Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Children – Hong Kong Study...

Checklist for Autism in Toddlers Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Third Edition (CHAT-3) for Chinese

Children – Hong Kong StudyChildren – Hong Kong Study

Checklist for Autism in Toddlers Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Third Edition (CHAT-3) for Chinese

Children – Hong Kong StudyChildren – Hong Kong StudyPrinciple InvestigatorPrinciple Investigator: Prof Virginia Wong: Prof Virginia Wong

Co-InvestigatorsCo-Investigators:: Dr Cheuk-Wing FungDr Cheuk-Wing FungDr Brian Hon-Yin ChungDr Brian Hon-Yin ChungDr Wing-Cheong Lee Dr Wing-Cheong Lee Dr Joy Lok-Sum Leung Dr Joy Lok-Sum Leung Ms Nancy TsangMs Nancy TsangMs Stella HuiMs Stella Hui

Research Background (1)

• Autistic disorder affects 5-30 in 10,000 of population

• most beneficial intervention : early and intensive special education

• Checklist for Autism in Toddlers– A screening tool for prospective

identification of autistic cases at 18-months of age (Baron-Cohen 1992)

• Modified Checklist for Autism in Toddlers (Robins et al (2001) )– 18 to 24-months of age

• Symbolic Play Test (Second Edition) to estimate the mental age– an adjunctive tool to understand

development of subjects– 4 separate situations – subject is allowed to play with the standard

sets of miniature toys with minimal prompting

Objectives (1)• To test the validity and reliability (internal

consistency and inter-rater reliability) of the new CHAT-3 in Chinese children in Hong Kong

• Any items that can best discriminate the autistic development will be sought

• To determine the most suitable cut-off criteria and risk stratification from the graduated scores of CHAT-3

Objectives (2)• To examine the utility of CHAT, M-CHAT and

CHAT-3• Consistency and accuracy between the

three screening tools • To test the applicability of Symbolic Play

Test in the Chinese population in determining the mental maturity of children

• To explore the possibility of CHAT-3 for population-wide or targeted high risk group screening.

Study method and Procedure:

• Cross-Sectional

• Subject:– Chinese population– Children aged between 18 months and 6 years old

– In the fieldtrips up to 19/06, we have interviewed 109 children.

– Normal nurseries: 31 – EETC (Heep Kong Society): 78 – (Among the 109 children, the demographic data of 17 children is not

available)

• Method– Written consent obtained before the interview– Demographic data – Self-administered Part A questionnaire

– Tests:1. Checklist for Autism in Toddlers 3rd Edition (CHAT-3)2. Symbolic Play Test3. Reynell4. The Functional Independence Measure (WeeFIM)

– We conducted tests 1-3 in the children of normal nursery (as the parents are present), and conducted all the 4 tests in the children of EETC.

Study method and Procedure

• Schedule:– 29/4- First meeting and interview– 28/5- Briefing session– 28-29/5-1st field trip (Portland Street)– 6/6- Workshop: training and inter-rater c

orrelation

Study Method and Procedure• Schedule

– 10/6- Toys collection, inter-rater correlation

– 11-25/6- Field trip and data entry– 17/6- mid- evaluation and inter-rater

correlation – 21-27/6- Data analysis– 27/6- Presentation

Toy Toy CollectionCollection

Field Trip

Tam To Centre (EETC)

SKH St Thomas DC

CHAT-3 Centre Visit Schedule

Date Centre Type 07/06/2002 Jessie & Thomas Tam Centr

11/06/2002 SKH St Thomas DC Normal Nursery

Leung King Centre EETC

12/06/2002 Cheerland DN & DC Normal Nursery

13/06/2002 Jockey Club Centre EETC

Pak Tin Centre EETC

Shun Lee Centre EETC

CHAT-3 Centre Visit Schedule (continue)

Date Centre Type

14/06/2002 Cheerland DN & DC Normal Nursery

Kwok Yip Lin Houn Cnetre EETC

17/02/2002 St James Settlement Kathleen McDonall CCC

Normal Nursery

18/02/2002 Jessie & Thomas Tam Centre

19/02/2002 St James Settlement Kathleen McDonall CCC

Normal Nursery

24/02/2002 HKSPC Portland Street DC Normal Nursery

25/02/2002 HKSPC Chan Kwan Biu Mem. Foundation DC

Normal Nursery

HKSPC Esther Lee DC Normal Nursery

Data Analysis: 21 June, 2002Data Analysis: 21 June, 2002

Study method and Procedure:• Analysis

– interrater correlation (>0.95) by taking data from same parents at least by 2 interviewers

