| Objectives: To determine early warning indicators of autism and their cut-off values, to explore a simple and fast warning tool of autism, and to provide the evidence of early recognition of autism through the acknowledge of the occurrence of the developmental deviation and abnormal behaviors of autistic children aged 6 to 36 months.Methods: Autistic children under 5 years old from several health care institutes in Wuhan, Changsha and other cities were included as the case group, and healthy children matched by sex, age and region as the control group. The main guardians of these children were surveyed by a self-designed questionnaire and Clancy Behavior Scale(CABS). EpiData 3.1 was used to establish a database, SPSS 20.0 software was used to analyze the data. The screening time was defined according to the requirement of “4.2.1” physical examination. On the basis of the abnormalities of autistic children and healthy children, we calculated children's scores of the warning indicators at different ages(6, 8, 12, 18, 24, 30 and 36 months), and then compared the scores from the two groups. The receiver operating characteristic curves were drawn to determine the early warning indicators of children at different ages and their cut-off values, and to compare the sensitivity and specificity of the early warning indicators of autism and CABS(30 and 36 months).Results:(1) General characters: 498 couples of children under 5 years old were investigated in this study, whose age was averaged 41.22±11.82 months and 41.83±12.05 months respectively. The ratio of gender was 6.32: 1. There was no statistical differences in age distribution of the two groups(? 2=2.732, P=0.435).(2) The occurrences of children's abnormal development and behaviors in the two groups:(1)The deviation of children's development was the main issue, and the emergence rate decreased with age. In terms of the development of social behaviors, the emergence rate of the case group was two times higher than that of the control group(“no reaction to the departure or return of the guardians”, “can't smile in respond of being kidding” and “no eye contacts with people”). 53.7 to 72.3% autistic children aged 8 to 12 months “can't distinguish between strangers and acquaintances”. In terms of the language development, 43.1 to 60.2% autistic children aged 6 to 8 months can't babble;(2)The occurrence of abnormal behaviors was the main issue, and the emergence rate increased with age. In terms of the social dysfunction situation, the number of abnormal behaviors of autistic children aged 24, 30 and 36 months increased from 3 to 6 types with the rate of over 50%. The rate of healthy children aged 12 to 36 months “who smile without any reasons” was between 5% and 10%. In terms of the dysfunction of verbal and non-verbal communication, the number of abnormal behaviors of autistic children aged 30 and 36 months increased from 4 to 7 types with the rate of over 40%. But the rate of healthy children aged 36 months who were not interested in what other people say or not seemed to listen was 3.6%. In terms of stereotyped and restricted behaviors and interests, the number of abnormal behaviors of autistic children aged 24, 30 and 36 months increased from 1 to 5 types with the rate of over 50%.(3) The determination of early warning indicators of autism and their cut-off values at different ages: The scores of autistic children were significantly higher than that of the healthy children(P<0.01).The early warning indicators of children aged 6 months include 3 items, such as “cannot babble” and “cannot smile in respond of being kidding” and their cut-off value is 1.5 point. The early warning indicators of children aged 8 months include “cannot distinguish between strangers and acquaintances” and “no reaction to the departure or return of the guardians”, and their cut-off value is 0.5 point. The early warning indicators of children aged 12 months include 4 items, such as “no eye contact with people” and “cannot smile in respond of being kidding”, and their cut-off value is 0.5 point. The early warning indicators of children aged 18 months include 8 items, such as “no contact with surrounding environment” and “cannot accept simple instructions”, and their cut-off value is 0.5 point. The early warning indicators of children aged 24 months include 15 items, such as “cannot participate in collective games or activities” and “refuse to imitate other people's actions, expression, or sound”, and their cut-off value is 0.5 point. The early warning indicators of children aged 30 months include 6 items, such as “be not interested in what other people say or not seemed to listen” and “cannot share interest and feelings”, and their cut-off value is 0.5 point. The early warning indicators of children aged 36 months include 4 items, such as “no contact with surrounding environment” and “cannot participate in collective games or activities”, and their cut-off value is 0.5 point.(4) Comparison of the early warning indicators of autism and CABS indicators: The autistic children's scores of the early warning indicators of autism and CABS indicators were significantly higher than that of the healthy children(P<0.01).(1)Comparison of the early warning indicators and CABS indicators of children aged 30 months: The area under ROC curve of the former is a little bit more than that of the latter(0.901, 0.895), the specificity is similar(0.939, 0.947), but the sensitivity is significantly higher than that of the latter one(0.824, 0.733);(2) Comparison of the early warning indicators and CABS indicators of children aged 36 months: The area under ROC curve of the former is similar with the latter one(0.873, 0.890), the specificity is also similar(0.952, 0.962), but the sensitivity is significantly higher than that of the latter(0.769, 0.712).Conclusion: The less and more-targeted early warning indicators of autism, and their best cut-off values for children aged 6 to 36 months were determined by receiver operating characteristic curve. The screening results of the early warning indicators of children aged 30 and 36 months tend to be better than that of CABS. |
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