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Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30 Weeks’ Gestation

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Abstract

Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test—II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at < 30 weeks’ gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18–36 months. Medical charts were abstracted 3.5 years later and showed that 4% (n = 24) of children had an ASD diagnosis. BITSEA competence (sensitivity = .74; specificity = .76) and ASD (sensitivity = .70; specificity = .73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity = .73; specificity = .64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings.

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Abbreviations

AAP:

American Academy of Pediatrics

AUC:

Area under the curve

ADOS:

Autism Diagnostic Observation Schedule

ASD:

Autism spectrum disorder

BITSEA:

Brief Infant Toddler Social Emotional Assessment

B-ASD:

Brief Infant Toddler Social Emotional Assessment, autism spectrum disorders subscale

B-COMP:

Brief Infant Toddler Social Emotional Assessment, competence subscale

B-PROB:

Brief Infant Toddler Social Emotional Assessment, problem subscale

LR−:

Negative likelihood ratio

LR+:

Positive likelihood ratio

M-CHAT:

Modified Checklist for Autism in Toddlers

M-CHAT-R-F:

Modified Checklist for Autism in Toddlers, Revised with Follow-up

NCH:

Nationwide Children’s Hospital

NICU:

Neonatal intensive care unit

PDDST-II-DCS:

Pervasive Developmental Disorders Screening Test—II, Stage 2, Developmental Clinic Screener

ROC:

Receiver operating characteristic

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Acknowledgements

We thank the families who participated in the study and Yvette Bean, Kendra Heck, Chenali Jayadeva, Julia Less, and Kamma Smith of Nationwide Children’s Hospital for data collection and administrative support.

Funding

The project described was supported by internal funds of the Research Institute at Nationwide Children’s Hospital, by The Marci and Bill Ingram Fund for Autism Spectrum Disorders Research, and Cures Within Reach. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Kelly M. Boone, Anne K. Brown & Sarah A. Keim

  2. Crane Center for Early Childhood Research and Policy and Schoenbaum Family Center, The Ohio State University, 175 East 7th Avenue, Columbus, OH, 43201, USA

    Kelly M. Boone

  3. Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA

    Sarah A. Keim

  4. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA

    Sarah A. Keim

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  1. Kelly M. Boone
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Correspondence to Kelly M. Boone.

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Boone, K.M., Brown, A.K. & Keim, S.A. Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30 Weeks’ Gestation. Child Psychiatry Hum Dev 49, 493–504 (2018). https://doi.org/10.1007/s10578-017-0768-2

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