• 100% was attained for Chat B and Symbolic Play Test

– Grouped according to • chronological and mental age• status of health and diagnosis (autism / PDD, developmental del

ay, cerebral palsy, multiple handicaps and normal)

– Double-blinded and controlled paired up

• Analysis (continue)– For children who have been diagnosed as AD or

PDD, results of CHAT-3 are compared with the previously charted diagnosis to show the validity

– For those who hasn’t been previously diagnosed as PDD / AD but picked up by CHAT-3 will be assessed using Autism Diagnostic Interview-Revised (AIDR, Catherine Lord et al (1994)) to confirm the diagnosis

Result: Chronological Age distribution of the

subjects:•All the children are aged between 18 months and 6 years old.•Youngest: 18 months old•Eldest: 59 months old•Aged between 18 and 36 months: 60.9%

Age at test (mos)

Age distribution of the subjects (up to 19/06)12

Std. Dev = 9.77

Mean = 34.9

N = 92.00

Symbolic Play Test - Age

SPT (Age)

Symbolic Play Test - Age (months)12

Std. Dev = 7.27

Mean = 25.0

N = 109.00

Reynell - Age

Reynell Verbal Expression - Age (yr.mo)

verbal exp

Missing

Reynell Expressive Expression - Age (yr.mo)

expressive exp

MissingC

Result:

•Boys: 66

•Girls: 43

• Gender

Boys Girls

Result: DiagnosisDiagnosis No. of subject Percentag

eMental retardation

or delayed development

54 51.4%

Cerebral palsy 1 1.0%

Pervasive developmental

disorders (include autism)

3 2.9%

Multiple handicaps 4 3.8%

Normal 43 41%

Handedness of the subjects

Handedness

bilateral

Missing

Head Circumference of the subjects

Head circumference (cm)

46-50.99

41-45.99

<=40.99

Missing

Demographic Data of Father

Occupation of father

Unskilled

Semi-skilled

Skilled - Maual and

Intermediate

Professional

Missing

Eduction level of father

Primary school (P.6)

Secondary school (F.Matriculate / Diplom

University degree or

Missing

Demographic Data of Mother

Occupation of mother

Unskilled

Semi-skilled

Skilled - Manual and

Intermediate

Professional

Missing

Eduction level of mother

No official educatio

Primary school (P.6)

Secondary school (F.

Matriculate / Diplom

University degree or

Missing

Domestic helper

Domestic Helper

Missing

CHAT-3CHAT-3CHAT-3CHAT-3

CHAT • 1. Results of CHAT A

• 2. Results of CHAT B

• 3. Internal consistency of CHAT

CHAT A • Difference between normal ,autistic and

developmental delay subjects in:

• 1. Total scores

• 2. Scores in the 6 discriminative items

• Questions 1 and 16 are buffer questions • those who fail either of the 2 buffer

questions are excluded from the analysis ;

• There are 5 normal and 9 developmental delay subjects being excluded

Failing definition • CHAT A : fail 3 or more questions in

the whole chat A

• The 6 discriminative items : fail 2 or more questions among the six

Total scores - normal subjects

2 5.3 6.3 6.31 2.6 3.1 9.41 2.6 3.1 12.54 10.5 12.5 25.02 5.3 6.3 31.38 21.1 25.0 56.3

10 26.3 31.3 87.53 7.9 9.4 96.91 2.6 3.1 100.0

32 84.2 100.06 15.8

38 100.0

14.0015.0016.0017.0018.0019.0020.0021.0022.00Total

SystemMissingTotal

Frequency Percent Valid PercentCumulative

Percent

14.00Frequency

Failing rate of normal subjects in CHAT A

PASS23

28 73.7 87.5 87.54 10.5 12.5 100.0

32 84.2 100.06 15.8

38 100.0

.001.00Total

SystemMissingTotal

Percent

PASS23

1.00.00MissingPercent

73.7% of normal subjects fail chat A

Results of normal subjects in the six

discriminative items

1 2.6 2.9 2.91 2.6 2.9 5.76 15.8 17.1 22.9

27 71.1 77.1 100.035 92.1 100.03 7.9

38 100.0

3.004.005.006.00Total

SystemMissingTotal

Percent

6.005.004.003.00

Frequency

Failing rate of normal in the 6 discriminative

PASS6Q

2 5.3 5.7 5.733 86.8 94.3 100.035 92.1 100.03 7.9

38 100.0

.001.00Total

SystemMissingTotal

Percent

PASS6Q

1.00.00Missing

Percent

5.3 % of normal fail the 6 items

Total scores - autistic subjects

18.009.007.00Frequency

1 33.3 33.3 33.31 33.3 33.3 66.71 33.3 33.3 100.03 100.0 100.0

7.009.0018.00Total

ValidFrequency Percent Valid Percent

CumulativePercent

Failing rate of autistic subjects in CHAT A

PASS23

3 100.0 100.0 100.0.00ValidFrequency Percent Valid Percent

CumulativePercent

All autistic subjects fail chat A

Results of autistic subjects in the 6

6.001.00.00Frequency

1 33.3 33.3 33.31 33.3 33.3 66.71 33.3 33.3 100.03 100.0 100.0

.001.006.00Total

CumulativePercent

failing rate of autistic subjects in the 6

PASS6Q

1.00.00Percent

PASS6Q

2 66.7 66.7 66.71 33.3 33.3 100.03 100.0 100.0

.001.00Total

CumulativePercent

66.7 % of autistic subjects fail the 6 items

Total scores - developmental delay

subjects

Frequency

1 2.0 2.2 2.22 4.0 4.4 6.78 16.0 17.8 24.46 12.0 13.3 37.82 4.0 4.4 42.25 10.0 11.1 53.3

14 28.0 31.1 84.44 8.0 8.9 93.32 4.0 4.4 97.81 2.0 2.2 100.0

45 90.0 100.05 10.0

50 100.0

13.0014.0015.0016.0017.0018.0019.0020.0021.0022.00Total

SystemMissingTotal

Percent

Failing rate of developmental delay subjects in CHAT A

PASS23

42 84.0 93.3 93.33 6.0 6.7 100.0

45 90.0 100.05 10.0

50 100.0

.001.00Total

SystemMissingTotal

Percent

84 % of developmental delay subjects fail chat A

Results of developmental delay

subjects in the six discriminative items

6.005.004.003.002.00Frequency

1 2.0 2.1 2.12 4.0 4.2 6.39 18.0 18.8 25.0

12 24.0 25.0 50.024 48.0 50.0 100.048 96.0 100.02 4.0

50 100.0

2.003.004.005.006.00Total

SystemMissingTotal

Percent

Failing rate of developmental delay

subjects in the 6 discriminative items

PASS6Q

12 24.0 25.0 25.036 72.0 75.0 100.048 96.0 100.02 4.0

50 100.0

.001.00Total

SystemMissingTotal

Percent

24 % of developmental delay subjects fail the 6 items

Failing rate

• In conclusion, the six items are more sensitive than other questions in discriminating autistic children from normal and developmental delay children

Total 6 questionsNormal 73.7 % 5.3 %Autistic 100% 66.7 %Developmental delay 84 % 24 %

CHAT B• Difference between normal, delay de

velopment and autistic subjects in:• 1. Eye contact• 2. Gaze monitoring • 3. Pretend play• 4. Protodeclarative pointing

CHAT B - Q1- Eye contact

Normal subjects

• Eye contact:• usually, sometimes = Pass (1); • seldom., never = Fail (0)

• All the subjects passed the test.

Autistic Subjects• All the autistic

subjects failed the test.

Delay Development

• Pass = 1 (91.5%)• Fail = 0 (8.5%)

• Conclusion:• All autistic subjects

failed in eye contact, while most of the other subjects passed the test.

CHAT B - Q2 - Gaze monitoring

‘ 小明 , 你睇…’ Normal subjects

• Result of Q2 in normal subjects

Fail = 1 (2.3 %)

Pass = 2 (97.7%)

Autistic subjectsResults

Pass= 2 (66.7%)

Fail = 1 (33.3%)

Delay Development Results

Pass= 2 ( 96.6% )

Fail = 1 (3.4%)

Conclusion

• Gaze monitoring • Most of the normal ( 97.7 %) ,

delay development (96.6%) and autistic subjects (66.7%) pass the test.

• This test may not be sensitive enough to distinguish autistic subjects from others.

Q3 - Pretend Play ‘ 倒茶茶’

Normal subjectsResult of Q3 in normal subjects

3 : yes(90.7%) 2 : simulate only(7%) 1 : no(2.3%)

Autistic subjects

B3 (Y=3, N=1)

2 66.7 66.7 66.71 33.3 33.3 100.03 100.0 100.0

13Total

CumulativePercent

Developmental Delay• Yes = 3 (83.1%)• Simulate only = 2

(10.2%)• No = 1 (5.1%)

Missing

Conclusion • Pretend Play• Most normal (90.7%) and delay

development subjects (83.1%) passed the test.

