Abstract

The aim of this proposal is to complete development and evaluation of a new tool to properly identify and refer toddlers who show early signs of Autism Spectrum Disorders (ASD).  Early screening for ASD has recently become a standard guideline for pediatric practice (AAP, 2006) following new evidence regarding the efficacy of early intervention (National Research Council, 2001).  The most widely recommended parent report screening measure is the Modified Checklist for Autism in Toddlers (MCHAT; Robins, Fein, & Barton, 1999). While the MCHAT has demonstrated superior psychometric characteristics, a major obstacle to the implementation of this measure in primary child health care settings is its large over-referral rate.  While a structured interview has been developed that greatly reduces this over-referral rate, it is not practical for administration during brief well child visits when the screening occurs.

We have developed a web-based decision support system (The Child Health and Development Interactive System, or CHADIS) that provides and scores pre-visit questionnaires such as the MCHAT. In addition, we have created a computerized version of the clinician-completed MCHAT follow-up. This follow-up interview is practical because it prompts doctors to ask a few specific follow-up questions to the parents in the case of a positive MCHAT, and because it is automatically rescored until a positive or negative result is obtained. We anticipate that our computerized MCHAT and Follow-Up interview will cut the over-referral rate by more than half.  CHADIS also provides decision support in the form of an electronic textbook linked to screening conclusions and resources that can be provided to the parents as handouts at the end of the clinical encounter.

Our CHADIS system is currently being implemented in a number of sites around the country, including an autism screening project in Maryland involving a sizable network of practices. However, implementation in settings with large numbers of disadvantaged families has been limited by a tendency for these parents to be less likely to complete questionnaires online from home prior to check-up visits.  We are therefore proposing the development of a waiting room alternative, such as an Interactive Voice Response (IVR) phone system, kiosk, or standard computer.  

The primary goals of the proposed research are to assess the predictive validity of this new computerized measure, and to compare alternative testing strategies with regard to patient satisfaction and costs. We hope to be able to illustrate that the new test system will be show advantages over paper alternatives, especially when the savings from unnecessary referral for false positive cases is considered.