study, a nationwide twin registry.
- Conducted telephone interviews with parents of 9- and 12-year-old twins using the A-TAC.
- Performed a comprehensive clinical follow-up at age 15 for screen-positive twins, co-twins, and controls (N=452).
Main Results:
- A-TAC demonstrated good to excellent sensitivity and specificity for predicting clinical diagnoses (AUCs 0.77-0.91).
- Screen-positive rates for clinical diagnoses were 48% for ASDs, 48% for ADHD, 16% for LDs, and 60% for TDs.
- A significant proportion of screen-positive children (4-35%) did not receive a diagnosis; screen-negative controls had low NDP prevalence (0-7%).
Conclusions:
- The A-TAC is a valid instrument for assessing NDPs in population-based, longitudinal studies.
- A-TAC exhibits good-to-excellent psychometric properties, distinguishing NDPs from non-NDPs over time.
- While effective for screening, specific A-TAC diagnoses did not perfectly align with later clinical diagnoses.
Background:
Identifying children with childhood-onset neurodevelopmental problems (NDPs, defined here as autism spectrum disorders [ASDs], attention-deficit/hyperactivity disorder [AD/HD], tic disorders [TDs], learning disorders [LDs] and development coordination disorder), using easily administered screening instruments, is a prerequisite for epidemiological research. Such instruments are also clinically useful to prioritize children for comprehensive assessments, to screen risk groups, and to follow controls.Autism-Tics, ADHD, and other Co-morbidities inventory (A-TAC) was developed to meet these requirements; here the A-TAC's prospective and psychometric properties are examined, when used in a population-based, epidemiological setting.
Methods:
Since 2004, parents of all Swedish twins have been asked to take part in an ongoing, nation-wide twin study (The Child and Adolescent Twin Study in Sweden). The study includes the A-TAC, carried out as a telephone interview with parents of twins aged 9 or 12. In the present study, screen-positive twins from three birth year cohorts (1993-1995) were invited to a comprehensive clinical follow-up (blinded for previous screening results) together with their co-twins and randomly selected, healthy controls at age 15 (Total N = 452).
Results:
Sensitivity and specificity of A-TAC scores for predicting later clinical diagnoses were good to excellent overall, with values of the area under the receiver operating characteristics curves ranging from 0.77 (AD/HD) to 0.91 (ASDs). Among children who were screen-positive for an ASD, 48% received a clinical diagnosis of ASDs. For AD/HD, the corresponding figure was also 48%, for LDs 16%, and for TDs 60%. Between 4% and 35% of screen-positive children did not receive any diagnosis at the clinical follow-up three years later. Among screen-negative controls, prevalence of ASDs, AD/HD, LDs, and TDs was 0%, 7%, 4%, and 2%, respectively.
Conclusions:
The A-TAC appeared to be a valid instrument to assess NDPs in this population-based, longitudinal study. It has good-to-excellent psychometric properties, with an excellent ability to distinguish NDPs (mainly ASDs) from non-NDPs at least three years after the screening evaluations, although specific diagnoses did not correspond closely to actual clinical diagnoses.
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