Using the M-CHAT-R/F to Identify Developmental Concerns in a High-Risk 18-Month-Old Sibling Sample.

OBJECTIVE: Given the high autism spectrum disorder (ASD) recurrence risk in younger siblings, it is important to identify early ASD markers within this high-risk population. Although there is increasing evidence that the Modified Checklist for Autism in Toddlers-Revised, with Follow-Up Interview can identify many low-risk children during the second year of life, there has yet to be a study of how the M-CHAT-R/F functions in a high-risk sibling population at very young ages. METHODS: As part of a larger population-based study, the authors screened 74 infant siblings with the Modified Checklist for Autism in Toddlers-Revised, with Follow-Up Interview at 18 months and assessed diagnoses between the ages of 18 and 43 months. RESULTS: The M-CHAT-R/F had the highest positive predictive value for identifying children at risk of any developmental concern (i.e., ASD, language delay). Overall, 33% of siblings who presented for follow-up evaluations received ASD diagnoses with an additional 22% showing other developmental concerns. CONCLUSION: Failing the M-CHAT-R/F at 18 months of age raises significant concern that a child will show some degree of developmental difference or delay over time. These findings highlight the need for close developmental monitoring of this high-risk sample.

Brief report: DSM-5 "levels of support:" a comment on discrepant conceptualizations of severity in ASD.

Proposed DSM-5 revisions to the diagnosis of autism spectrum disorder (ASD) include a "severity" marker based on degree of impairment. Although qualitative differences between support levels are described, quantitative methods or practice recommendations for differentiating between levels remain undetermined. This leaves the field vulnerable to potential discrepancies between severity categorizations that may have inadvertent service implications. We examined overlap between mild, moderate, and severe impairment classifications based on autism symptoms, cognitive skills, and adaptive functioning in 726 participants (15 months-17 years) with ASD. Participants with mild, moderate, and severe autism symptoms demonstrated varying levels of adaptive and cognitive impairment. These discrepancies highlight the need for a clearly elucidated method of classifying level of support in ASD diagnosis.

Relationship satisfaction, parenting stress, and depression in mothers of children with autism.

Mothers of children with autism report higher levels of depression than mothers of children with other developmental disabilities. We explored the relations between child characteristics of diagnostic severity and problem behaviors, parenting stress, relationship quality, and depressive symptoms in 70 mothers of young children with autism. We hypothesized that relationship quality and parenting stress would relate to maternal depression beyond contributions of child characteristics. Multiple regression analysis revealed a main effect of parenting stress above and beyond child problem behaviors and autism severity. A significant interaction emerged, with relationship quality buffering the effect of parenting stress on depression. Results suggest that the relation between child problem behaviors and maternal depression should be considered in conjunction with other measures of marriage and family stress. Relationship quality and parenting stress may also represent important factors to be explicitly considered within intervention paradigms for young children with autism spectrum disorders.

The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change?

The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment.