Autism screening and conditional cash transfers in Chile: Using the Quantitative Checklist (Q-CHAT) for early autism detection in a low resource setting
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Diagnosis of Autism Spectrum Conditions (ASC) can be an extended procedure since ASC tend to both vary greatly across individual symptoms and diagnostic pathways with serious challenges to opportune access and diagnosis in low resource settings. We adapted the Q-CHAT-25 for use in a routine health check-ups programme at Chilean primary health clinics by developing a 10-item version of this questionnaire recruiting n = 287 (F: 112/M: 175) participants (Controls: n = 125, F: 58/M: 67; Developmental Delay: n = 149, F: 53/M: 96; Autism Spectrum Conditions: n = 13, F: 1/M: 12). Our findings show that the Q-CHAT-10 can be successfully applied in health-check programmes. The results for the Q-CHAT-10 show high internal consistency (Cronbach's alpha: 0.85) and good overall performance, significantly correlating (r = 0.79, p < 0.0001) with the Q-CHAT-25. The Q-CHAT-10 had a sensitivity of 92.86% and a specificity of 76.86% in the Developmental Delay sample. The positive predictive value was 48% with a positive likelihood ratio of 4.01 and a negative likelihood ratio of 0.09 with a post-test probability of disease of 19%. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 is a cost-effective measure that improves diagnosis of Autism Spectrum Conditions in those participating in conditional cash transfer programmes in low- and middle-income countries or low resource setting in high income countries. Lay abstract Getting a diagnosis of autism can take long, because autism is different across people, but also because it depends on the way it gets diagnosed. This is especially important in poorer countries or in the case of poor people living in wealthier countries that have significant groups of disadvantaged communities. We adapted a 10-item version of the Q-CHAT-25 questionnaire for use in routine health check-ups programme in Chile and recruited 287 participants under the age of three divided into three groups: Controls (125), Developmental Delay (149) and Autism Spectrum Condition (13). Our results show that a short questionnaire for autism screening can be successfully applied in a health-check programme in poor resource settings. Our results show that our questionnaire had good overall performance, not different to its longer version, the Q-CHAT-25. Our questionnaire was autism specific, with good sensitivity and reliability, and is suitable to be used in a screening setting. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 provides value for money and improves diagnosis of Autism Spectrum Condition in those participating in routine health check-up programmes in developing countries or poor areas of wealthy countries.
Gillings Fellowship in Global Public Health and Autism Research YOG054 Innovative Medicines Initiative 2 Joint Undertaking (JU) 777394 European Commission EFPIA AUTISM SPEAKS Autistica SFARI Autism Research Trust UK Research & Innovation (UKRI) Medical Research Council UK (MRC) Wellcome Trust European Commission National Institute for Health Research (NIHR) National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust
Artículo de publicación ISI
Quote ItemAutism 2021, Vol. 25(4) 932–945
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