Norwegian Institute of Public Health, Oslo, Norway.
Paediatr Perinat Epidemiol. 2014 May;28(3):255-62. doi: 10.1111/ppe.12114. Epub 2014 Feb 18.
Previous research on clinical and high-risk samples suggests that signs of autism spectrum disorder (ASD) can be detected between 1 and 2 years of age. We investigated signs of ASD at 18 months in a population-based sample and the association with later ASD diagnosis.
The study sample includes 52,026 children born 2003 through 2008 and is a subset of children that participated in the Norwegian Mother and Child Cohort (MoBa), a population-based longitudinal study, and the Autism Birth Cohort (ABC), a sub-study on ASD. Parents completed all 23 items from the Modified Checklist for Autism in Toddlers (M-CHAT) at 18 months.
The M-CHAT 6-critical-item criterion and the 23-item criterion had a specificity of 97.9% and 92.7% and a sensitivity of 20.8% and 34.1%, respectively. In the 173 children diagnosed with ASD to date, 60 children (34.7%) scored above the cut-off on either of the screening criteria. The items with the highest likelihood ratios were 'interest in other children', 'show objects to others' and 'response to name'.
Even though one-third of the children who later received an ASD diagnosis were identified through M-CHAT items, the majority scored below cut-off on the screening criteria at 18 months. The results imply that it might not be possible to detect all children with ASD at this age.
先前针对临床和高危样本的研究表明，自闭症谱系障碍（ASD）的迹象可在 1 至 2 岁之间被检测到。我们在基于人群的样本中调查了 18 个月大的 ASD 迹象，并研究了其与日后 ASD 诊断的关联。
研究样本包括 52026 名于 2003 年至 2008 年出生的儿童，他们是参与挪威母婴队列（MoBa）和自闭症出生队列（ABC）研究的子样本，这两项研究均为基于人群的纵向研究。父母在孩子 18 个月时完成了自闭症诊断观察量表修订版（M-CHAT）的全部 23 个项目。
M-CHAT 的 6 个关键项目标准和 23 个项目标准的特异性分别为 97.9%和 92.7%，敏感性分别为 20.8%和 34.1%。在迄今诊断出的 173 名 ASD 儿童中，有 60 名（34.7%）在任何一个筛查标准中得分超过临界值。具有最高似然比的项目是“对其他儿童感兴趣”、“向他人展示物品”和“对名字有反应”。
尽管三分之一后来被诊断为 ASD 的儿童通过 M-CHAT 项目被识别出来，但在 18 个月时，大多数儿童的筛查标准得分低于临界值。结果表明，在这个年龄段可能无法发现所有患有 ASD 的儿童。
