Part 1: Screening scales
CHAT: (?Checklist for Autism in Toddlers)
A questionnaire tool used to screen young children 18-24 months of age for risk of developing autism spectrum disorders. It was first developed and published in 1992 by Baron-Cohen, Allen and Gillberg at the University of Cambridge, UK. The main focus was on "early social communication", "****enticular attention", and "pretend play".
The CHAT consists of 14 questions, nine in Part A, which are completed by parents or guardians and are intended to determine the child's play habits and behaviors, and five in Part B, which are completed by professional observers and focus on the child's behaviors and responses to a number of stimuli.
M-CHAT:
The M-CHAT scale is a modified version of the CHAT, designed by Diana Robins, Deborah Fein & Marianne Barton, and published in 1999.The M-CHAT consists of 23 judgmental questions to be completed by the child's caregiver. It is designed to maximize sensitivity to children's daily behaviors and to minimize missed screenings. It is intended for use with children 16-30 months of age.
CHAT-23:
The CHAT-23 was designed by Dr. Virginia Wong of the Duchess of Kent Children's Hospital at Queen Mary Hospital in Hong Kong, combining the CHAT with the modified M-CHAT in the U.S. The CHAT-23 combines the 23 questions of the M-CHAT parent questionnaire with the behavioral aspects of the CHAT. The CHAT-23 combines the 23 questions of the M-CHAT parent questionnaire and the 5 behavioral observations of the CHAT scale with a revised scoring method.
STAT:
The STAT is effective in clarifying the diagnosis of children 14 to 47 months of age with suspected manifestations of autism.*** It has 12 items, including 2 play items, 4 imitation items, 2 demand items, and 4*** hedonic attention items, and the complete assessment takes approximately 15-20 minutes.The STAT is designed to predict whether a child is at risk for an autism diagnosis. at risk for an autism diagnosis, rather than providing a direct diagnosis. Children who score high risk on the STAT should be referred for the next step in the diagnostic evaluation.The greatest strength of the STAT scale is that it is specific to children with autism, and the assessment of interactive communication skills provides a clear picture of the interactive communication problems of the child being tested; in addition to its role as an assessment, it is also very effective in the development of early intervention programs for the disorder.
The Social Responsiveness Scale (SRS):
A well-established and internationally recognized tool for assessing social interaction. Developed by Constantino and Gruber in 2005 and updated to the SRS-2 in 2012, it has the following characteristics:
● A parent/teacher-completed tool for assessing socialization in children 4-18 years of age, which can be used to assess the degree of social impairment in ASD and as an aid in the screening and diagnosis of ASD.
● It consists of 5 subscales*** and 65 items: 5 subscales*** and 65 items: 5 subscales*** and 65 items: 5 subscales*** and 5 items: 5 subscales*** and 5 subscales***. 65 items: the 5 subscales are Social Perception, Social Cognition, Social Communication, Social Motivation and Autism Behavioral Style.
● The items of the SRS encompass the 3 main aspects of the DSM-IV diagnostic criteria: impairments in social interaction, impairments in social communication, and stereotyped and narrow interests.
The Social Communication Scale SCQ:
Developed and published by Michael Rutter and Catherine Lord in 2003, the SCQ is currently sold by WPS; the Chinese version was translated and introduced by Susan Shur-Fen Gau's team in Taiwan in 2011, and reliability and validity studies have been conducted, and a mainland norm is available.
Characteristics of the scale:
●Autism screening tool for children over 4 years of age, with an intellectual age of >2 years, completed by parents, 40 questions, completion time: 10-15 minutes.
● The SCQ items were developed based on the most discriminatory diagnostic validity of the ADI-R and the DSM-IV, and are divided into three major domains of functioning: Social Interaction (15 questions), Communication (13 questions), and Restrictive, Repetitive, and Stereotyped Behavioral Patterns (8 questions).
