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Brief Report: Replication and Validation of the Brief Autism Detection in Early Childhood (BADEC) in a Clinical Sample

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Abstract

We investigated the clinical validity of the BADEC, an abbreviated, five-item version of the Autism Detection in Early Childhood, level-2 screening tool for autism. Initially developed by Nah et al. (2019) using a research sample, the present study replicated Nah et al. (2019) procedures in a clinical population. Using a cutoff score of five, five items were identified as most effective in discriminating children who later received an ASD diagnosis by an interdisciplinary team. This algorithm had improved validity compared to the original research algorithm. Results supported the efficacy of a very brief, easy to administer ASD screening tool in identifying children under three who are likely to have ASD.

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Acknowledgments

This research was supported by Nationwide Children’s Hospital Clinical and Translational Intramural Grant #203213 awarded to Darren Hedley. The researchers would like to thank Associate Professor Dr. Robyn Young and Dr. Yong-Hwee Nah of Flinders University, Australia, for assistance with the development of a training protocol for the ADEC and for reviewing training tapes. We particularly thank the staff at the Child Development Center at Nationwide Children’s Hospital, Columbus, Ohio, and those children and families who participated in this study. We also thank Brianna Murphy, Sarah Beinkampen, and Emily Mariotti for their assistance with data collection.

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Authors and Affiliations

  1. Nationwide Children’s Hospital, Columbus, OH, USA

    Rose E. Nevill & Darren Hedley

  2. Ohio State University, Columbus, OH, USA

    Rose E. Nevill

  3. Curry School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400260, Charlottesville, VA, 22904-4260, USA

    Rose E. Nevill

  4. Olga Tennison Autism Research Centre, La Trobe University, Bundoora, VIC, Australia

    Darren Hedley

  5. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Mirko Uljarević

  6. School of Psychological Sciences, The University of Melbourne, Melbourne, Australia

    Mirko Uljarević

Authors
  1. Rose E. Nevill
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  2. Darren Hedley
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  3. Mirko Uljarević
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Correspondence to Rose E. Nevill.

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Appendix

Appendix

NASD Group Diagnoses

The subsample who did not receive an ASD diagnosis were diagnosed with another developmental disorder (ODD; n = 29, Mage = 27.76, SD = 6.23), a diagnosis of an anxiety or behavioral disorder (n = 10, Mage = 31.15, SD = 3.47), did not receive any diagnosis (n = 4, Mage = 27.05, SD = 6.36), or had ASD ruled but did not have another diagnosis confirmed (n = 18, Mage= 29.54, 6.39).

ROC Analyses of Individual ADEC Items Comparing ASD to NASD Subgroups

We further examined individual ADEC items’ performance in discriminating children with ASD from children with ODD diagnoses, excluding the typically developing subsample. Based on the ASD versus ODD group comparisons, the following four items emerged with highest AUC Scores (ordered highest to lowest): Gaze Monitoring, Task Switching, Reciprocity of a Smile, and Response to Name. Though Following Verbal Commands emerged with the fifth highest AUC score, its score fell within the poor range.

Application of Current BADEC to Nah et al. (2019) Research Sample

The current BADEC algorithm was applied to Nah et al. (2019) research sample to examine its performance in discriminating children with ASD. The current algorithm resulted in a strong model, AUC = .93, p < .001, 95% CI (.91, .96). Applying a cutoff of three, the current algorithm resulted in good model with balanced sensitivity, specificity, and accuracy (Se = .82, Sp = .79, PPV = .82, NPV = .88, Accuracy = .80) that were almost equal to Nah et al. (2019) BADEC algorithm when applying a cutoff of four. Applying a cutoff of four with the current algorithm, specificity and accuracy improved, yet sensitivity remained the same (Se = .82, Sp = .89, PPV = .71, NPV = .87, Accuracy = .86).

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Nevill, R.E., Hedley, D. & Uljarević, M. Brief Report: Replication and Validation of the Brief Autism Detection in Early Childhood (BADEC) in a Clinical Sample. J Autism Dev Disord 49, 4674–4680 (2019). https://doi.org/10.1007/s10803-019-04153-3

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