結合多重訊息來源篩檢3歲以下自閉症類群疾患幼兒

Combining Information from Multiple Sources to Screen Children with Autism Spectrum Disorders under the Age of 3 Years

研究目的：臨床實務常使用篩檢工具協助自閉症類群幼兒之診斷。本研究探究結合多重訊息來源篩檢年幼自閉症類群之效度。研究方法：本文研究期間為2012年4月至2015年4月。參與者為24至36個月大的自閉症類群或發展遲緩幼兒各45名，及其家長，兩組幼兒在生理年齡、整體心理年齡及性別比例，沒有顯著差異。使用「臺灣版兩歲期自閉症篩檢工具」與「克氏行為量表」進行評估。兩組幼兒接受臺灣版兩歲期自閉症篩檢工具評估，家長填寫克氏行為量表。克氏行為量表以全部14題（克氏行為量表-14）及關鍵9題（克氏行為量表-9）進行分析。研究結果：單一篩檢工具，臺灣版兩歲期自閉症篩檢工具以2作為切截分數，敏感度.89、特異度.84；CBS-14以12為切截分數，敏感度為.78、特異度為.71；克氏行為量表-9以7為切截分數，敏感度及特異度皆為.76。結合兩項篩檢工具時，臺灣版兩歲期自閉症篩檢工具與克氏行為量表-14一致時，敏感度.97、特異度.96；臺灣版兩歲期自閉症篩檢工具與克氏行為量表-9一致時，敏感度.97、特異度1。研究結論：本研究再次驗證臺灣版兩歲期自閉症篩檢工具是具備良好效度的層次二ASDs幼兒篩檢工具，而克氏行為量表僅為可接受程度。合併臺灣版兩歲期自閉症篩檢工具與克氏行為量表使用時，能提升診斷正確性，如二者結果不一致，宜以訪談澄清。

Purpose: It is conventional to use screening tools to diagnose children with autism spectrum disorders (ASDs) in a clinical setting. However, no study has used different ASDs screening tools simultaneously to screen young children with ASDs. In the current study, we examine the validity of diagnoses based on combining multiple information sources for screening young children with ASDs. Methods: A total of 90 young children aged 24 -36 months and their caregivers were recruited between April 2012 and April 2015. They comprised two groups, including 45 with ASDs, and 45 with developmental delays. The groups were matched on chronological age, mental age, and sex ratio. The Screening Tool for Autism in Two-Year-Olds Taiwan Version (T-STAT) and the Clancy Behavior Scale (CBS) were used simultaneously to screen ASDs. The T-STAT is an interactive tool in which the examiner directly observes the social-communicative behaviors of the children in strange contexts. The CBS is a parent report questionnaire for caregivers to fill out based on the daily behaviors of their children. For the CBS, we used two criteria: sum scores of the total 14 items (CBS-14), and the critical nine items (CBS-9). Results: Using 2 as the cutoff for the T-STAT, the results yielded a sensitivity of .89, and a specificity of .84. The T-STAT had good accuracy of classification. Using 12 as the cutoff score for the CBS-14, the results indicated a sensitivity of .78, and specificity of. 71. Using the 7 as the cutoff score for the CBS-9, the results indicated a sensitivity and specificity of .76. The CBS had an acceptable classification accuracy, but the accuracy of the T-STAT was higher. Combining the T-STAT and the CBS-14 yielded a sensitivity of .97 and specificity of .96. Combining the T-STAT and the CBS-9 yielded a sensitivity of .97 and specificity of 1. The results indicated that combing multiple information sources resulted in excellent classification accuracy. Conclusions: The current study replicated prior results indicating that the T-STAT is a promising level-two screening tool for differentiating young children with ASDs from young children with developmental delays. However, the CBS is only an acceptable leveltwo screening tool. Combining the information from the two screening tools in a clinical setting yielded excellent sensitivity and specificity. However, when the results of the T-STAT and CBS are different, an interview may be needed to further clarify the diagnosis.