In addition, the scale includes four questions on current language skills (not included in the total score), self-injurious behavior, unusual attachment, and attention to the human voice. Scale questions are answered as "yes" or "no". A total score of ≥15 indicates a positive initial screening;
●There are two forms available for the SCQ*** -
The SCQ Lifetime Edition Scoring Form: the child's entire developmental history is used as a reference for the responses, and the results of the scores obtained determine the need for referral for more thorough diagnostic evaluation.
The current version of the SCQ is scored using the child's behavior in the last 3 months as a reference, and the results of the scores reflect the patient's day-to-day life experiences, allowing for an assessment of the effectiveness of therapeutic and educational interventions.
The scale is very flexible, reasonably adapted to the child's language level, and can be done with or without spoken language.
Part II: Diagnostic Scales
The Autism Observation Scale (Second Edition) ADOS-2
Released by Catherine Lord and Dr. Michael Rutter, et al. in 2012, it is based on a revised version of the ADOS released in 1999.
Scale characteristics:
● For age: 12 months +; a semi-structured, standardized, interactive assessment tool, administered by a professional in 40-60 minutes.
● Depending on the child's language ability and age, the ADOS-2 is divided into 5 different modules: ModuleT, 1-4; it is used to assess 4 areas of communication, social interaction, play/imaginativeness, restricted interests and stereotyped behaviors.
The diagram partially illustrates the overall ADOS-2 assessment idea. The assessment process involves a series of standardized, semi-structured activities that place specific social pressures on the child being assessed in order to observe developmental deficits and deviations that may occur during the assessment process. For example, deficits in social responding and initiating, showing repetitive and stereotyped movements when excited, and showing limited interest in playing with toys.
The Childhood Autism Rating Scale CARS
Developed by Eric Schopler et al. in 1980, the CARS was revised in 2010 with the publication of the CARS-2.
Characteristics of the scale:
●Applicable age: 2 years +; tool for autism diagnosis by professionals based on observations of the child.
●***15 items, each rated on a scale of 1-4, takes about 30 minutes; assesses social interaction, communication, restricted interests and stereotyped behaviors, physical sensation, and intelligence;
●CARS-2: Because the CARS has a low sensitivity for identifying high-functioning autism, the CARS-2 is based on the CARS, which has been revised as the CARS2-ST. for "Standard Form" and CARS2-HF for "High Functioning"
●CARS-2: Due to the low sensitivity of CARS for identifying high functioning autism, CARS-2 has revised CARS2-ST based on CARS. CARS2-ST: Age <6 years, or older than 6 years but with an IQ of less than 80, or with significant communication deficits.
CARS2-HF: Age ≥6 years, IQ ≥80 and has communication fluency.
Autism Diagnostic Interview Scale Revised ADI-R
Developed and published in 2003 by Dr. Michael Rutter, Dr. Ann LeCouteur, B.A., and Dr. Catherine Lord.
Scale characteristics:
● Age appropriate: 2 years +; tool for autism diagnosis by professionals based on an interview format with parents.
● Duration: 90-150 minutes.
● Assessed in three areas: language/communication, reciprocal social interactions, restricted interests and stereotyped behaviors.
● Eight content areas are addressed -
(1) The subject's background, including family, education, previous diagnoses, and medications.
(2) An overview of the subject's primary behaviors.
(3) Early developmental experiences and significant points in growth.
(4) Acquisition and loss of language or other skills.
(5) Current situation in language and communication.
(6) Performance of social skills.
(7) Interests and behaviors.
(8) Clinically relevant behaviors such as aggression, self-harm, possible epileptic features.
The biggest difference between these three scales as diagnostic tools is the way in which they are assessed: the ADOS looks primarily at interactions, the ADI-R relies primarily on interviews, and the CARS relies primarily on observation.
The above cold knowledge, parents can understand, because it involves a high degree of professionalism, so the final discretion and interpretation are in the hands of the doctor. What we parents need to do is to go to the hospital or relevant professional organizations for evaluation and screening when we find that our children have speech and social problems.