We used the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5) to compare the behavioral and emotional problems of children diagnosed with ASD, suspected ASD, and TD children under the age of 3, and explored whether the CBCL/1.5-5 scores could predict the diagnosis of ASD at 3 years of age.
A total of 331 children aged 24-30 months from communities and clinics were screened using the Modified Checklist for Autism in Toddlers, Revised and Follow-Up (M-CHAT-R/F). At 3 years of age, all children received clinical diagnostic interview by child psychiatrists, they were categorized into three groups: ASD group (n=54), suspected ASD group (n=114), and TD group (n=163). The DSM-Oriented Scales, broad-band behavioral and emotional syndromes and Total Problems scores were derived from the CBCL/1.5-5 scale. Analysis of variance was used to examine whether significant differences of CBCL/1.5-5 scores existed between the 3 groups. Multivariable logistic regression analysis was employed to examine whether the CBCL/1.5-5 scores could predict a diagnosis of ASD at 3 years of age.
Among the 5 DSM-Oriented Scales, Affective Problems scores, Autism Spectrum Problems scores, and Oppositional Defiant Problems scores reached significant differences between the ASD and suspected ASD group, ASD and TD group, and suspected ASD and TD group, with the ASD group scoring highest, followed by the suspected ASD and TD group (all p0.05). Regarding the Internalizing, Externalizing, and Total Problems score, significant differences were shown among groups, with the ASD group scoring highest, followed by the suspected ASD and TD group (all p0.05). Results of logistic regression analysis showed that with each 1-point increase in the Autism Spectrum Problems and Oppositional Defiant Problems scores, the odds ratio of being diagnosed with ASD increased by 2.291 and 1.432 times, respectively (both p0.001).
The differences in CBCL/1.5-5 scores between the children with ASD, suspected ASD, and TD children revealed that the CBCL/1.5-5 scores have high predictability for the diagnosis of ASD under the age of 3.
The promising results encouraged pediatric physiotherapists and medical professionals to consider early identification of behavioral and emotional problems and combined with clinical evaluation to identify children who have high risk of ASD diagnosis under age 3. Furthermore, routine follow-up for those problems and syndromes are needed to detect of ASD early.
behavior problems
early identification
