Validation of a Video-Guided Screening Instrument for Autism Spectrum Disorders

Principal Investigator: Rebecca Landa

The overarching goal of this proposed project is to assess the criterion validity of a new autism spectrum disorder (ASD) screening tool by comparing it to a gold standard ASD diagnostic tool known as the ‘Autism Diagnostic Observation Schedule (ADOS)’ paired with the clinical judgment of a professional trained in the diagnosis of autism spectrum disorders (ASD). This instrument is a parent report measure that uses video examples to contrast typical behavior from autism behavior in young children and also presents parents with questions addressing those same behaviors in their children. This ASD screening tool could potentially be available for widespread use if found to have criterion validity due to its low cost and accessibility for families.

Children aged 12 months to 60 months and their parents will join the study. We will recruit children whose parents have no concerns about their child’s development, children whose parents have concerns about their child’s development but no concern about ASD, children whose parents have concerns that their child has ASD, and children who already have an ASD diagnosis. Children and their parents will arrive at the Center for Autism and Related Disorders (CARD) at the Kennedy Krieger Institute (KKI) for a two-part assessment. In one part of the assessment, parents will complete three paper-based screening questionnaires as well as the newly-developed screener, hereafter referred to as the Video-Guided Caregiver Report (VGCR). After viewing the videos in the VGCR, parents will answer questions about their child’s behavior as it relates to the qualities exemplified in the video examples. In the second part of the assessment, children will be seen for a direct assessment during which time the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule (ADOS) will be administered to them. This second part of the assessment may be purely research-based, or it may be part of the child’s KKI clinical diagnostic assessment visit (which will include, at a minimum, the Mullen and ADOS) conducted by a professional trained in the field of autism. After the Mullen and ADOS assessment with the child, a research team member will follow-up with the clinician regarding the child’s diagnosis. The diagnosis will be recorded by the research team member on the Assessment Summary Sheet. Families recruited through KKI clinic waiting lists, or lists of clinic patients who have been scheduled for a clinical evaluation, will come to CARD for their research visit no more than one month before their gold-standard diagnostic evaluation on a day that is convenient for them. While most participants will complete everything on the same day, there may be instances when the protocol would be completed over two days. The Caregiver Concerns Questionnaire, M-CHAT, VCPR and SCQ must all be completed in a single session. It is permissible for the ADOS and Mullen to be administered in a separate session if the family wishes for the patients of the KKI Clinics . All other participants must complete all the assessments on the same day to minimize attrition and incomplete data collection. The exception to this will be if the child becomes fatigued or fussy and the parent wishes to continue the child’s testing on a different day. This will be acceptable.

We anticipate three outcome groups based on the diagnostic assessments administered to the children: No Delay group; Non-ASD Developmental Delay group; and ASD group. Using these outcome groupings and data from the ADOS, the sensitivity, specificity, and Positive Predictive Value of the VGCR for identifying risk for ASD will be assessed. ROC analyses will be conducted to identify VGCR score thresholds for high versus low risk for ASD.