NUH leads a large-scale study to evaluate an autism screening tool,
demonstrating promising results that may facilitate early detection and intervention.
Issue 5 | June 2024
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Autism spectrum disorders (ASD) encompass a range of neuro-developmental conditions affecting approximately one in 100 children worldwide. Such disorders typically manifest as challenges in social interaction and communication. Atypical patterns of activities and behaviours are common. Some children may also fixate intensely on details or have unusual reactions to sensations.
Although the hallmarks of autism can be apparent in early childhood, diagnosis often occurs much later. The earlier autism is detected, the sooner interventions can begin, which could significantly improve the ability of children on the autism spectrum to communicate effectively and interact socially. These early interventions not only improve the quality of life for them but promote more independent living capabilities later in life.
To facilitate early screening, the Child Development Unit at the National University Hospital (NUH)’s Khoo Teck Puat – National University Children’s Medical Institute (KTP-NUCMI) has carried out a large-scale study to evaluate an autism screening tool, with funding provided by NUH and the Octava Foundation. Called the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), the screening tool has shown promise to transform early autism detection in Singapore, offering hope for more timely and effective interventions.
M-CHAT-R/F, which comprises 20 questions, prompts parents to observe whether their children can perform simple actions such as pointing to objects with one finger, or if they try to mimic a parent’s actions, all of which help identify early signs of autism. The study carried out by KTP-NUCMI was designed to validate the performance of the screening tool in our local well-child population; the first team to do so in Singapore. Conducted between August 2020 and November 2022, the research involved 5,336 children aged 17 to 20 months, who were assessed during their routine developmental screenings at seven National University Polyclinics.
The results were promising: approximately two per cent of children were identified to be at higher likelihood of being on the autism spectrum, with 85.7% of these children diagnosed upon further evaluation. Compared to earlier data showing a mean diagnosis age of 35.5 months and the start of intervention at 42 months, children in this study received evaluations and began therapy much earlier—at an average of 21.9 and 22.1 months respectively.
Reception among nurses was also overwhelmingly positive—98% of them endorsed the practicality and effectiveness of M-CHAT-R/F for routine use within the polyclinic setting.
The study’s senior author, Dr Aishworiya Ramkumar, Consultant, Division of Developmental and Behavioural Paediatrics, Department of Paediatrics, KTP-NUCMI, NUH, highlights its significance: “The study is a crucial step towards systematic autism screening in primary care settings in Singapore. It’s the first to use such a comprehensive, community-based approach. We have plans for further research to refine the screening process, including determining the most appropriate age for screening, and determining caregiver acceptance and perceptions towards screening.”
Dr Ramkumar cautions that “a positive result is not a definitive diagnosis”, as thorough clinical assessments must follow a positive screen to confirm the presence of autism.
| Extending care beyond the patient |
| Oftentimes, effective treatment extends beyond the individual patient—encompassing the entire family unit to create a supportive healing environment. Recognising this, the KTP-NUCMI has established the Child and Adolescent Family Support Services (CAFSS) programme, which is made possible through the support by the EtonHouse Community Fund (ECF) to help alleviate the financial burden for the beneficiaries. This initiative delivers specialised psychosocial support not only to young patients affected by chronic illnesses but also to their family members—as such conditions can exert an immense emotional and psychological toll on parents and siblings too. The CAFSS programme provides a range of helpful services, including counselling and support interventions, all aimed at bolstering family resilience and emotional wellbeing. “By integrating psychosocial support directly within the hospital setting, our goal is to enhance the quality of life for all family members affected by chronic conditions. We want to ensure we provide holistic and all-encompassing care to our patients,” says Ms Ng Siau Hwei, Head of Psychology, Department of Paediatrics, KTP-NUCMI, NUH. |
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