Level 2 Screening for Autism Spectrum Disorder in Young Children: Cross-Cultural Adaptation and Validation of the...

Early screening tools for autism spectrum disorders (ASDs) have made great strides in recent years. The BeDevel is a comprehensive and precise screening instrument that addresses many of the shortcomings found in other screening instruments, including limited cultural adaptability and insufficient sensitivity. Therefore, we further analyzed its cultural adaptability and validity.

We worked with the original development team to translate and back-translate the BeDevel into Chinese. With the guidance of a committee, we made semantic and cultural modifications to the BeDevel to assess its cross-cultural adaptability. We gathered validation data from 542 participants (9-11 months, n = 24; 12-17 months, n = 61; 18-23 months, n = 136; 24-35 months, n = 217; 36-42 months, n = 104). The study included 191 individuals with ASD, 103 with DD and 248 with TD. Individual items and total scores were analyzed for internal consistency, agreement with clinical diagnosis (yielding optimal cut off numbers of Item, sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]) and consistency with existing diagnostic instruments.

The mean Cronbach's α coefficients of the Chinese version of BeDevel-I/P were all above 0.8 (ranging from 0.872 to 0.93), with correlation coefficients greater than 0.05 (r = 0.061 to 0.834). Metrics of diagnostic accuracy across age groups were as follows: κ coefficient, 0.064-0.722; sensitivity, 0.853-0.962; specificity, 0.429-1.000; PPV, 0.758-1.000; and NPV, 0.700-0.974. κ values for interinstrument consistency ranged from 0.432 to 0.973 and exceeded 60% for all instruments compared.

The Chinese version of the BeDevel has demonstrated high reliability and effectiveness in screening for autism. Therefore, we recommend this validated C-BeDevel for Level 2 ASD screening in both clinical and maternal and child health settings.