Checklist for Autism in Toddlers Checklist for Autism in Toddlers Third Edition (CHAT-3) for Third Edition (CHAT-3) for Chinese Children – Hong Kong Chinese Children – Hong Kong Study Study Principle Investigator Principle Investigator : Prof Virginia : Prof Virginia Wong Wong Co-Investigators Co-Investigators : : Dr Cheuk-Wing Fung Dr Cheuk-Wing Fung Dr Brian Hon-Yin Dr Brian Hon-Yin Chung Chung Dr Wing-Cheong Lee Dr Wing-Cheong Lee Dr Joy Lok-Sum Leung Dr Joy Lok-Sum Leung Ms Nancy Tsang Ms Nancy Tsang Ms Stella Hui Ms Stella Hui
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Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Children – Hong Kong Study Principle Investigator: Prof Virginia Wong Co-Investigators:Dr.
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Checklist for Autism in Toddlers Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Third Edition (CHAT-3) for Chinese
Children – Hong Kong StudyChildren – Hong Kong Study
Checklist for Autism in Toddlers Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Third Edition (CHAT-3) for Chinese
Children – Hong Kong StudyChildren – Hong Kong StudyPrinciple InvestigatorPrinciple Investigator: Prof Virginia Wong: Prof Virginia Wong
Co-InvestigatorsCo-Investigators:: Dr Cheuk-Wing FungDr Cheuk-Wing FungDr Brian Hon-Yin ChungDr Brian Hon-Yin ChungDr Wing-Cheong Lee Dr Wing-Cheong Lee Dr Joy Lok-Sum Leung Dr Joy Lok-Sum Leung Ms Nancy TsangMs Nancy TsangMs Stella HuiMs Stella Hui
Research Background (1)
• Autistic disorder affects 5-30 in 10,000 of population
• most beneficial intervention : early and intensive special education
Research Background (2)
• Checklist for Autism in Toddlers– A screening tool for prospective
identification of autistic cases at 18-months of age (Baron-Cohen 1992)
• Modified Checklist for Autism in Toddlers (Robins et al (2001) )– 18 to 24-months of age
Research Background (3)
• Symbolic Play Test (Second Edition) to estimate the mental age– an adjunctive tool to understand
development of subjects– 4 separate situations – subject is allowed to play with the standard
sets of miniature toys with minimal prompting
Objectives (1)• To test the validity and reliability (internal
consistency and inter-rater reliability) of the new CHAT-3 in Chinese children in Hong Kong
• Any items that can best discriminate the autistic development will be sought
• To determine the most suitable cut-off criteria and risk stratification from the graduated scores of CHAT-3
Objectives (2)• To examine the utility of CHAT, M-CHAT and
CHAT-3• Consistency and accuracy between the
three screening tools • To test the applicability of Symbolic Play
Test in the Chinese population in determining the mental maturity of children
• To explore the possibility of CHAT-3 for population-wide or targeted high risk group screening.
Study method and Procedure:
• Cross-Sectional
• Subject:– Chinese population– Children aged between 18 months and 6 years old
– In the fieldtrips up to 19/06, we have interviewed 109 children.
– Normal nurseries: 31 – EETC (Heep Kong Society): 78 – (Among the 109 children, the demographic data of 17 children is not
available)
Study method and Procedure:
• Method– Written consent obtained before the interview– Demographic data – Self-administered Part A questionnaire
– Tests:1. Checklist for Autism in Toddlers 3rd Edition (CHAT-3)2. Symbolic Play Test3. Reynell4. The Functional Independence Measure (WeeFIM)
– We conducted tests 1-3 in the children of normal nursery (as the parents are present), and conducted all the 4 tests in the children of EETC.
