Roald A Øien1,2, Synnve Schjølberg3, Fred R Volkmar2, Frederick Shic4,5, Domenic V Cicchetti2, Anders Nordahl-Hansen6, Nina Stenberg7, Mady Hornig8,9, Alexandra Havdahl3,10, Anne-Siri Øyen3,11, Pamela Ventola2, Ezra S Susser8,12, Martin R Eisemann13, Katarzyna Chawarska2. 1. Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway; roald.a.oien@uit.no. 2. Child Study Center, School of Medicine, Yale University, New Haven, Connecticut. 3. Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. 4. Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington. 5. Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington. 6. Department of Special Needs Education, University of Oslo, Oslo, Norway. 7. Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. 8. Department of Epidemiology, and. 9. Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York. 10. Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom. 11. Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway; and. 12. New York State Psychiatric Institute, New York, New York. 13. Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
Abstract
OBJECTIVES: We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS: We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS: Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS: This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.
OBJECTIVES: We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS: We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS: Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS: This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.
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