Testing an online screening for autism in the COVID-19 pandemic: a psychometric study of the Q-CHAT-24 in Chilean toddlers

BackgroundThe aim of this study was to examine some psychometric characteristics of the Chilean-adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-24) (24) in a group of unselected children (community sample). This version was administered remotely through an online version during the pandemic period to caregivers of children, aged 18–24 months, registered in four primary care polyclinics of the Health Service Araucanía Sur, Chile.MethodsAn intentional non-probabilistic sampling was used. Three hundred and thirteen toddlers were examined. Participants completed an online version of the Q-CHAT-24 which was disseminated through the REDCap platform. Evidence of reliability through internal consistency and evidence of predictive validity through ROC curve analysis were realized.ResultsThe mean age of the children evaluated was 21.16 months. The Shapiro-Wilk test revealed that Q-CHAT-24 scores was normally distributed. 71 cases (23.12%) scored 38 points or more on the Q-CHAT-24, qualifying as Autistic Risk. 48 cases (15.63%) were confirmed as autistic through the ADOS-2 Module T. All items were positively correlated with Q-CHAT-24 total score. All items were positively correlated with Q-CHAT-24 total score. Internal consistency was acceptable for the Q-CHAT-24 (Cronbach ́s α=0.78). The internal consistencies were analyzed for the Q-CHAT-24 Factors, and they were good for factor 1 “Communication and Social Interaction” (Cronbach ́s α=0.85) and acceptable for factor 2 “Restrictive and Repetitive Patterns” (Cronbach ́s α=0.74). Receiver operating characteristic (ROC) curve analyses were performed. The AUC values were 0.93 with statistical significance (p<0.01). For the cut-off point of 38, the Sensitivity, Specificity and Youden index values were 0.89, 0.8 and 0.7, respectively. The Positive Predictive Value (PPV) was 86% and the Negative Predictive Value (NPV) was 85%.ConclusionsIn accordance with the objectives of this study, evidence of reliability and predictive validity was demonstrated for the Q-CHAT-24 in this Chilean population. More importantly, this study provides Sensitivity and Specificity data for a remote application version of an autism screening tool already validated in Chile. The implications of this have to do with the possibility of establishing a remote assessment system for children at risk of autism on a population scale

Testing an online screening for autism in the COVID-19 pandemic: a psychometric study of the Q-CHAT-24 in Chilean toddlers

Background: The aim of this study was to examine some psychometric characteristics of the Chilean-adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-24) (24) in a group of unselected children (community sample). This version was administered remotely through an online version during the pandemic period to caregivers of children, aged 18-24 months, registered in four primary care polyclinics of the Health Service Araucanía Sur, Chile. Methods: An intentional non-probabilistic sampling was used. Three hundred and thirteen toddlers were examined. Participants completed an online version of the Q-CHAT-24 which was disseminated through the REDCap platform. Evidence of reliability through internal consistency and evidence of predictive validity through ROC curve analysis were realized. Results: The mean age of the children evaluated was 21.16 months. The Shapiro-Wilk test revealed that Q-CHAT-24 scores was normally distributed. 71 cases (23.12%) scored 38 points or more on the Q-CHAT-24, qualifying as Autistic Risk. 48 cases (15.63%) were confirmed as autistic through the ADOS-2 Module T. All items were positively correlated with Q-CHAT-24 total score. All items were positively correlated with Q-CHAT-24 total score. Internal consistency was acceptable for the Q-CHAT-24 (Cronbach ́s α=0.78). The internal consistencies were analyzed for the Q-CHAT-24 Factors, and they were good for factor 1 “Communication and Social Interaction” (Cronbach ́s α=0.85) and acceptable for factor 2 “Restrictive and Repetitive Patterns” (Cronbach ́s α=0.74). Receiver operating characteristic (ROC) curve analyses were performed. The AUC values were 0.93 with statistical significance (p<0.01). For the cut-off point of 38, the Sensitivity, Specificity and Youden index values were 0.89, 0.8 and 0.7, respectively. The Positive Predictive Value (PPV) was 86% and the Negative Predictive Value (NPV) was 85%. Conclusions: In accordance with the objectives of this study, evidence of reliability and predictive validity was demonstrated for the Q-CHAT-24 in this Chilean population. More importantly, this study provides Sensitivity and Specificity data for a remote application version of an autism screening tool already validated in Chile. The implications of this have to do with the possibility of establishing a remote assessment system for children at risk of autism on a population scale

