Autism spectrum disorder screening in preschools

• Published in: Autism : the international journal of research and practice Vol. 25; no. 2; pp. 516 - 528
• Main Authors: Au, Angel Hoe-chi, Shum, Kathy Kar-man, Cheng, Yongtian, Tse, Hannah Man-yan, Wong, Rose Mui-fong, Li, Johnson, Au, Terry Kit-fong
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2021; SAGE PUBLICATIONS, INC
• Subjects: Autism; Autism Spectrum Disorder - diagnosis; Autistic children; Autistic Disorder; Checklists; Child, Preschool; Classroom observation; Classrooms; Clinical assessment; Clinical training; Day care centers; Foreign Countries; Health care; Humans; Interaction; Mass Screening; Medical personnel; Medical screening; Original; Parents; Peer Relationship; Peer relationships; Peers; Pervasive Developmental Disorders; Prediction; Preschool Children; Preschool Education; Preschool teachers; Professional training; School Teachers; Screening Tests; Teachers; Test Reliability; Test Validity; Workers; Hong Kong; screening; preschool; autism spectrum disorder; early identification; peer interaction
• ISSN: 1362-3613; 1461-7005
• DOI: 10.1177/1362361320967529

Can non-clinicians spot preschoolers likely to have autism spectrum disorder by observing their everyday peer interaction? We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic “stress test” to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule–2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later (odds ratios = 14.6 and 6.7, respectively). This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder. Lay abstract With professional training and regular opportunities to observe children interacting with their peers, preschool teachers are in a good position to notice children’s autism spectrum disorder symptomatology. Yet even when a preschool teacher suspects that a child may have autism spectrum disorder, fear of false alarm may hold the teacher back from alerting the parents, let alone suggesting them to consider clinical assessment for the child. A valid and convenient screening tool can help preschool teachers make more informed and hence more confident judgment. We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic “stress test” to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule–2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later. This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder.