1、Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Children Hong Kong Study,Principle Investigator: Prof Virginia WongCo-Investigators:Dr Cheuk-Wing FungDr Brian Hon-Yin ChungDr Wing-Cheong Lee Dr Joy Lok-Sum Leung Ms Nancy TsangMs Stella Hui,Research Background (1),Autistic disorde
2、r affects 5-30 in 10,000 of population most beneficial intervention : early and intensive special education,Research Background (2),Checklist for Autism in ToddlersA screening tool for prospective identification of autistic cases at 18-months of age (Baron-Cohen 1992) Modified Checklist for Autism i
3、n Toddlers (Robins et al (2001) )18 to 24-months of age,Research Background (3),Symbolic Play Test (Second Edition) to estimate the mental agean adjunctive tool to understand development of subjects4 separate situations subject is allowed to play with the standard sets of miniature toys with minimal
4、 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 KongAny items that can best discriminate the autistic development will be soughtTo determine the most suitable cut-off criteria and risk str
5、atification from the graduated scores of CHAT-3,Objectives (2),To examine the utility of CHAT, M-CHAT and CHAT-3Consistency 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 childrenTo explor
6、e the possibility of CHAT-3 for population-wide or targeted high risk group screening.,Study method and Procedure:,Cross-SectionalSubject:Chinese populationChildren aged between 18 months and 6 years oldIn the fieldtrips up to 19/06, we have interviewed 109 children.Normal nurseries: 31 EETC (Heep K
7、ong Society): 78 (Among the 109 children, the demographic data of 17 children is not available),Study method and Procedure:,MethodWritten consent obtained before the interviewDemographic data Self-administered Part A questionnaire Tests:Checklist for Autism in Toddlers 3rd Edition (CHAT-3)Symbolic P
8、lay TestReynellThe 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 interview28/5- Briefing session28-29/5-
9、1st field trip (Portland Street)6/6- Workshop: training and inter-rater correlation,Study Method and Procedure,Schedule10/6- Toys collection, inter-rater correlation11-25/6- Field trip and data entry17/6- mid- evaluation and inter-rater correlation 21-27/6- Data analysis27/6- Presentation,Toy Collec
10、tion,Field Trip,Tam To Centre (EETC),SKH St Thomas DC,CHAT-3 Centre Visit Schedule,CHAT-3 Centre Visit Schedule (continue),Data Analysis: 21 June, 2002,Study method and Procedure:,Analysisinterrater correlation (0.95) by taking data from same parents at least by 2 interviewers 100% was attained for
11、Chat B and Symbolic Play TestGrouped according to chronological and mental agestatus of health and diagnosis (autism / PDD, developmental delay, cerebral palsy, multiple handicaps and normal)Double-blinded and controlled paired up,Study method and Procedure:,Analysis (continue)For children who have
12、been diagnosed as AD or PDD, results of CHAT-3 are compared with the previously charted diagnosis to show the validityFor those who hasnt 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 con
13、firm the diagnosis,Result: Chronological Age distribution of the subjects:,All the children are aged between 18 months and 6 years old.Youngest: 18 months oldEldest: 59 months oldAged between 18 and 36 months: 60.9%,Symbolic Play Test - Age,Reynell - Age,Result:,Boys: 66Girls: 43,Gender,Result: Diag
14、nosis,Handedness of the subjects,Head Circumference of the subjects,Demographic Data of Father,Demographic Data of Mother,Domestic helper,CHAT-3,CHAT,1. Results of CHAT A 2. Results of CHAT B3. Internal consistency of CHAT,CHAT A,Difference between normal ,autistic and developmental delay subjects i
15、n:1. Total scores2. 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 quest