Study method and Procedure
• Schedule:– 29/4- First meeting and interview– 28/5- Briefing session– 28-29/5-1st field trip (Portland Street)– 6/6- Workshop: training and inter-rater c
orrelation
Study Method and Procedure• Schedule
– 10/6- Toys collection, inter-rater correlation
– 11-25/6- Field trip and data entry– 17/6- mid- evaluation and inter-rater
correlation – 21-27/6- Data analysis– 27/6- Presentation
Toy Toy CollectionCollection
Field Trip
Tam To Centre (EETC)
SKH St Thomas DC
CHAT-3 Centre Visit Schedule
Date Centre Type 07/06/2002 Jessie & Thomas Tam Centr
eEETC
11/06/2002 SKH St Thomas DC Normal Nursery
Leung King Centre EETC
12/06/2002 Cheerland DN & DC Normal Nursery
13/06/2002 Jockey Club Centre EETC
Pak Tin Centre EETC
Shun Lee Centre EETC
CHAT-3 Centre Visit Schedule (continue)
Date Centre Type
14/06/2002 Cheerland DN & DC Normal Nursery
Kwok Yip Lin Houn Cnetre EETC
17/02/2002 St James Settlement Kathleen McDonall CCC
Normal Nursery
18/02/2002 Jessie & Thomas Tam Centre
EETC
19/02/2002 St James Settlement Kathleen McDonall CCC
Normal Nursery
24/02/2002 HKSPC Portland Street DC Normal Nursery
25/02/2002 HKSPC Chan Kwan Biu Mem. Foundation DC
Normal Nursery
HKSPC Esther Lee DC Normal Nursery
Data Analysis: 21 June, 2002Data Analysis: 21 June, 2002
Study method and Procedure:• Analysis
– interrater correlation (>0.95) by taking data from same parents at least by 2 interviewers
• 100% was attained for Chat B and Symbolic Play Test
– Grouped according to • chronological and mental age• status of health and diagnosis (autism / PDD, developmental del
ay, cerebral palsy, multiple handicaps and normal)
– Double-blinded and controlled paired up
Study method and Procedure:
• Analysis (continue)– For children who have been diagnosed as AD or
PDD, results of CHAT-3 are compared with the previously charted diagnosis to show the validity
– For those who hasn’t been previously diagnosed as PDD / AD but picked up by CHAT-3 will be assessed using Autism Diagnostic Interview-Revised (AIDR, Catherine Lord et al (1994)) to confirm the diagnosis
Result: Chronological Age distribution of the
subjects:•All the children are aged between 18 months and 6 years old.•Youngest: 18 months old•Eldest: 59 months old•Aged between 18 and 36 months: 60.9%
Age at test (mos)
60.0
57.5
55.0
52.5
50.0
47.5
45.0
42.5
40.0
37.5
35.0
32.5
30.0
27.5
25.0
22.5
20.0
17.5
Age distribution of the subjects (up to 19/06)12
10
8
6
4
2
0
Std. Dev = 9.77
Mean = 34.9
N = 92.00
Symbolic Play Test - Age
SPT (Age)
Symbolic Play Test - Age (months)12
10
8
6
4
2
0
Std. Dev = 7.27
Mean = 25.0
N = 109.00
Reynell - Age
Reynell Verbal Expression - Age (yr.mo)
verbal exp
4.095
4.040
4.010
3.600
3.105
3.080
3.040
3.020
3.000
2.100
2.080
2.060
2.030
2.010
1.100
1.080
1.030
1.010
Missing
Co
un
t
10
8
6
4
2
0
Reynell Expressive Expression - Age (yr.mo)
expressive exp
6.550
4.055
4.005
3.100
3.060
3.020
2.110
2.080
2.050
2.010
1.100
1.070
1.030
1.000
MissingC
ou
nt
12
10
8
6
4
2
0
Result:
•Boys: 66
•Girls: 43
• Gender
Boys
Girls
Boys Girls
Result: DiagnosisDiagnosis No. of subject Percentag
eMental retardation
or delayed development
54 51.4%
Cerebral palsy 1 1.0%
Pervasive developmental
disorders (include autism)
3 2.9%
Multiple handicaps 4 3.8%
Normal 43 41%
Handedness of the subjects
Handedness
bilateral
left
right
Missing
Head Circumference of the subjects
Head circumference (cm)
>51
46-50.99
41-45.99
<=40.99
Missing
Demographic Data of Father
Occupation of father
Unskilled
Semi-skilled
Skilled - Maual and
Intermediate
Professional
Missing
Eduction level of father
Primary school (P.6)
Secondary school (F.Matriculate / Diplom
University degree or
Missing
Demographic Data of Mother
Occupation of mother
Unskilled
Semi-skilled
Skilled - Manual and
Intermediate
Professional
Missing
Eduction level of mother
No official educatio
Primary school (P.6)
Secondary school (F.
Matriculate / Diplom
University degree or
Missing
Domestic helper
Domestic Helper
yes
No
Missing
CHAT-3CHAT-3CHAT-3CHAT-3
CHAT • 1. Results of CHAT A
• 2. Results of CHAT B
• 3. Internal consistency of CHAT
CHAT A • Difference between normal ,autistic and
developmental delay subjects in:
• 1. Total scores
• 2. Scores in the 6 discriminative items
Notes
• Questions 1 and 16 are buffer questions • those who fail either of the 2 buffer
questions are excluded from the analysis ;
• There are 5 normal and 9 developmental delay subjects being excluded
Failing definition • CHAT A : fail 3 or more questions in
the whole chat A
• The 6 discriminative items : fail 2 or more questions among the six
24 % of developmental delay subjects fail the 6 items
Failing rate
• In conclusion, the six items are more sensitive than other questions in discriminating autistic children from normal and developmental delay children
Spearman's rhoAge at test (mos)SPT (Age) verbal expexpressive exp
Correlation is significant at the .01 level (2-tailed).**.
Result: Overall• A combined picture of the results of
normal children and children from EETC• All results are statistically significant• All correlations are positive• All have r > 0.6• Best correlation between language
expression and verbal comprehension
Comment
• Result from EETC shows better correlations than from normal nurseries
• Children perform well in part I of the Reynell likely to do well also in Reynell part II
• Children perform well in SPT also likely to perform well in Reynell