Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder:a longitudinal study

Background Several studies have shown the effectiveness of the Early Start Denver Model(ESDM),but few studies have explored the long-term efficacy of ESDM.This study aimed to explore the efficacy and moderating factors of ESDM in Chinese toddlers with autism spectrum disorder(ASD)in a longitudinal way.Methods A total of 60 toddlers with ASD were recruited and randomly divided into two groups:ESDM group all received 24 weeks intervention;Control group were waiting for intervention.Baseline assessment(T0)was conducted before intervention,including Gesell Developmental Scale(GDS)and Psycho-educational Profile-3rd Edition(PEP-3).All toddlers with ASD were examined in the first assessment(T1)at 6 months and in the second assessment(T2)at 12 months.Results In T1 assessment,the increments in speech and personal communication development quotient in GDS were significantly larger in the ESDM group than in the control group(P=0.010,0.047).In T2 assessment,the ESDM group had higher elevation in cognitive verbal/preverbal(CVP),social reciprocity and characteristic verbal behaviors assessed by PEP-3(P=0.021,0.046,0.014).In addition,the severity of stereotyped behavior was negatively associated with improvement in CVP.Family income was positively associated with improvement in speech and CVP(all P<0.05).Conclusions ESDM can effectively improve speech and communication in toddlers with ASD after 24-week intervention.More importantly,ESDM can promote cognition and social interaction and can reduce stereotyped verbal behavior in toddlers with ASD in longitudinal observation.The severity of stereotyped behavior and family ecological factors may be considered as affecting the efficacy of ESDM.

Reliability and validity of the translated Chinese version of Autism Spectrum Rating Scale (2-5 years)

Background Early autism screening is of great value,but there is lack of a screening tool of early age (2-5 years) in China.The Autism Spectrum Rating Scale (ASRS,2-5 years) is a newly developed autism screening tool in the USA.This study aimed to evaluate the reliability and validity of the translated Chinese version of ASRS (C_ASRS) in Chinese children population before its application in China for early autism screening.Methods Caregivers of general children aged 2-5 years from 17 kindergartens and autism spectrum disorder (ASD) cases from five special education schools in five cities were recruited to complete the C_ASRS.1910 valid questionnaires from kindergarteners and 192 from ASD cases were included for analyses.Results The item reliability (Cronbach's alpha) was more than 0.80 in the screening scale and DSM-5 scale,and 0.51-0.81 in the treatment scale.ASD cases scored higher on total score and most subscales compared to the kindergarteners (Cohen's d ranging from 1.34 to 3.37).C_ASRS showed good discriminatory validity with an area under the receiver operating characteristic curve of 0.850 (95% confidence interval:0.819-0.881).The cutoff ≥ 60 achieved sensitivity of 65.63% and specificity of 85.63% in discriminating autism children from the general population.Conclusion The results indicate that C_ASRS (2-5 years) could be used as an early level-2 screening tool for autism screening in China and should be further revised for level-1 screening.

Evaluating autism in a Chinese population:the Clinical Autism Diagnostic Scale

Background:The purpose of this study was to report on the psychometric measures and discriminatory function of a new diagnostic test for autism spectrum disorders,the Clinical Autism Diagnostic Scale(CADS).Methods:The CADS was used to test 216 children in the study,including 86 with low-functioning autism specturm disorders(ASD),16 children with highfunctioning ASD,16 with pervasive developmental disorder,not otherwise specified,7 with Asperger syndrome,65 with typical development,11 children with language impairments and 15 with intellectual disabilities.Ages ranged from 38-73 months.Behaviors for the groups were compared across seven domains.Results:The results indicated the instrument was reliable,valid,and successfully differentiated the different groups of children with and without autism.All ASD groups were found to display difficulties in the domains of sensory behaviors and stereotyped behaviors.The play and social domains were found to measure similar underlying concepts of behaviors,while the receptive language and expressive language domains were also found to measure similar underlying-language concepts.The group of children diagnosed as having low-functioning autism performed less well on all tested domains in the instrument than did the other three groups of children with ASD,and these other three groups each also presented unique patterns of behaviors and differed on individual domains.Conclusions:CADS is a reliable and valid test.It successfully differentiates the abilities of children with ASD at different levels of functioning.