• Most autistic subjects (66.7%) failed the test.

Q4 Protodeclarative pointing

‘ 燈燈呢 ?’ Normal subjects

Result of Q4 in normal subjects

4 : point and look(83.7%) 3 : point only(0%)

2 : look only(11.6%) 1 : no(4.7%)

Autistic subjects

• Point and look = 4 (33.3%)• Look only = 2 (66.7%)

Developmental Delay• Point and look = 4

(54.2%)• Point only = 3

(1.7%)• Look only = 2

(22.8%)• No = 1 (15.3%)

Conclusion

• Protodeclarative Pointing:• Most of the normal (83.7%) and delay

development subjects (54.2%) achieved high scores.

• Most autistic subjects (66.7%) failed in the test.

Q4 First object the child responses

Normal subjects

B4 object (1= light, 2=ball, 3=car, 4=doll)

19 44.2 46.3 46.313 30.2 31.7 78.08 18.6 19.5 97.61 2.3 2.4 100.0

41 95.3 100.02 4.7

43 100.0

LightBallcardollTotal

99MissingTotal

Percent

Autistic subjects

2 66.7 66.7 66.71 33.3 33.3 100.03 100.0 100.0

LightBallTotal

CumulativePercent

Developmental Delay

4 6.8 9.1 9.124 40.7 54.5 63.613 22.0 29.5 93.23 5.1 6.8 100.0

44 74.6 100.015 25.459 100.0

NoneLightBallcarTotal

99MissingTotal

Percent

Internal consistency of CHAT

• To check the consistence between

• 1. Q7 in part A (A7)and Q4 in part B(B4) , where both focus on protodeclarative pointing

• 2. Q5 in part A(A5) and Q3 in part B(B3), where both focus on pretend play

• We are checking the consistency seperately for :

• 1. Normal subjects• 2. Autistic subjects• 3. Developmental delay subjects

Normal subjects : A7 and B4

B4 (Y=4, N=1) * NEWA7 Crosstabulation

1 14 4

3 28 313 33 36

B4 (Y=4,N=1)

.00 1.00NEWA7

Normal subjects : A5 and B3

NEWA5 * B3 (Y=3, N=1) Crosstabulation

2 21 3 30 341 3 32 36

.001.00

1 2 3B3 (Y=3, N=1)

Autistic subjects : A7 and B4

2 21 1

.001.00

2 4B4 (Y=4, N=1)

Autistic subjects : A5 and B3

1 11 1 22 1 3

.001.00

1 3B3 (Y=3, N=1)

Developmental delay subjects : A7 and B4

3 5 10 184 10 17 317 15 27 49

.001.00

1 2 4B4 (Y=4, N=1)

Developmental delay subjects : A5 and B3

2 4 62 3 38 432 5 42 49

.001.00

1 2 3B3 (Y=3, N=1)

Symbolic Play TestsSymbolic Play TestsSymbolic Play TestsSymbolic Play Tests

Local table of ‘Age equivalent of

score’Report

23.000 2 7.07128.000 1 .33.000 1 .40.500 1 .33.000 1 .34.500 2 2.12129.500 3 6.61433.875 4 5.29737.000 1 .36.000 1 .46.500 1 .32.944 18 6.682

SPT_T910111214161718212223Total

Mean NStd.

Deviation

24222018161412108

score’

Limitations • There are not enough sample in

each age group• The children in normal nurseries

are shy to play with the toys

score’Suggestion:• Follow up of missing data• Continue data collection of normal

children

A New Symbolic Play A New Symbolic Play TestTest

Situation IIICURRENT SPT

• Relates knife or fork to plate

• Relates fork, knife, or plate to table

• Relates spoon, fork, knife, or plate to doll

NEW SPT• Relates chopsticks

to bowl• Relates chopsticks

or bowl to table• Relates chopsticks

or bowl to doll

SPT Situation IIIDrawbacks of the new set:• The size of chopsticks and bowl

are not proportional to other toys.• The chopsticks and bowl are

bigger and attract children to play with them.

