Early detection of autism – comparison of two screening tools

Introduction: The aim of the study was comparison of a newly developed test Trivandrum Autism behaviour checklist with gold standard test, CHAT. Method: The present study was done in pediatric OPD (Bundelkhand Medical College, Sagar, (MP). The study was done in the children of 24 to 36 month of age over a period of one year. The study including sex, age of the father & mother, education of father & mother, place of residence, antenatal history, natal & neonatal history, immunization history, developmental history and also two tools – CHAT & TABC. Result: There are many factors taken during study but there is relation between these factors and Autism. However, Autism is more common in age group of 21 to 30 month of age and also common in male than female. It is more common in urban areas. It is shown that the Birth weight of babies were 2.5 to 3.00kg. The incidence is also high in immunized children. There is no relation with age and education of the parents, Antenatal History, Developmental history. In present study, the maximum no. of cases were screened by CHAT test (28 case) while 11 cases by TABC case. However, 11 cases were screen by both CHAT and TABC. In study sensitivity of the TABC (Trivandrum Autism behaviour checklist) 39.2 it is low, hence TABC is not good test for screening. Specificity 99.4 it is high, hence TABC is good test for diagnosis or confirmatory test. Conclusion: It is shown that chat is a good test for screening of Autism then TABC. The TABC is good test for the diagnosis or confirmation of the disease.


Introduction
Autism is a developmental disorder that appears in first three years of life and is characterized by impaired social communication and interaction. Autism is also characterized by restricted and repetitive behaviour. It is also called as pervasive developmental disorder. Fombonne E et al study shows the prevalence to be 0.9/1000 with highest prevalence rate in rural areas [1]. Studies conducted across the world have shown that the cases of autism have increased from 50% to 2000% [2]. This number could have increased partly due to improvement in awareness and clinical practice [3]. The exact cause of autism is unknown. Autism is linked to genetic predisposition and also to infections occurring during prenatal, perinatal or postnatal phases [4][5][6][7]. Certain environmental factors could also act as trigger. Siblings of children with autism are at a higher risk of developing autism. Drugs like thalidomide and valproic acid taken during pregnancy are believed to be risk factors for autism [8,9]. High parental age is also believed to be one of the risk factors [10]. Despite profound research the pathophysiology of autism is still not well understood. There is alteration of brain system and this is believed to occur immediately after conception [11].
Several screening tools have been developed for successful diagnosis of autism. Adequate use of these tools requires training and experience. The signs and symptoms of the toddlers should be Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 689|P a g e monitored for early diagnosis of autism. They primarily include impaired social interaction, language problems, repetitive behaviour, delayed developmental milestones, absent protodeclarative pointing and history of frequent infections. There is no known cure. These children can benefit with speech and behavioural interventions if started at early stage.
The prognosis of patients with autism is dependent on their intelligence quotient (IQ). Patients with low functioning IQ may find it difficult to live independently throughout their entire life. Patients with high functioning IQ may be able to carry out their responsibilities independently and even progress in life.

Methodology
Aims-The aim of our study to publish is to diagnosed autism earlier as possible.
Objective: The object of this study is to identify autistic child as early as possible by chat & TABC.
To compare the two test (CHAT & TABC) to diagnose the autism as earlier as possible.
Type of study-It is cross sectional case study. Present study was done is pediatrics O.P.D. in Bundelkhand Medical College, Sagar-M.P.). We have taken children of 24-36 months age group. There is no difference on the basis of sex, religion and education. We have compare these babies with CHAT screen and TABC score. We have examine children in following orders. -age, sex, Birth order, Place of Residence, Age of the father & mother, Presenting Complaints, Anternatal History, Natal & Neonatal History, Immunization History, Developmental History.

Tools-CHAT (Check list for Autism Toddlers) Research Centre at the University of Cambridge
Questions for the parents 1. Does your child ever pretend, for example to make a cup of tea by using a toy cup and teapot or pretend other things? 2. Does your child ever use his or her index finger to point, to indicate interest in something? 3. Does your child take an interest in other children? 4. Does your children enjoy playing peek-a-boo or hide-and-seek? 5. Does your child ever bring objects over to you to show you something?
[If the answer to two or more of the above is "No" than autism is suspected (except in the presence of server generalized developed delays)] Physicians' observation 1. During the appointment, has the child made eye contact with you? 2. Get the child's attention, then point across the room at an interesting object and say "Oh look! There's a (name object)". Watch the child's face. Does the child look across to see what you are pointing at? 3. Get the child's attention, the give the child a miniature toy cup and teapot and say, "Can you make a cup of tea? "Does the child pretend to pour out tea, drink it, etc? (May use other objects for pretend play). 4. Say to the child, "Where's the light? or "Show me the light" does the child point with his or her index finger at the light? [If the answer to two or more of the above is, "No" autism is suspected].

Total 201
Most of babies birth weight was in 2.5 -3 Kg.

Discussion
The Trivandrum Autism Behavioral Checklist TABC test is one simple tool developed by the Child development centre, Medical College, Thiruvanthapuram, India which has been found to be equally good to screen the children for Autism. As per our study the frequency of occurrence of Autism is 1.5%. More and more children are currently being diagnosed for Autism then before.
In present study, out of 201 children of 24-36 months, it shows the autism is more common in the age group of 24-30 months (58.70%). The forborne also reported 57.91 cases [1]. In present study, it shows that autism in more common in male (55.72%) than female children (44.27%). This is because of male babies suffer more than female children naturally. In present study, most of the

Original Research Article
Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 692|P a g e babies (87.56%) delivered with mothers age group of 21-30 years of age as also reported by Di martion A et al [2]. In present study, out of 201 most of the father came in the age group of 21-30 years of age (66.16%) cases followed by 31-35 years of age (17.91%) as reported by Jin [3].
In present study, out of 201 children, higher children came in the birth order of II (48.7%) as compared with 49% as reported by HAS [4] followed by birth order 41.29% and birth order III (8.9%). In present study out of 201, most of the father (63.18% cases) were educated, as 9.45% father were schooled up to primary level, 24.87% father were studies up to high school and 25.37% had degree in various subjects as also reported by crespi B et al [5]. In present studies, out of 201, most of the children belonged to urban area (52.36%). Children came from villages were 47.26% as also reported by Reichow B [6].
Out of 201 mother, 98.50% mother have no positive antenatal history.1.49% mothers had infection during pregnancy as also reported by Patterson et al [7]. In present study, out of 201, most of babies were in the age group of 2.5-3.4kg weight group (54.72%). It is followed by 3.00 Kg -above (22.8%), similar findings were also reported by Rossignol DA et all [8]. In