Department of Clinical Sciences, Lund University, Malmö (TL; HA), Lund (MR), Sweden.
BMC Psychiatry. 2013 Sep 25;13:233. doi: 10.1186/1471-244X-13-233.
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.
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).
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.
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.
使用易于管理的筛查工具识别儿童期起病的神经发育问题（NDPs，这里定义为自闭症谱系障碍[ASD]、注意力缺陷/多动障碍[AD/HD]、抽动障碍[TD]、学习障碍[LD]和发育协调障碍）是进行流行病学研究的前提。这些工具在临床上也很有用，可以优先对儿童进行全面评估、筛查风险群体，并对对照组进行随访。自闭症-抽搐-ADHD 及其他合并症量表（A-TAC）就是为满足这些要求而开发的；在此，我们将在基于人群的流行病学环境中检验 A-TAC 的前瞻性和心理测量学特性。
自 2004 年以来，瑞典所有双胞胎的父母都被邀请参加一项正在进行的全国性双胞胎研究（瑞典儿童和青少年双胞胎研究）。该研究包括 A-TAC，由父母对 9 或 12 岁的双胞胎进行电话访谈完成。在本研究中，来自三个出生年份队列（1993-1995 年）的筛查阳性双胞胎，以及他们的同卵双胞胎和随机选择的、健康的对照组，在 15 岁时接受了全面的临床随访（对之前的筛查结果进行盲法）（总人数=452）。
A-TAC 评分预测后来临床诊断的敏感性和特异性总体上较好到极好，受试者工作特征曲线下面积值范围从 0.77（AD/HD）到 0.91（ASD）。在 ASD 筛查阳性的儿童中，48%的儿童被诊断为 ASD。AD/HD 的对应比例也为 48%，LDs 为 16%，TDs 为 60%。在三年后的临床随访中，4%至 35%的筛查阳性儿童未被诊断出任何疾病。在筛查阴性对照组中，ASD、AD/HD、LDs 和 TDs 的患病率分别为 0%、7%、4%和 2%。
在这项基于人群的纵向研究中，A-TAC 似乎是一种评估 NDPs 的有效工具。它具有良好到极好的心理测量学特性，在筛查评估至少三年后，能够很好地区分 NDPs（主要是 ASD）和非 NDPs，尽管具体诊断与实际临床诊断并不完全相符。
