Autism spectrum disorder screening in Chinese-language preschools

This study examined the reliability and validity of the 13-item Classroom Observation Scale as used by teachers and non-clinically trained observers to identify children who more likely than their peers to have autism spectrum disorder in less-resourced preschools. A total of 534 children (ages 2;10 to 4;5, Mean = 3;8) from nine Chinese-language preschools serving families from lower-middle to middle socioeconomic backgrounds in Hong Kong were observed in their first preschool year using the Classroom Observation Scale. The 75 screen-positive children and 55 randomly selected typically developing peers were clinically assessed for autism spectrum disorder 1 year later. The Classroom Observation Scale as used by teachers and non-clinically trained researchers helped to identify preschoolers who were later diagnosed with autism spectrum disorder with odds ratios of 3.11 and 8.66, respectively. This study provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and observers with little or no clinical training in the early identification of children with autism spectrum disorder in community settings. Lay abstract The 13-item Classroom Observation Scale is an autism spectrum disorder screening tool for teachers and non-clinically trained observers to make real-time observation of children's peer interaction (or the lack thereof) in regular preschool classrooms. The Classroom Observation Scale was originally developed in English and validated with ethnically diverse preschoolers at English-speaking international schools serving families from middle to middle-upper socioeconomic backgrounds in Hong Kong. These private schools can usually afford a higher teacher-student ratio, which is not typical for most preschools. This study, therefore, investigated whether the Classroom Observation Scale is ecologically valid when used by Chinese teachers with teacher-student ratios typically found in less-resourced preschools. We found that the Classroom Observation Scale reliably helped observers with little or no clinical training-research assistants with just a few hours of Classroom Observation Scale training and preschool teachers with an hour of briefing-to identify children in their first year of Chinese-language preschool who were more likely than their peers to have autism spectrum disorder. Reliability estimates of Classroom Observation Scale-Teacher and Classroom Observation Scale-Researcher in this study were comparable to those for the original English Classroom Observation Scale. Our results provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and non-clinically trained observers in the early identification of children with autism spectrum disorder in community settings.