The Quantitative Checklist for Autism in Toddlers (Q-CHAT): A preliminary psychometric study in Chile

The aim of this study was to examine the psychometric properties of an adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT), an early screening tool that quantifies autistic traits dimensionally, in a community sample of Chilean children aged 18-24 months. An intentional non-probabilistic sampling was used. All primary caregivers of children aged 18-24 months who attended health check-up at four primary care clinics in Chile's Araucanía region during the study period were invited to participate. One hundred and eighty-eight toddlers were screened. Evidence of construct validity was determined through Exploratory Factor Analysis (EFA), evidence of convergent validity with the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), and evidence of reliability through internal consistency and test-retest. The EFA showed a two-factor structure, which explained 42.2 % of the variance: “Restrictive and Repetitive Patterns” (factor 1), and “Communication and Social Interaction” (factor 2). The total Q-CHAT scores correlated positively and significantly with the total M-CHAT-R/F scores (r=0.59, p&lt;0.01) with a large effect size. Internal consistency was acceptable for the scale in general (α=0.74), acceptable for factor 1 (α = 0.76) and good (α=0.85) for factor 2. Regarding test-retest stability, the intraclass correlation coefficient was good (ICC=0.86, p&lt;0.001). In terms of the factor structure evidenced by the EFA, the two factors are theoretically consistent with the current diagnostic criteria of the DSM-5. The evidence of validity and reliability of Q-CHAT is encouraging when considering its use as an early detection tool in Chile

The Quantitative Checklist for Autism in Toddlers (Q-CHAT): A preliminary psychometric study in Chile

The aim of this study was to examine the psychometric properties of an adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT), an early screening tool that quantifies autistic traits dimensionally, in a community sample of Chilean children aged 18-24 months. An intentional non-probabilistic sampling was used. All primary caregivers of children aged 18-24 months who attended health check-up at four primary care clinics in Chile's Araucanía region during the study period were invited to participate. One hundred and eighty-eight toddlers were screened. Evidence of construct validity was determined through Exploratory Factor Analysis (EFA), evidence of convergent validity with the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), and evidence of reliability through internal consistency and test-retest. The EFA showed a two-factor structure, which explained 42.2 % of the variance: “Restrictive and Repetitive Patterns” (factor 1), and “Communication and Social Interaction” (factor 2). The total Q-CHAT scores correlated positively and significantly with the total M-CHAT-R/F scores (r=0.59, p&lt;0.01) with a large effect size. Internal consistency was acceptable for the scale in general (α=0.74), acceptable for factor 1 (α = 0.76) and good (α=0.85) for factor 2. Regarding test-retest stability, the intraclass correlation coefficient was good (ICC=0.86, p&lt;0.001). In terms of the factor structure evidenced by the EFA, the two factors are theoretically consistent with the current diagnostic criteria of the DSM-5. The evidence of validity and reliability of Q-CHAT is encouraging when considering its use as an early detection tool in Chile

Testing an online screening for autism in the COVID-19 pandemic: a psychometric study of the Q-CHAT-24 in Chilean toddlers

Peer reviewed: TrueAcknowledgements: We would like to thank Susana Román and Virginia Monroy C, from the Children’s Health and Rural Health Equity Program of the Southern Araucanía Health Service, for their logistical contribution to this research.BackgroundThe aim of this study was to examine some psychometric characteristics of the Chilean-adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-24) (24) in a group of unselected children (community sample). This version was administered remotely through an online version during the pandemic period to caregivers of children, aged 18–24 months, registered in four primary care polyclinics of the Health Service Araucanía Sur, Chile.MethodsAn intentional non-probabilistic sampling was used. Three hundred and thirteen toddlers were examined. Participants completed an online version of the Q-CHAT-24 which was disseminated through the REDCap platform. Evidence of reliability through internal consistency and evidence of predictive validity through ROC curve analysis were realized.ResultsThe mean age of the children evaluated was 21.16 months. The Shapiro-Wilk test revealed that Q-CHAT-24 scores was normally distributed. 71 cases (23.12%) scored 38 points or more on the Q-CHAT-24, qualifying as Autistic Risk. 48 cases (15.63%) were confirmed as autistic through the ADOS-2 Module T. All items were positively correlated with Q-CHAT-24 total score. All items were positively correlated with Q-CHAT-24 total score. Internal consistency was acceptable for the Q-CHAT-24 (Cronbach ́s α=0.78). The internal consistencies were analyzed for the Q-CHAT-24 Factors, and they were good for factor 1 “Communication and Social Interaction” (Cronbach ́s α=0.85) and acceptable for factor 2 “Restrictive and Repetitive Patterns” (Cronbach ́s α=0.74). Receiver operating characteristic (ROC) curve analyses were performed. The AUC values were 0.93 with statistical significance (p&amp;lt;0.01). For the cut-off point of 38, the Sensitivity, Specificity and Youden index values were 0.89, 0.8 and 0.7, respectively. The Positive Predictive Value (PPV) was 86% and the Negative Predictive Value (NPV) was 85%.ConclusionsIn accordance with the objectives of this study, evidence of reliability and predictive validity was demonstrated for the Q-CHAT-24 in this Chilean population. More importantly, this study provides Sensitivity and Specificity data for a remote application version of an autism screening tool already validated in Chile. The implications of this have to do with the possibility of establishing a remote assessment system for children at risk of autism on a population scale.</jats:sec

Analysing the use trends of new psychoactive substances using wastewater-based epidemiology in Europe: A systematic review

Background and Aims: New psychoactive substances (NPS) pose challenges not only due to their harms to users but also because they are difficult to monitor with traditional epidemiologic methods. Wastewater-based epidemiology (WBE) offers a reliable method to assess drug-taking habits in different geographical settings and their evolution over time. The aim of this systematic review was to examine NPS preferences and trends across Europe. Methods: We searched electronic databases between September 5th to 30th, 2022, included OVID/Embase, PubMed, Scopus, and Web of Knowledge. Key search terms focused on NPS, WBE, prevalence, and geographic Europe. 18 articles were included in the systematic review. All studies were WBE studies, with 17 studies collecting samples from wastewater treatment plants, one collecting from pissoirs. Due to heterogeneity across studies, a meta-analysis was not performed. Results: Literature reviewed in this study showed a trend towards stimulant-type NPS use, with the United Kingdom showing highest detection frequency. The most detected chemical class of NPS were synthetic cathinones. Southern and Western Europe showed the largest variety of NPS detected. Metabolite detection ranged extensively across countries. Conclusion: This is the first systematic review to address types of new psychoactive substances present in wastewater in Europe. Gaps in literature point to a need for standardization in wastewater-based epidemiology so that drug policies and public health policies, including drug and harm reduction services, can be targeted to those NPS that are most widely used

Autism incidence and spatial analysis in more than 7 million pupils in English schools: a retrospective, longitudinal, school registry study.

