Early detection of autism in childhood outpatient department practice: insight from pediatric neurology in Hyderabad, India

Habib Khan Pathan; Syed Shah Naseeruddin Sarmast; Pavan Reddy; Syed Mohammad Nusrath Qurram

doi:10.18203/2349-3291.ijcp20260098

Authors

Habib Khan Pathan Department of Pediatrics, Deccan College of Medical Sciences, Hyderabad, Telangana, India
Syed Shah Naseeruddin Sarmast Department of Pediatrics, Deccan College of Medical Sciences, Hyderabad, Telangana, India
Pavan Reddy Department of Pediatrics, Deccan College of Medical Sciences, Hyderabad, Telangana, India
Syed Mohammad Nusrath Qurram Department of Pediatrics, Deccan College of Medical Sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20260098

Keywords:

Autism spectrum disorder, M-CHAT, Screening, Early detection ASD, Neurodevelopmental disorder

Abstract

Background: Autism spectrum disorder (ASD) is prevalent neurodevelopmental disorder marked by core challenges in social communication, social interaction and presence of restrictive and repetitive behaviors. Early identification through effective screening is essential, as timely intervention significantly enhances developmental outcomes.

Methods: This descriptive cross-sectional study was conducted on a sample of 506 children aged 16 to 30 months attending the pediatric OPD clinic. Eligible children who met the inclusion criteria were screened for the risk of autism using the revised modified checklist for autism in toddlers (Revised M-CHAT).

Results: Among 506 children screened with the revised M-CHAT tool, 1.6% screened positive for ASD. The study population had a mean age of approximately 21.6 months without male predominance (59.6%). Key factors significantly associated with positive ASD screening included partial immunization, preterm birth, lack of exclusive breastfeeding, and exposure to more than 2 hours of screen time. Other demographic variables such as gender, mode of delivery, and parental education showed no significant association. Revised M-CHAT questionnaire items (notably questions 1, 2, 7, 10, and 12) were frequently positive among ASD screen-positive children, suggesting particular sensitivity for screening. Breastfeeding, screen-time exposure and immunization are confirmed statistically by this study.

Conclusions: All toddlers attending Pediatric clinics should be routinely screened for autism by a child specialist. The revised M-CHAT is a simple, easy-to-administer, and validated screening tool suitable for use in busy pediatric outpatient settings.

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References

Wieckowski AT, Hamner T, Nanovic S, Porto KS, Coulter KL, Eldeeb SY, et al. Early and Repeated Screening Detects Autism Spectrum Disorder. J Pediat. 2021;234:227-35.

Zhang Y, Zhou Z, Xu Q, Li H, Lv Y, Zhu G, et al. Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits. Front Psychiat 2022;13:879625. DOI: https://doi.org/10.3389/fpsyt.2022.879625

Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, et al. Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics. 2015;136(1):S41S59.

Jullien S. Screening for autistic spectrum disorder in early childhood. BMC Pediatr 2021;21(1):349. DOI: https://doi.org/10.1186/s12887-021-02700-5

Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, et al. Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics. 2015;136(1):S41S59. DOI: https://doi.org/10.1542/peds.2014-3667D

Robins DL, Dumont-Mathieu TM. Early screening for autism spectrum disorders: update on the modified checklist for autism in toddlers and other measures. Journal of developmental and behavioral pediatrics: JDBP. 2006;27(2):S111-9. DOI: https://doi.org/10.1097/00004703-200604002-00009

Wieckowski AT, Hamner T, Nanovic S, Porto KS, Coulter KL, Eldeeb SY, et al. Early and Repeated Screening Detects Autism Spectrum Disorder. Pediat. 2021;234:227-35. DOI: https://doi.org/10.1016/j.jpeds.2021.03.009

Miller LE, Dai YG, Fein DA, Robins DL. Characteristics of toddlers with early versus later diagnosis of autism spectrum disorder. Autism. 2021;25(2):416-28. DOI: https://doi.org/10.1177/1362361320959507

Amit G, Bilu Y, Sudry T, Avgil Tsadok M, Zimmerman DR, Baruch R, et al. Early Prediction of Autistic Spectrum Disorder Using Developmental Surveillance Data. JAMA Network Open. 2024;7(1):e2351052. DOI: https://doi.org/10.1001/jamanetworkopen.2023.51052

Okoye C, Obialo-Ibeawuchi CM, Obajeun OA, Sarwar S, Tawfik C, Waleed MS, et al. Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits. Cureus. 2023;15(8):e43226.

