A New Instrument to Aid in Early Diagnosis for Autism Spectrum Disorder

1. A New Instrument to Aid in Early Diagnosis for Autism Spectrum Disorder Presented By Peter D. Marle, M.A. Coolidge Autistic Symptoms Survey – Toddler Version

2. A Brief History of Autism Anecdotal Accounts of Autism Prior to Scientific Documentation Martin Luther, 1652 Changeling Babies Feral children (e.g., Victor “wild boy” of Aveyron) Scientific Investigation the Autism Spectrum Early 20th Century De Sanctis, Earl, & Potter Mid 20th Century Leo Kanner and Hans Asperger Differentiated autistic behaviors from schizophrenia Studied children with mild forms of autism Kanner was suspect of autism being derived from “cold parents” Led to Bettelheim and the term “refrigerator mothers” Bernard Rimland eventually dissuaded this notion Coolidge Autistic Symptoms Survey – Toddler Version

3. A Brief History of Autism Scientific Investigation the Autism Spectrum Late 20th Century Wakefield et al. 1998 Prompted mass hysteria with study suggesting vaccines cause autism Was it correct? People such as Jenny McCarthy still propagate this notion Coolidge Autistic Symptoms Survey – Toddler Version

4. A Brief History of Autism Scientific Investigation the Autism Spectrum Late 20th Century Wakefield et al. 1998 Prompted mass hysteria with study suggesting vaccines cause autism Was it correct? People such as Jenny McCarthy still propagate this notion Current Research Directions for Autism Emphasis on genetics, neuroscience Also, there is a movement toward the hope that autism may be recoverable (Ozonoff, 2013) May be preemptive May only be applicable to changing behaviors in milder forms of autism However, early interventions in children with an autism spectrum disorder (ASD) can greatly influence the developmental trajectory of a child Coolidge Autistic Symptoms Survey – Toddler Version

5. Early Identification of ASD Rationale for the Coolidge Autistic Symptoms Survey – Toddler Version (CASS-T) Changes in DSM Diagnostic Criteria Forthcoming DSM-5 is expected to combine autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and PDD-NOS into Autism Spectrum Disorder Changes to the diagnostic criteria ensued Language criteria expected to be removed Addition of 3 Levels of Severity, ranging from mild to severe APA’s rationale for the changes: Literature regarding the differentiation of these disorders has been unreliable Combination was subject to common diagnosable symptomatology Current surveys exist, but may soon be outdated due to these changes Coolidge Autistic Symptoms Survey – Toddler Version

6. Development of the CASS-T • Item Development • A total of 39 items were derived from DSM-5 diagnostic criteria and • Extant literature on autism spectrum disorders • Items only pertinent to children under the age of 5 were included • Hypotheses • A 1-component solution (as determined by principal components analysis) would best fit the structure 39-item CASS-T • The CASS-T would show good internal reliability (Cronbach’s α ≥ .80) • The CASS-T would have good test-retest and split-half reliabilities (r ≥ .80). • The CASS-T would significantly differentiate among children with • milder forms of autism (e.g., Asperger’s disorder and high-functioning autism) • moderate-to-severe forms of autistic spectrum disorders • no diagnoses (i.e., a group-matched control group) • There would be a strong, positive correlation between the CASS-T and CASS • (The CASS has been developed separately as an ASD diagnostic tool for children over 5 years of age) Coolidge Autistic Symptoms Survey – Toddler Version

7. Development of the CASS-T • Method • Participants • Materials • Informed Consent Form • Demographic Sheet • 39-item CASS-T (Retrospective) • 83-item CASS • Procedure • All data were collected with IRB approval • Packets were either • hand-delivered to parents or • given in an electronic format (via a secure online survey host; i.e., PsychData.com) • Packets took approximately 30 min to complete • Participants were given the option of returning the materials via a self-addressed return envelope, postage paid or returning the materials to the CITI-trained researcher Coolidge Autistic Symptoms Survey – Toddler Version

8. Development of the CASS-T • Results • Hypothesis 1 • A 1-component solution would provide the best fit for the CASS-T • (accounting for at least 50% of the variance) • Either a 4-component (total variance explained = 65.5%) or • 5-component solution (total variance explained = 69.5%) best fit the data Coolidge Autistic Symptoms Survey – Toddler Version

9. Development of the CASS-T • Results • Hypothesis 2 • The CASS-T would show good internal reliability (Cronbach’s α ≥ .80) • Cronbach’s α = .97 (n = 88) Coolidge Autistic Symptoms Survey – Toddler Version

10. Development of the CASS-T • Results • Hypothesis 3 • The CASS-T would have good test-retest reliability (r ≥ .80) • r(90) = .95, p < .001 • The CASS-T would have good split-half reliability (r ≥ .80) • r(38; 1 week) = .80, p < .001 Coolidge Autistic Symptoms Survey – Toddler Version

11. Development of the CASS-T • Results • Hypothesis 4 • There would be significant differences among the group means for the CASS • the moderate-to-severe autism group would have the significantly highest mean, • the mild autism group would have the second highest mean, and • the group-matched control group would have the significantly lowest mean • F(2, 64) = 199.93, • p < .0005; η2 = .86 Coolidge Autistic Symptoms Survey – Toddler Version

12. Development of the CASS-T • Results • Hypothesis 5 • There would be a strong, positive correlation between the CASS-T and the CASS means • Correlation coefficient • r(92) = .89, p < .0005 Coolidge Autistic Symptoms Survey – Toddler Version

13. Development of the CASS-T • Results • Hypothesis 5 • There would be a strong, positive correlation between the CASS-T and the CASS means • Correlation coefficient • r(92) = .89, p < .0005 Coolidge Autistic Symptoms Survey – Toddler Version

14. Development of the CASS-T • Results • Hypothesis 5 • There would be a strong, positive correlation between the CASS-T and the CASS means • Correlation coefficient • r(92) = .89, p < .0005 Coolidge Autistic Symptoms Survey – Toddler Version

15. Development of the CASS-T Discussion Relating to the Development of the CASS-T With the exception of Hypothesis 1, all other hypotheses were confirmed It appears that the CASS-T can be used to assess ASD in children younger than 5, although current study assessed via retrospective Limitations and Future Research A limitation of the study was the sample size used for PCA Further research is necessary to determine the component structure of the CASS-T Current diagnoses for ASD do not typically generate a moderate (Level 2) diagnosis Once a diagnosis of Level 2 ASD becomes more common, the CASS-T should be re-evaluated for its ability to differentially assess this part of the spectrum Future research should also assess the sensitivity and specificity of the CASS-T Coolidge Autistic Symptoms Survey – Toddler Version

16. Thank you! Questions?