BACKGROUND: Understanding how certain factors affect autism incidence can help to identify inequities in diagnostic access. We aimed to investigate the incidence of autism in England as a function of geography and sociodemographics, examining spatial distribution across health service boundaries. METHODS: In this retrospective, longitudinal, school registry study, we sourced data for the years 2014-17 from the summer school census, which is a component of the National Pupil Database, a government registry of pupils under state education in England. Our main outcome was the incidence of autism in the English state-funded education system, defined by the amount of new autism-specific Education, Health and Care Plans or autism-specific special education needs and disability support recorded during each summer school census year since the 2014 baseline. After excluding prevalent cases in 2014, we calculated unadjusted incidence and age-adjusted, sex-adjusted incidence per 100 000 person-years per subsequent school year and by various sociodemographic categories and local authority districts. We report spatial effects using local indicators of spatial association. We used a three-level mixed-effects logistic regression model with two random intercepts (lower-layer super output area [a geographical area in England containing 1000-3000 residents] and pupil identifier) to calculate odds ratios (ORs) for autism incidence, adjusting for age, sex, ethnicity, claimed eligibility for free school meals, ethnic density quintile, Index of Multiple Deprivation quintile, first language spoken at home, and year, with our reference category being White girls without claimed eligibility for free school meals who speak English as their first language. FINDINGS: Between 2014 and 2017, our total sample included 31 580 512 person-years and 102 338 newly diagnosed autistic pupils, corresponding to an unadjusted annual autism incidence of 429·1 cases per 100 000 person-years (95% CI 426·4-431·7) and an age-adjusted, sex-adjusted annual incidence of 426·9 cases per 100 000 person-years (423·5-430·4). The adjusted incidence of autism was slightly higher in 2014-15 than in 2015-16 or 2016-17, and, of the age groups, pupils aged 1-3 years, 4-6 years, and 10-12 years had the highest incidence of autism. Adjusted autism incidence in boys was 3·9-times the incidence in girls (668·6 cases per 100 000 person-years [95% CI 662·5-674·6] vs 173·2 cases per 100 000 person-years [170·1-176·3]). Across ethnic groups, adjusted incidence was highest in pupils who had an unclassified ethnicity (599·4 cases per 100 000 person-years [574·5-624·3]) or were Black (466·9 cases per 100 000 person-years [450·8-483·0]). However, in our fully adjusted mixed-effects logistic regression model, we observed lower odds of autism among Asian (OR 0·65 [0·59-0·71]), Black (0·84 [0·77-0·92]), and Chinese (0·62 [0·42-0·92]) girls compared with White girls when these groups had not claimed free school meals and spoke English as a first language. Boys from all ethnicities irrespective of first language spoken and free school meals status had increased odds of autism compared with White girls with no claimed eligibility for free school meals who spoke English as their first language. We also found that claimed free school meal eligibility, first language spoken, sex, and ethnicity differentially impacted the odds of autism. Our spatial analysis showed significant spatial autocorrelation across lower-layer super output areas in England, with 2338 hotspots (high-incidence areas surrounded by other high-incidence areas). INTERPRETATION: The incidence of autism varies across sex, age, ethnicity, and geographical location. Environmental and social factors might interact with autism aetiology. Speaking a language other than English and economic hardship might increase access barriers to autism diagnostic services, autism-specific Education, Health and Care Plans, and school-level support. FUNDING: The Commonwealth Fund, the Institute for Data Valorization, the Fonds de recherche du Québec-Santé, Calcul Quebec, the Digital Research Alliance of Canada, the Wellcome Trust, the Innovative Medicines Initiative, the Autism Centre of Excellence, the Simons Foundation Autism Research Initiative, the Templeton World Charitable Fund, the Medical Research Council, the National Institute for Health and Care Research Cambridge Biomedical Research Centre, and the National Institute for Health and Care Research Applied Research Collaboration East of England-Population Evidence and Data Science

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) one year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March-April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3742 of which were self-harm presentations. Rate of psychiatric ED presentations in March-April 2021 was twice as high as March-April 2020 (IRR, 1.93; 95% CI, 1.60-2.33), and 50% higher than March-April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March-April 2020 and March-April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and overall 1.7 times higher than March-April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March-April 2021 with March-April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (OR, 1.30; 95% CI, 1.05-1.62), whilst female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered four times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue utilizing follow-up appointments to support discharge from EDs. Diversity & inclusion statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the wor

Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. Diversity &amp; inclusion statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work