Accuracy of behavioral responses in early detection of autism spectrum disorders in children aged 18 months to 4 years with speech delay

IF 0.2 Q4 PEDIATRICS

Paediatrica Indonesiana Pub Date : 2024-02-20 DOI:10.14238/pi64.1.2024.17-21

Nugroho Danu, S. Handryastuti, I. Mangunatmadja, H. Pusponegoro

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Abstract

Background Early detection of autism spectrum disorders (ASD) in children with speech delay is important to improve outcomes. Behavioral responses to calling, teasing, poking, and blocking can be used to screen for ASD in daily practice. Objective To evaluate the accuracy of behavioral responses to stimuli in detecting ASD in children aged 18 months to 4 years with speech delay. Methods This cross-sectional study was conducted in children with speech delay aged 18 months to 4 years who visited the Outpatient Clinic of Cipto Mangunkusumo Hospital, Jakarta. Subjects were stimulated while playing by poking, teasing, calling, and blocking (stopping the child’s play using the examiner’s hand) and were assessed for their responses. Lack of seeking eye contact with the examiner following the stimulus was considered as a response suggestive of ASD. Independent diagnosis based on DSM-V criteria was considered the gold standard to diagnose ASD or non-ASD. Results A total of 109 children were included in this study, with an average age of 32 (SD 7.4) months. There were 52 subjects (47.7%) with ASD and 57 subjects (52.2%) with non-ASD. Behavioral response analysis revealed that calling, blocking and teasing had high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying ASD. The poking response had the highest specificity to rule out ASD compared to other stimuli, with 75% sensitivity (95%CI 63.2% to 86.7%), 93% specificity (95%CI 86.3% to 99.6%), 90% PPV (95%CI 82% to 99.3%), and 80% NPV (95%CI 70.7% to 89.9%). When all behavioral responses were combined, with lack of a response to all four stimuli considered suggestive of ASD, we obtained 100% specificity, 42% sensitivity, 100% PPV and 65% NPV. Conclusion The combination of behavioral responses had high specificity, sensitivity, PPV, and NPV for early detection of ASD in children with speech delay.

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行为反应对早期发现 18 个月至 4 岁语言发育迟缓儿童自闭症谱系障碍的准确性

背景早期发现语言发育迟缓儿童的自闭症谱系障碍（ASD）对改善治疗效果非常重要。在日常实践中，可以利用对呼叫、逗弄、戳戳和阻挡的行为反应来筛查自闭症谱系障碍。目的评估对刺激的行为反应在检测 18 个月至 4 岁言语发育迟缓儿童 ASD 方面的准确性。方法本横断面研究的对象是在雅加达 Cipto Mangunkusumo 医院门诊就诊的 18 个月至 4 岁语言发育迟缓儿童。受试者在玩耍时受到刺激，包括戳、逗、叫和阻止（用检查者的手阻止儿童玩耍），并对他们的反应进行评估。受试者在受到刺激后不寻求与检查者进行目光接触，这被认为是一种暗示自闭症的反应。基于 DSM-V 标准的独立诊断被认为是诊断 ASD 或非 ASD 的金标准。结果本研究共纳入 109 名儿童，平均年龄为 32 个月（标准差为 7.4 个月）。52名受试者（47.7%）患有自闭症，57名受试者（52.2%）患有非自闭症。行为反应分析表明，呼叫、阻挡和戏弄在识别 ASD 方面具有较高的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。与其他刺激相比，戳人的反应对排除 ASD 的特异性最高，灵敏度为 75%（95%CI 为 63.2% 至 86.7%），特异性为 93%（95%CI 为 86.3% 至 99.6%），PPV 为 90%（95%CI 为 82% 至 99.3%），NPV 为 80%（95%CI 为 70.7% 至 89.9%）。如果将所有行为反应结合起来，并将对所有四种刺激均无反应视为提示 ASD，则我们获得了 100% 的特异性、42% 的灵敏度、100% 的 PPV 和 65% 的 NPV。结论行为反应组合对于早期发现言语发育迟缓儿童的 ASD 具有较高的特异性、灵敏度、PPV 和 NPV。

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