SPT Situation IIISuggestion:• Modify the size of toys

Situation IVCURRENT SPT

• Moves tractor or trailer along

• Relates log(s) to tractor, trailer or man

• Lines up tractor and trailer

• Attaches tractor to trailer

NEW SPT

• Moves train along

• Put train cars on rail

• Lines up train cars

• Attaches train cars

SPT Situation IVDrawbacks of new set:• It cannot replace the current one

because there are no man and logs.• Some new items cannot be

compared with that of current items: Put engine on either end Put train cars on rail

SPT Situation IVSuggestion:• Modify the design of toys

Current: Relates knife or fork to plateNew: Relates chopsticks to bowl

New0 1 Total

EETC Current

0 12 21 331 4 24 28

Total 16 45 61

Nursery Current

0 7 11 181 3 10 13

Total 10 21 31

Overall*

Current

0 19 32 511 7 34 41

Total 26 66 92

* p<0.05 ** p<0.01

Current: Relates fork, knife, or plate to table New: Relates chopsticks or bowl to table

New0 1 Total

EETC* Current

0 17 14 311 7 22 29

Total 24 36 60

Nursery*

Current

0 7 8 151 2 14 16

Total 9 22 31

Overall**

Current

0 24 22 461 9 36 45

Total 33 58 91* p<0.05 ** p<0.01

Current: Relates spoon, fork, knife, or plate to doll New: Relates chopsticks or bowl to doll

New0 1 Total

EETC** Current

0 42 6 481 4 8 12

Total 46 14 60

Nursery*

Current

0 18 4 221 4 5 9

Total 22 9 31

Overall**

Current

0 60 10 701 8 13 21

Total 68 23 91

* p<0.05 ** p<0.01

Current: Moves tractor or trailer alongNew: Moves train along

New0 1 Total

EETC Current

0 1 6 71 8 50 58

Total 9 56 65

Nursery Current

0 0 0 01 1 30 31

Total 1 30 31

Overall Current

0 1 6 71 9 80 89

Total 10 86 96

* p<0.05 ** p<0.01

Current: Relates log(s) to tractor, trailer or manNew: Put train cars on rail

New0 1 Total

EETC Current

0 8 9 171 16 31 47

Total 24 40 64

Nursery Current

0 0 7 71 4 20 24

Total 4 27 31

Overall Current

0 8 16 241 20 51 71

Total 28 67 95

* p<0.05 ** p<0.01

Current: Lines up tractor and trailer New: Lines up train cars

New0 1 Total

EETC** Current

0 25 19 441 2 20 22

Total 27 39 66

Nursery Current

0 8 13 211 1 9 10

Total 9 22 31

Overall**

Current

0 33 32 651 3 29 32

Total 36 61 97

* p<0.05 ** p<0.01

Current: Attaches tractor to trailerNew: Attaches tractor to trailer

New0 1 Total

EETC** Current

0 42 13 551 3 8 11

Total 45 21 66

Nursery Current

0 15 12 271 1 3 4

Total 16 15 31

Overall**

Current

0 57 25 821 4 11 15

Total 61 36 97

* p<0.05 ** p<0.01

Mean ScoreCorrelati

onSig.

Situation III

Current

3.480.909 0.000

New 3.92

Situation IV

Current

3.430.768 0.001

New 3.86

TotalCurrent

14.460.961 0.000

New 15.31

Reynell AnalysisReynell AnalysisReynell AnalysisReynell Analysis

Reynell Analysis• Subjects divided into

– Normal children– Children from EETC– Total

Correlation Test• Spearman’s correlation test used• Variables :

– verbal comprehension(Reynell)– Language expression(Reynell)– SPT(age)– Age at test

NormalCorrelations

1.000 .662** .653** .518**. .000 .000 .004

43 42 42 29.662** 1.000 .703** .597**.000 . .000 .001

42 42 41 28.653** .703** 1.000 .464*.000 .000 . .013

42 41 42 28.518** .597** .464* 1.000.004 .001 .013 .

29 28 28 29

Correlation CoefficientSig. (2-tailed)NCorrelation CoefficientSig. (2-tailed)NCorrelation CoefficientSig. (2-tailed)NCorrelation CoefficientSig. (2-tailed)N

SPT (Age)

verbal exp

expressive exp

Age at test (mos)

Spearman's rhoSPT (Age) verbal expexpressive expAge at test (mos)

Correlation is significant at the .01 level (2-tailed).**. Correlation is significant at the .05 level (2-tailed).*.

Results: Normal• All are statistically significant with p

value smaller than 0.05• All shows positive correlation• All except the correlation between age

and language exp(0.464) shows r >0.5• Strongest correlation between language

exp and verbal comprehension(0.703)

EETCCorrelations

1.000 .842** .853** .806**. .000 .000 .000

59 59 54 53.842** 1.000 .775** .754**.000 . .000 .000

59 62 55 54.853** .775** 1.000 .902**.000 .000 . .000

54 55 55 54.806** .754** .902** 1.000.000 .000 .000 .

