Department of Child Healthcare, Children's Hospital of Fudan University, Shanghai.
Department of Child Healthcare, Xuhui District Maternal and Child Healthcare Hospital, Xuhui District, Shanghai, China.
Autism Res. 2018 Sep;11(9):1206-1217. doi: 10.1002/aur.1984. Epub 2018 Sep 19.
Most children with autism spectrum disorder (ASD) are not diagnosed until the age of 4, thus missing the opportunity for early intervention. The objective of this study was to investigate the feasibility of an early screening program for ASD applied during well-child visits in a community-based sample. The study lasted for 4 years and was divided into two stages. Stage I involved the implementation of the basic screening model in 2014. Toddlers received level 1 screening via section A of the Chinese-validated version of the Checklist for Autism in Toddlers (CHAT-23) during 18- and 24-month well-child visits in Xuhui District, Shanghai, China. Screen-positive children were referred to receive section B of the CHAT-23 for level 2 screening, and those still screen-positive were referred to undergo diagnosis and evaluation. Stage II involved the implementation of the improved screening model from 2015 to 2017 with the following modifications: (a) an added observational component in level 1 screening; (b) telephone follow-ups with the screen-positive families; and (c) dissemination of information on ASD to families. The results showed that 42 of 22,247 screened children were diagnosed with ASD. The ASD diagnosis rates were 0.1% in Stage I and 0.21% in Stage II. The screen-positive rate and the show rate of referral for level 1 screening increased by 76.92% and 58.43%, respectively, in Stage II compared to Stage I. Our results suggest that with appropriate logistic support, this two-level screening model is feasible and effective for the early screening of ASD during well-child visits. Autism Res 2018, 11: 1206-1217. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Difficulty in the timely identification of autism spectrum disorder (ASD) results in missed opportunities for many ASD children to receive early intervention. In this study, we established an early screening model for ASD among children aged 18-24 months in the community by relying on the three-level child healthcare system in China. The results showed that this model can effectively identify and diagnose ASD in children at an early age and thus enable early intervention.
大多数自闭症谱系障碍（ASD）患儿直到 4 岁才被确诊，因此错过了早期干预的机会。本研究旨在探讨在社区样本中通过常规儿童保健访视进行 ASD 早期筛查的可行性。研究持续了 4 年，分为两个阶段。第一阶段（2014 年）实施基本筛查模式。在上海徐汇区，24 月龄以下的婴幼儿在 18 个月和 24 个月的常规儿童保健访视时，通过经过中国验证的自闭症幼儿检查表（CHAT-23）的 A 部分进行一级筛查。对筛查阳性的儿童进行 CHAT-23 的 B 部分进行二级筛查，对仍筛查阳性的儿童进行诊断和评估。第二阶段（2015 年至 2017 年）实施改良筛查模式，具体措施如下：（a）一级筛查增加观察性内容；（b）对筛查阳性家庭进行电话随访；（c）向家庭普及 ASD 相关知识。结果显示，在 22247 名接受筛查的儿童中，有 42 名被诊断为 ASD。ASD 的诊断率在第一阶段为 0.1%，第二阶段为 0.21%。与第一阶段相比，第二阶段一级筛查的阳性率和转诊率分别提高了 76.92%和 58.43%。研究结果表明，在适当的后勤支持下，这种两阶段筛查模式能够有效且可行地用于在常规儿童保健访视中对 ASD 进行早期筛查。自闭症研究 2018，11：1206-1217。 © 2018 国际自闭症研究协会，威利父子出版公司。
