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Research Program in Early Detection and Intervention

Program Leader:  Diana Robins

Program Overview

Early Detection: Dr. Diana Robins spearheaded recent advances in toddler screening for ASD using the Modified Checklist for Autism in Toddlers (M-CHAT), and its recent revision, the M-CHAT-R with Follow-Up (M-CHAT-R/F). Evidence indicates that if a standardized screening protocol is implemented during pediatric well-child care visits at 18 and 24 months, including immediate referral of children who demonstrate risk for ASD on the M-CHAT-R/F, the average age of diagnosis can be reduced by two years compared to the national median. In addition, more than three times as many toddlers were flagged for possible ASD risk based on the M-CHAT-R/F compared to the doctor’s surveillance, suggesting that the use of a standardized screening tool is essential to promote early detection for the greatest number of children. The M-CHAT-R/F is a brief, cost-effective, parent-report survey that can be integrated into a variety of settings in order to reach as many toddlers as possible.

Early Intervention: The EDI program at the A.J. Drexel Autism Institute aims to better link early detection with early intervention research. One of the main arguments against screening and early diagnosis is that not all children have high-quality, evidence-based intervention available. This program aims to study cost-effective methods of disseminating treatment to children in the community, as well as to adapt existing interventions to best meet the needs of underserved children and families. Finally, the program will contribute to the development of novel interventions that can best serve children with ASD and their families.

Dr. Robins' work was highlighted in Exel, Drexel University's Research Magazine.

Early Detection Project

The ongoing goals of the Early Detection Project include examining the optimal schedule for routine ASD screening, better integrating of screening with surveillance and other strategies to detect ASD, and broadening the scope of screening beyond pediatric primary care. The study builds on the seminal M-CHAT work (e.g., Robins et al., 2001; Chlebowski et al., 2013; Robins et al., 2014). This study will investigate three key questions: (1) What is the best age to initiate screening? (2) Can physician screening and surveillance improve after brief, focused training? (3) What are the factors associated with disparity in effective ASD screening and surveillance at the child/family level and at the physician/practice level? The proposed study will answer key remaining questions about early ASD screening, thereby impacting the early health monitoring of children across the nation, and helping ensure that the promise of early ASD detection can become a reality.

Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R01HD039961

CURE Autism Screening in Child Care Centers

Many efforts toward early detection of autism have focused on universal screening in the medical home, usually conceptualized as the child’s primary care physician. However, this approach overlooks an important community setting with regular access to young children: childcare settings. To date, childcare providers have received less attention and could offer tremendous potential for increasing early recognition of developmental issues in very young children, especially in underserved communities. Childcare providers have extensive exposure to typical child behavior and many hours of engagement with children, including many in daycares. Thus, engagement of childcare providers in toddler screening could present an opportunity for significant improvements in ASD early identification and the reduction of disparities in age of diagnosis and early treatment for autism and other developmental disabilities. The goals of this pilot study are to demonstrate feasibility and acceptability of screening in childcare centers, with particular emphasis on screening underserved children. Additionally, we aim to strengthen the partnership among childcare workers and parents to meet the needs of children, particularly those from underserved regions. To meet these goals, a mixed method design will pilot toddler ASD screening in childcare settings located in the Philadelphia Promise Zone.

Funded by Commonwealth Universal Research Enhancement (CURE) Program Grant, Project #13

Mobilizing Community Systems

It is vitally important to connect all aspects of care for children with ASD, from the initial screening at their primary care physician or other community setting, to the early intervention system mandated by the Individuals with Disabilities education Act (IDEA) Part C. By integrating different levels of care, we expect to reduce disparities and better serve children with ASD and other developmental delays. This study is a collaboration among 4 universities and involves: primary care training in ASD, universal screening using the Smart Early Screening for Autism and Communication Disorders (Smart ESAC), tracking of referrals and their uptake, and early intervention training, which are all supported by a web-based platform. The principal investigators, Drs. Amy Wetherby, Ami Klin, Craig Newschaffer, and Catherine Lord, are seasoned senior autism researchers on early detection, diagnosis, early treatment, and large-scale multisite longitudinal research.  Working together with a team of additional key investigators, consultants, and collaborators, they bring unique expertise related to family engagement, early intervention systems, and health disparities.

Funded by National Institute of Mental Health (NIMH) R01MH104423