Early screening for autism spectrum disorder in Serbia: A pilot study of screening instruments for parents and child care workers

Introduction: Early diagnosis of autism spectrum disorder (ASD) can lead to early interventions, which may improve developmental and academic outcomes in children with ASD. Early screening is thus of significant importance. Aims: This study had two aims. First, it was aimed to translate into Serbian five screening instruments for ASD: Modified Checklist for Autism in Toddlers - Revised, (M-CHATR), Quantitative Checklist for Autism in Toddlers (Q-CHAT), Infant-Toddler Checklist (ITC), and Early Screening Autistic Traits Questionnaire (ESAT) for parents and the Checklist for Early Signs of Developmental Disorders (CESDD) for child care workers. Second, it was aimed to test the feasibility of the included data from parents and child care workers in early ASD screening. Methods: The translation and cultural adaptation process included standardized forward and backward translation with pilot testing. For screening within a childcare setting, one day-care center was selected. Data from at least one parent and a child care worker were collected for 47 children aged 28.94 months on average (SD = 8.39). Results: The face and content validity of each version of the instruments is satisfactory. The correlations among the scores showed that the ESET, M-CHAT-R, Q-CHAT, and ITC evaluate slightly different aspects of ASD. The M-CHAT covers similar aspects to the CESDD. Eight (17%) children were positively screened for ASD with at least one instrument. All positively screened with the ESAT, QCHAT, or ITC were also positive with the CESDD, while not all positively screened with M-CHAT-R were detected with the CESDD. All five instruments were able to detect the child with confirmed ASD in the final stage - clinical assessment. Conclusions: All five screening instruments are targeting ASD symptoms at early stage of life in our population. It is feasible to include reports from parents and child care workers in early ASD screening and there is an added value of combining data from the two.