Sobieski M, Sobieska A, Sekułowicz M, Bujnowska-Fedak MM. Tools for early screening of autism spectrum disorders in primary health care - a scoping review. BMC Primary Care. 2022;23(1):46. DOI: https://doi.org/10.1186/s12875-022-01645-7

Øien RA, Vivanti G, Robins DL. Editorial SI. Early Identification in Autism Spectrum Disorders: The Present and Future, and Advances in Early Identification. J Autism Dev Disord. 2021;51(3):763-8. DOI: https://doi.org/10.1007/s10803-020-04860-2

Salgado-Cacho JM, Moreno-Jiménez MDP, de Diego-Otero Y. Detection of Early Warning Signs in Autism Spectrum Disorders: A Systematic Review. Children (Basel). 2021;8(2):164. DOI: https://doi.org/10.3390/children8020164

Okoye C, Obialo-Ibeawuchi CM, Obajeun OA. Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits. Cureus. 2023;15(8):e43226. DOI: https://doi.org/10.7759/cureus.43226

Dalwai S, Ahmed S, Udani V, Mundkur N, Kamath SS, Nair MK. Consensus statement of the Indian academy of pediatrics on evaluation and management of autism spectrum disorder. Indian pediatrics. 2017;54(5):385-93. DOI: https://doi.org/10.1007/s13312-017-1112-4

Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ. 2023;72(2):114. DOI: https://doi.org/10.15585/mmwr.ss7202a1

Chauhan A, Jitendra KS, Nishant J, Kiran K, Amit A, Jasleen K, et al Prevalence of ASD in Indian children: A systematic review and metaanalysis. Neurol India 2019;67(1):100-4. DOI: https://doi.org/10.4103/0028-3886.253970

Curran EA, O'Neill SM, Cryan JF, Kenny LC, Dinan TG, Khashan AS, et al. Research review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiatry. 2015;56(5):500-8. DOI: https://doi.org/10.1111/jcpp.12351

Ravi S, Venkatesh C, Shivanand K, Mahadevan S. Maternal and birth risk factors for children screening positive for ASDs on M-CHAT-R. Asian J Psychiatry. 2016;22:17-21. DOI: https://doi.org/10.1016/j.ajp.2016.04.001

Manohar H, Rajkumar RP. Role of exclusive breastfeeding in conferring protection in children at-risk for autism spectrum disorder: results from a sibling case-control study. J Neurosc Rural Pract. 2018;9(01):132-6. DOI: https://doi.org/10.4103/jnrp.jnrp_331_17

Wendy R, Mary H. Immunization and children at risk for autism. Pediatric Child Health. 2002;7(9):623-32. DOI: https://doi.org/10.1093/pch/7.9.623

Jain A, Jaclyn M, Ami B, Tim B, Jonathan PK, Craig JN. Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA. 2015;313(15):1534-40. DOI: https://doi.org/10.1001/jama.2015.3077

DeStefano F, Shimabukuro TT. The MMR Vaccine and Autism. Annu Rev Virol. 2019;6(1):585-600. DOI: https://doi.org/10.1146/annurev-virology-092818-015515

Breslau N, Davis GC, Andreski P. Risk factors for PTSD-related traumatic events: A prospective analysis. Am J Psychiat. 1995;152(4):529-35. DOI: https://doi.org/10.1176/ajp.152.4.529

Hultman CM, Sparén P, Cnattingius S. Perinatal risk factors for infantile autism. Epidemiology. 2002;13(4):417-23. DOI: https://doi.org/10.1097/00001648-200207000-00009

Leavey A, Zwaigenbaum L, Heavner K, Burstyn I. Gestational age at birth and risk of autism spectrum disorders in Alberta, Canada. J Pediatr. 2013;162(2):361-8. DOI: https://doi.org/10.1016/j.jpeds.2012.07.040

Richter SA, Nunes ML. COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Children and Adolescents-A Systematic Review. Rev J Autism Develop Disorders. 2022;23:1-26.

Mazurek MO, Shattuck PT, Wagner M, Cooper BP. Prevalence and correlates of screen-based media use among youths with autism spectrum disorders. J Autism Develop Disorders. 2012;42(8):1757-67. DOI: https://doi.org/10.1007/s10803-011-1413-8

Healy S, Nacario A, Braithwaite RE, Hopper C. The effect of physical activity interventions on youth with autism spectrum disorder: A meta‐analysis. Autism Res. 2018;11(6):818-33. DOI: https://doi.org/10.1002/aur.1955

MacMullin JA, Lunsky Y, Weiss JA. Plugged in: Electronics use in youth and young adults with autism spectrum disorder. Autism. 2016;20(1):45-54. DOI: https://doi.org/10.1177/1362361314566047

Dong HY, Wang B, Li HH, Yue XJ, Jia FY. Correlation Between Screen Time and Autistic Symptoms as Well as Development Quotients in Children with Autism Spectrum Disorder. Front Psychiatry. 2021;12:619994. DOI: https://doi.org/10.3389/fpsyt.2021.619994