Examining the clinical utility of the modified Alarm Distress Baby Scale (m-ADBB) for the detection of early signs of Autism Spectrum Disorder

Abstract

Background / Aim Signs of Autism Spectrum Disorder (ASD) can be observed in the first two years of life. However early detection of ASD remains challenging, partly because no reliable and easy to use routine screening instrument for infants and toddlers is currently available to clinicians. Some early ASD related deficits in social communication and interaction are also typical of sustained social withdrawal in infants and toddlers. The current study aims to test whether a brief observational screening instrument for social withdrawal in infants, the modified Alarm Distress Baby Scale (m-ADBB), may be clinically useful for detection of ASD in the first two years of life. It is hypothesised, that children with ASD will score higher on the m-ADBB than typically developing (TD) children, indicating more symptoms of social withdrawal. Method Home-video recordings of children with ASD and of TD children from approximately age 12 month and 24 month were analysed using the m-ADBB. Results Home-videos of 10 children with ASD and 10 TD children were available at each age. Children with a diagnosis of ASD scored statistically significantly higher on the m-ADBB than TD children at 12 month (Z=-2.54; p=0.023; r=-0.57) and at 24 month (Z=-2.40; p=0.023; r=-0.54). Five of ten children with ASD met the m-ADBB criterion for social withdrawal in their 12 month videos, and four out of ten in their 24 month videos. Using a lower cut-off score increased detection rates (7 at 12 month; 8 at 24 month). False positive rates were low at both ages and for both cut-off scores (range 1 to 3 out of 10). Conclusion Observing only five social withdrawal behaviours as operationalized by the m-ADBB appears to be useful in flagging possible presence of ASD during the first two years of life. The scale’s sensitivity and specificity for ASD detection needs to be established in a larger sample.