16、ions in the whole chat AThe 6 discriminative items : fail 2 or more questions among the six,Total scores - normal subjects,Failing rate of normal subjects in CHAT A,73.7% of normal subjects fail chat A,Results of normal subjects in the six discriminative items,Failing rate of normal in the 6 discrim
17、inative items,5.3 % of normal fail the 6 items,Total scores - autistic subjects,Failing rate of autistic subjects in CHAT A,All autistic subjects fail chat A,Results of autistic subjects in the 6 discriminative items,failing rate of autistic subjects in the 6 discriminative items,66.7 % of autistic
18、subjects fail the 6 items,Total scores - developmental delay subjects,Failing rate of developmental delay subjects in CHAT A,84 % of developmental delay subjects fail chat A,Results of developmental delay subjects in the six discriminative items,Failing rate of developmental delay subjects in the 6
19、discriminative items,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,CHAT B,Difference between normal, delay development and autist
20、ic subjects in:1. Eye contact2. Gaze monitoring 3. Pretend play4. Protodeclarative pointing,CHAT B - Q1- Eye contact Normal subjects,Eye contact:usually, sometimes = Pass (1); seldom., never = Fail (0) All the subjects passed the test.,Autistic Subjects,All the autistic subjects failed the test.,Del
21、ay Development,Pass = 1 (91.5%)Fail = 0 (8.5%)Conclusion:All autistic subjects failed in eye contact, while most of the other subjects passed the test.,CHAT B - Q2 - Gaze monitoring 小明 ,你睇 Normal subjects,Autistic subjects,Delay Development,.,Conclusion,Gaze monitoring Most of the normal ( 97.7 %) ,
22、 delay development (96.6%) and autistic subjects (66.7%) pass the test. This test may not be sensitive enough to distinguish autistic subjects from others.,Q3 - Pretend Play 倒茶茶 Normal subjects,Autistic subjects,Developmental Delay,Yes = 3 (83.1%)Simulate only = 2 (10.2%)No = 1 (5.1%),Conclusion,Pre
23、tend Play Most normal (90.7%) and delay development subjects (83.1%) passed the test. Most autistic subjects (66.7%) failed the test.,Q4 Protodeclarative pointing 燈燈呢? Normal subjects,Autistic subjects,Point and look = 4 (33.3%)Look only = 2 (66.7%),Developmental Delay,Point and look = 4 (54.2%)Poin
24、t only = 3 (1.7%)Look only = 2 (22.8%)No = 1 (15.3%),Conclusion,Protodeclarative Pointing:Most of the normal (83.7%) and delay development subjects (54.2%) achieved high scores. Most autistic subjects (66.7%) failed in the test.,Q4 First object the child responsesNormal subjects,Autistic subjects,De
25、velopmental Delay,Internal consistency of CHAT,To check the consistence between 1. Q7 in part A (A7)and Q4 in part B(B4) , where both focus on protodeclarative pointing2. Q5 in part A(A5) and Q3 in part B(B3), where both focus on pretend play,We are checking the consistency seperately for : 1. Norma
26、l subjects2. Autistic subjects3. Developmental delay subjects,Normal subjects : A7 and B4,Normal subjects : A5 and B3,Autistic subjects : A7 and B4,Autistic subjects : A5 and B3,Developmental delay subjects : A7 and B4,Developmental delay subjects : A5 and B3,Symbolic Play Tests,Local table of Age e
27、quivalent of score,Local table of Age equivalent of score,Limitations There are not enough sample in each age groupThe children in normal nurseries are shy to play with the toys,Local table of Age equivalent of score,Suggestion:Follow up of missing dataContinue data collection of normal children,A N
28、ew Symbolic Play Test,Situation III,CURRENT SPTRelates knife or fork to plateRelates fork, knife, or plate to tableRelates spoon, fork, knife, or plate to doll,NEW SPTRelates chopsticks to bowlRelates chopsticks or bowl to tableRelates chopsticks or bowl to doll,SPT Situation III,Drawbacks of the ne
