The Application Of Children Neuropsychological And Behavioral Scale In Developmental Assessment And Early Screening For Children With Autism Spectrum Disorders

The First Part: The Efficacy al and Behavioral Scale-Revision 2016 in Screening for Autism Spectrum Disorder Objectives: The aim was to determine the clinical value of the Children Neuropsychological and Behavioral Scale-Revision 2016(CNBS-R 2016)for autism spectrum disorder(ASD)screening in developmental monitoring and to provide a theoretical basis for the application of CNBS-R 2016 in primary care centers.Methods: Children with ASD aged 0-42 months were recruited from the Child Health Department of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between August 2019 and March 2021.The CNBS-R 2016 and the classic Gesell Developmental Diagnostic Scale(GDS)were used to evaluate the development of children with ASD.The newly added Communication Warning Behavior subscale of CNBSR 2016 was used for the early screening of children with ASD.All participants were evaluated by CNBS-R 2016 and GDS,respectively.To analyze the consistency between the two scales,Spearman’s correlation coefficients and Kappa values were computed.Using the GDS as a reference assessment,the performance of CNBS-R 2016 for detecting developmental delays of children with ASD was analyzed with receiver operating curves(ROC).The ability of CNBS-R 2016 to screen for ASD is determined by comparing Communication Warning Behavior scores with the Autism Diagnostic Observation Schedule-Second Edition(ADOS-2).Results: In total,150 children with ASD were enrolled in this study.The developmental quotient of Gross Motor,Adaptive Behavior,Language and Personal-social Behavior in CNBS-R 2016 were highly related to the corresponding developmental quotient in GDS(r= 0.82 ～ 0.94,P < 0.05).The CNBS-R 2016 had a good diagnostic agreement with GDS when detecting early developmental delay in children with ASD(Kappa = 0.73 ～ 0.89).However,in the Fine Motor,the two scales showed a moderate correlation(r = 0.62),and the diagnostic agreement for detecting fine motor delay was poor(kappa = 0.27).The percentage of the fine motor delay according to the CNBS-R 2016 was significantly higher than that determined by the GDS(86.0% VS 77.3%).Using GDS as the gold standard,the Area under the Curve(AUC)of ROC in Gross Motor,Adaptive Behavior,Language,and Personal-social Behavior was 0.95 to 0.99,except for Fine Motor(AUC value = 0.70).Using the ADOS-2 as the gold standard,there was a good diagnostic agreement of the children with ASD determined by Communication Warning Behavior scores of CNBS-R2016 and ADOS-2.When 7 and 12 points were used as positive cut-off values for screening ASD by Communication Warning Behavior subscale of CNBS-R 2016,the diagnostic agreement rates with ADOS-2 were 100% and 93.5%,respectively.Conclusions: The CNBS-R 2016 and the GDS have good consistency in the developmental assessment of children.Moreover,the CNBS-R 2016 performed well on screening children with ASD by Communication Warning Behavior scores.Therefore,the CNBS-R 2016 is worthy of clinical application in children with ASD in China.The Second Part: The Relationship of Gestures,Motor skills and LanguageCommunication Abilities in Early Childhood with ASDObjectives: The study aimed to compare the number and type of gestures in children with ASD and typically developing(TD)children by assessing and monitoring early gestures using CNBS-R 2016,and to further investigate the relationship between gestures,motor skills,language-communication abilities in children with ASD.The study tried to provide evidence for early gestures characteristics in children with ASD and provide clues for improving language,motor skills,and language and communication abilities.Methods: Children aged 18-36 months with ASD and TD who met the inclusion criteria were included in this study,and they were matched for gender and developmental age.All children had completed the CNBS-R 2016 assessment.Eight gesture items from 0 to 24 months were recorded,with a score of 1 for those who passed and 0 for those who failed.The number and type of gesture development were compared between the two groups.Point binary correlation analysis was used to examine the correlation between gestures,motor skills,and language-communication abilities.In addition,according to the existing theory and research results,deictic gestures,iconic gestures,language-communication,and motor skills were included as latent variables to construct preliminary model.The Confirmatory Factor Analysis(CFA)was performed for each latent variable,excluding the observation variables that do not meet the criteria.The final Structural Equation Model(SEM)was performed to examine the relationship between gestures,motor skills and languagecommunication abilities.Results: There are 103 children with ASD and 103 TD children in this study.Compared with TD children,children with ASD had significantly lower number of normal deictic gestures(“giving”,“sharing”,and “pointing”)and iconic gestures(“representation”,“welcome”,“goodbye”,“no”)(P < 0.05).There was no significant difference in the number of normal iconic gesture(“hugging”)between the ASD and TD children(P > 0.05).The pass rate of iconic gestures was worse than deictic gestures in children with ASD(17.47% VS 53.39%),while the pass rates of both iconic and deictic gestures were higher in TD children(93.23% & 100.00%).In the correlation analysis between gestures,motor skills,language,and communication in early childhood,deictic gesture(“sharing”)showed a significant moderate correlation with Fine Motor DQs(r = 0.48,P < 0.05);deictic gestures(“giving”,“pointing”,and “sharing”)showed a significant moderate correlation with Language DQs(r = 0.45,0.40,0.47,P < 0.05);and deictic gesture(“giving”)showed a significant moderate correlation with Personal-social Behavior DQs(r = 0.44,P < 0.05).The fit for constructed SEM model indices revealed a good fit,X~2/df = 2.0,CFI = 0.90,GFI = 0.90,RMSEA = 0.09.There was a moderate positive correlation between deictic gestures and language-communication abilities(r = 0.69,P < 0.05),a moderate positive correlation between motor skills and language-communication abilities(r = 0.47,P<0.05),and motor skills can indirectly influence language-communication abilities through deictic gestures.Conclusions: Children with ASD have poorer gestures development than children with TD,of which the impairment of deictic gestures(“giving”,“pointing”,“sharing”)was predominant.In addition,the study found that gestures are closely related to languagecommunication abilities under the influence of motor skills.All these results provide a theoretical basis for exploring the role of early gestures and motor skills in the early identification of ASD.