Ricardo Canal-Bedia



Professor in Behaviour Disorders. University of Salamanca (Spain). Department of Personality, Assessment and Psychological Treatments. PhD in Psychology. Specialist in Clinical Psychology. Research fellow at the University Institute for Community Integration (INICO). University of Salamanca. Areas of expertise: ASD research on early detection; Social and communicative development in ASD; Early diagnostic and early intervention; Problem behavior and behavior modification in persons with intellectual disabilities; Disabilities Services and support. He is the Head of the Clinical Services for people with Autistic Spectrum Disorders at the University of Salamanca (InFoAutismo), and has significantly contributed during the last decade to the development of the ASD screening program in Castilla y León (Spain), where he serves as general coordinator. His professional tasks include his participation in diverse research and innovation projects in Spain and the European Union. He was MC member of the project Enhancing the Scientific Study of Early Autism (ESSEA)- COST Action (http://www.cost-essea.com/wg3.html) and Chair of WG3 (Testing how well screening instruments work in prospectively identifying cases) within this project. He is currently participating as a member in the ASD-EU project, where he is coordinator of the working group No. 2 on Early detection, diagnosis and evidence-based intervention.

ASD Screening in Primary Care: 10 years of the M-CHAT Program in Spain

Great efforts have made put into developing methods and tools for early identification of children at risk of Autism Spectrum Disorder (ASD). However, despite recommendations from various institutions and organizations in the world to implement population screening programs, there is little scientific analysis to evaluate it from the perspective of the public health system (PHS). There is a need to validate the usage of standardized instruments as a cost-efficient strategy in the PHS.

The main goal of this communication is to evaluate the “M-CHAT and M-CHAT-R ASD Early Screening Program” in community settings, after 10 years ongoing in two regions of the North of Spain (Salamanca and Zamora), in terms of feasibility, reliability and costs with the purpose of extending the program at regional and national levels.

During the period from October 2005 to October 2015, 54 pediatric teams (including nurses and pediatricians) in the areas of health of Salamanca and Zamora have asked parents who attended with their child within the Well Baby Check-up Program  to complete the questionnaire M-CHAT (and updated M-CHAT / R since April 2014 version) at 18 months and 24 months. The program includes a telephone verification in cases with positive result in the questionnaire. The differential diagnosis was made following a standardized protocol, using the tests: Vineland I and II, Merrill-P-R and ADOS-G and 2. Of great importance to detect false negatives, it was to have established a coordination with early intervention teams and diagnostic units at the hospitals as part of the specialized health care at each area.

Throughout the period a total of 20.069 questionnaires were administered (M-CHAT and M-CHAT-R), of which 1.651 (8.2%) were positive, being 175 (0.9%) confirmed after phone verification. After the evaluation process, 71 children were diagnosed with ASD, and other 95 were diagnosed with other neurodevelopmental disorders according to DSM-IV or DSM-5 (depending on the year of assessment). The 74% of the professionals who participated, said the program is entirely feasible and 22% considered it moderately feasible (n = 54). Finally, the identification device of false negatives, identified 12 children with ASD from total of participants. The psychometric properties of the program are indicating that there is a sensitivity of 0,83, a specificity of 0,99 and a positive predictive value (PPV) of 0,38 for cases of ASD; being 0,94 the VPP when all neurodevelopmental disorders are considered.

This study supports the feasibility of implementing a long-term program of screening for children at risk for ASD within the public health system. This study has been able to show for the first time in Spain, the feasibility of a long lasting ASD screening program within the PHS. The current findings suggest that training on social and communicative development and dissemination of ASD early signs among pediatric teams, besides the use of a standardized tool, is essential for progress in the early detection of these disorders. The feasibility of this program should be considered