29、w set:The size of chopsticks and bowl are not proportional to other toys.The chopsticks and bowl are bigger and attract children to play with them.,SPT Situation III,Suggestion:Modify the size of toys,Situation IV,CURRENT SPTMoves tractor or trailer alongRelates log(s) to tractor, trailer or manLine
30、s up tractor and trailerAttaches tractor to trailer,NEW SPTMoves train along Put train cars on railLines up train carsAttaches train cars,SPT Situation IV,Drawbacks of new set:It cannot replace the current one because there are no man and logs.Some new items cannot be compared with that of current i
31、tems: Put engine on either end Put train cars on rail,SPT Situation IV,Suggestion:Modify the design of toys,Current: Relates knife or fork to plateNew: Relates chopsticks to bowl,* p0.05* p0.01,Current: Relates fork, knife, or plate to table New: Relates chopsticks or bowl to table,* p0.05* p0.01,Cu
32、rrent: Relates spoon, fork, knife, or plate to doll New: Relates chopsticks or bowl to doll,* p0.05* p0.01,Current: Moves tractor or trailer alongNew: Moves train along,* p0.05* p0.01,Current: Relates log(s) to tractor, trailer or manNew: Put train cars on rail,* p0.05* p0.01,Current: Lines up tract
33、or and trailer New: Lines up train cars,* p0.05* p0.01,Current: Attaches tractor to trailerNew: Attaches tractor to trailer,* p0.05* p0.5Strongest correlation between language exp and verbal comprehension(0.703),EETC,Result:EETC,All results are statistically significantAll shows positive correlation
34、All have r 0.7Best correlation between language expression and verbal comprehension(0.902)Generally good correlation between age and SPT , age and Reynell (r0.8),Overall,Result: Overall,A combined picture of the results of normal children and children from EETCAll results are statistically significa
35、ntAll correlations are positiveAll have r 0.6Best correlation between language expression and verbal comprehension,Comment,Result from EETC shows better correlations than from normal nurseriesChildren perform well in part I of the Reynell likely to do well also in Reynell part IIChildren perform wel
36、l in SPT also likely to perform well in ReynellOlder kids generally perform better,WeeFIM,WeeFIM,AimsSubject: all EETC3 catagoriesSelf Care Domain RatingMobility Domain RatingCognition Domain RatingTotal WeeFIM RatingMethod: face-to-face interview,Results,Descriptive dataMethod:CatagorizeChi-square
37、testSignificant (p 0.05)SPT ageReynellIntra-correlation With WeeFIM raw score,Descriptive Data,8 EETC; 78 Children70 valid WeeFIMGender: boys (65.7%) & girls (34.3%)Chronological Age: 70% between 31 to 40 mSome are developmental delay (74%)WF Total: 60% less than 26 months(According to Western Norm
38、Data),Dermographic data with WeeFIM,All are not significantGenderChronological ageHead circumferenceParents occupation, education levelDiagnosisDomestic helper,Chat A with WeeFIM,Not significantWF1, WF2, WF3 against Chat AReasonWeeFIM mainly related to the performance status,SPT-age with WeeFIM,Sign
39、ificantWF1(p=0.001)WF2 (p=0.05)WF total (p=0.001)Not significantWF3 (p=0.089),Proposed Reasons:Expected to be related to mental ageSubjects with isolated speech delayParents may not notice in detailsAt nurseriesAt home“I havent tried it BUT.”,Reynell Verbal with WeeFIM,All are significantWF1 (p=0.00
40、0)WF2 (p=0.000)WF3 (p=0.003)WF Total (p=0.000),Reynell Expression with WeeFIM,SignificantWF1 (p=0.000)WF3 (p=0.016)WF Total (p=0.000)Not significantWF2 (p=0.082),WF2 and Reynell Expression are independently related to age,Intra-correlation,Problem encountered,Rating is not reliableParents may not notice minor items or not notice the items questioned in WeeFIM,Video demonstration,Case 1 prematurityCase 2 PrematurityCase 3 Preparation,