53 54 54 54

Age at test (mos)

SPT (Age)

verbal exp

expressive exp

Spearman's rhoAge at test (mos)SPT (Age) verbal expexpressive exp

Correlation is significant at the .01 level (2-tailed).**.

Result:EETC• All results are statistically significant• All shows positive correlation• All have r >0.7• Best correlation between language expr

ession and verbal comprehension(0.902)• Generally good correlation between age

and SPT , age and Reynell (r>0.8)

OverallCorrelations

1.000 .734** .731** .650**. .000 .000 .000

92 92 86 85.734** 1.000 .740** .725**.000 . .000 .000

92 109 101 100.731** .740** 1.000 .852**.000 .000 . .000

86 101 101 99.650** .725** .852** 1.000.000 .000 .000 .

85 100 99 100

Age at test (mos)

SPT (Age)

verbal exp

expressive exp

Spearman's rhoAge at test (mos)SPT (Age) verbal expexpressive exp

Correlation is significant at the .01 level (2-tailed).**.

Result: Overall• A combined picture of the results of

normal children and children from EETC• All results are statistically significant• All correlations are positive• All have r > 0.6• Best correlation between language

expression and verbal comprehension

Comment

• Result from EETC shows better correlations than from normal nurseries

• Children perform well in part I of the Reynell likely to do well also in Reynell part II

• Children perform well in SPT also likely to perform well in Reynell

• Older kids generally perform better

WeeFIMWeeFIMWeeFIMWeeFIM

WeeFIM• Aims• Subject: all EETC• 3 catagories

– Self Care Domain Rating– Mobility Domain Rating– Cognition Domain Rating

• Total WeeFIM Rating• Method: face-to-face interview

Results• Descriptive data• Method:

– Catagorize– Chi-square test

• Significant (p <0.05)– SPT age– Reynell– Intra-correlation With WeeFIM raw score

Descriptive Data• 8 EETC; 78 Children• 70 valid WeeFIM• Gender: boys (65.7%) & girls (34.3%)• Chronological Age: 70% between 31 to 40 m

• Some are developmental delay (74%)• WF Total: 60% less than 26 months

(According to Western Norm Data)

WFTOTAL

95.090.0

85.080.0

75.070.0

65.060.0

55.050.0

45.040.0

35.030.0

WFTOTALFrequency

Std. Dev = 18.16

Mean = 63.8

N = 70.00

Dermographic data with WeeFIM

All are not significant• Gender• Chronological age• Head circumference• Parents’ occupation, education level• Diagnosis• Domestic helper

Chat A with WeeFIM• Not significant

– WF1, WF2, WF3 against Chat A• Reason

– WeeFIM –mainly related to the performance status

SPT-age with WeeFIM• Significant

– WF1(p=0.001)– WF2 (p=0.05)– WF total

(p=0.001)

• Not significant– WF3 (p=0.089)

• Proposed Reasons:– Expected to be related

to mental age– Subjects with isolated

speech delay– Parents may not

notice in details• At nurseries• At home

– “I haven’t tried it BUT...”

Reynell Verbal with WeeFIM

• All are significant– WF1 (p=0.000)– WF2 (p=0.000)– WF3 (p=0.003)– WF Total

(p=0.000)

Reynell Expression with WeeFIM

• Significant– WF1 (p=0.000)– WF3 (p=0.016)– WF Total

(p=0.000)

• Not significant– WF2 (p=0.082)

• WF2 and Reynell Expression are independently related to age

Intra-correlationWF1 WF2 WF3 WF T

WF1 0.000 0.047 0.000

WF2 0.000 0.001 0.000

WF3 0.047 0.001 0.005

WF T 0.000 0.000 0.005

Problem encountered• Rating is not reliable• Parents may not notice minor items o

r not notice the items questioned in WeeFIM

Video demonstration• Case 1 – prematurity• Case 2 – Prematurity• Case 3 – Preparation

Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Children – Hong Kong Study...

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Transcript of Checklist for Autism in Toddlers Third Edition (CHAT-3) for Chinese Children – Hong Kong Study...

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1402205864 Toddlers

Toddlers Town

Toddler Factsheet HEALTHY EATING FOR TODDLERS eating for toddlers Toddlers' nutritional requirements Toddlers' nutritional requirements differ quite markedly from those of older children