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Diagnosing Autism Spectrum Disorder in Children with Low Mental Age

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Abstract

Autism Spectrum Disorder (ASD) diagnostic tools are not designed for mental ages (MA) below 12 months. Autism Diagnostic Observation Schedule (ADOS) and Childhood Autism Rating Scale (CARS) were examined in 2-year-olds with ASD-low MA (n = 53), Global Developmental Delay (GDD; n = 175), and ASD-higher MA (n = 425). ADOS and CARS demonstrated similar agreement with clinical diagnosis, but ADOS over-classified ASD in low MA, whereas CARS both over- and under-classified. All ADOS items differentiated GDD from ASD. Elementary social behaviors (e.g., eye contact, social interest) were similar across ASD groups, although advanced skills (e.g., pointing, play) were more impaired in ASD-low MA. ASD-low MA, a severe presentation, may require a modified ADOS algorithm to account for developmental delays.

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Authors and Affiliations

  1. Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA

    Lauren E. Miller, Jeffrey D. Burke & Deborah A. Fein

  2. A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA

    Diana L. Robins

Authors
  1. Lauren E. Miller
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  2. Jeffrey D. Burke
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  3. Diana L. Robins
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  4. Deborah A. Fein
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Contributions

The authors thank the families who participated in the current study, the physicians who assisted by offering the M-CHAT(-R) screening study to their patients, and the research teams at the University of Connecticut and Georgia State University. This manuscript was prepared from LM’s doctoral dissertation; accordingly, she thanks Marianne Barton, Ph.D., Rhiannon Smith, Ph.D., and Juliane Fenster, Ph.D. for their helpful feedback on earlier versions of the text. The authors also acknowledge the following sources of funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant R01HD039961, Maternal and Child Health Bureau Grant R40MC00270, U.S. Department of Education Student-Initiated Research Grant, the University of Connecticut’s Research Foundation Faculty Grant, the National Alliance of Autism Research, and a National Institute of Mental Health Predoctoral Fellowship F31MH12550.

Corresponding author

Correspondence to Lauren E. Miller.

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Conflict of interest

Diana Robins and Deborah Fein are part owners of M-CHAT, LLC, which receives royalties from companies that incorporate the M-CHAT(-R) into commercial products and charge for its use. Data reported in this manuscript are from the freely available paper version of the M-CHAT(-R). Lauren Miller and Jeffrey Burke declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from caregivers of all individual participants included in the study.

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Miller, L.E., Burke, J.D., Robins, D.L. et al. Diagnosing Autism Spectrum Disorder in Children with Low Mental Age. J Autism Dev Disord 49, 1080–1095 (2019). https://doi.org/10.1007/s10803-018-3810-8

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  • DOI: https://doi.org/10.1007/s10803-018-3810-8

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