Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study

Lauren C Shuffrey; Brandon Rennie; Xiuhong Li; Noya Galai; Nicolò Pini; Anahid Akbaryan; Akram Alshawabkeh; Judy Aschner; Julianna Collazo Vargas; Lauren Costello; Viren D'Sa; Sean Deoni; Anne Dunlop; Amy J Elliott; William P Fifer; Jonica Hash; Daphne Koinis-Mitchell; Jin-Shei Lai; Bennett L Leventhal; Johnnye Lewis; Maristella Lucchini; Kristen L McArthur; Santiago Morales; Sara S Nozadi; Thomas G O'Connor; T Michael O'Shea; Grier P Page; Cathi Propper; Ayesha Sania; Coral Shuster; Emily Zimmerman; Amy E Margolis; ECHO Cohort Consortium

doi:10.1038/s41390-024-03306-0

Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study

Pediatr Res. 2024 Jun 12:10.1038/s41390-024-03306-0. doi: 10.1038/s41390-024-03306-0. Online ahead of print.

Authors

Lauren C Shuffrey¹, Brandon Rennie², Xiuhong Li³, Noya Galai^{3

4}, Nicolò Pini⁵, Anahid Akbaryan⁶, Akram Alshawabkeh⁷, Judy Aschner⁸, Julianna Collazo Vargas⁶, Lauren Costello⁶, Viren D'Sa⁹, Sean Deoni¹⁰, Anne Dunlop¹¹, Amy J Elliott¹², William P Fifer^{5

13}, Jonica Hash¹⁴, Daphne Koinis-Mitchell¹⁵, Jin-Shei Lai¹⁶, Bennett L Leventhal^{2

17}, Johnnye Lewis², Maristella Lucchini⁵, Kristen L McArthur³, Santiago Morales¹⁸, Sara S Nozadi¹⁹, Thomas G O'Connor²⁰, T Michael O'Shea²¹, Grier P Page²², Cathi Propper²³, Ayesha Sania⁵, Coral Shuster²⁴, Emily Zimmerman²⁵, Amy E Margolis⁵; ECHO Cohort Consortium

Affiliations

¹ Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA. [email protected].
² Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA.
³ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Statistics, University of Haifa, Mt Carmel, Israel.
⁵ Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
⁶ Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
⁷ College of Engineering, Northeastern University, Boston, MA, USA.
⁸ Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
⁹ Department of Pediatrics, Brown University, Providence, RI, USA.
¹⁰ Maternal Newborn and Child Health: Discovery & Tools, The Bill & Melinda Gates Foundation, Seattle, WA, USA.
¹¹ Department of Gynecology & Obstetrics, Emory University, Atlanta, Georgia.
¹² Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, USA.
¹³ Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
¹⁴ Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA.
¹⁵ Departments of Pediatrics and Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹⁶ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁷ Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA.
¹⁸ Departments of Psychology and Pediatrics, Developmental and Brain and Cognitive Science Areas, University of Southern California, Los Angeles, CA, USA.
¹⁹ Community Environmental Health Program, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
²⁰ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
²¹ Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
²² Analytics Program, RTI International, Research Triangle Park, NC, USA.
²³ School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
²⁴ The Brown Center for the Study of Children at Risk, Woman & Infants Hospital of Rhode Island, Providence, RI, USA.
²⁵ Department of Communication Sciences and Disorders, Northeastern University, Chicago, IL, USA.

PMID: 38867029
PMCID: PMC11635013 (available on 2025-12-12)
DOI: 10.1038/s41390-024-03306-0

Abstract

Background: Sleep problems are reported for up to 80% of autistic individuals. We examined whether parsimonious sets of items derived from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Brief Infant Sleep Questionnaire (BISQ) are superior to the standard M-CHAT-R in predicting subsequent autism spectrum disorder (ASD) diagnoses.

Methods: Participants from 11 Environmental influences on Child Health Outcomes (ECHO) cohorts were included. We performed logistic LASSO regression models with 10-fold cross-validation to identify whether a combination of items derived from the M-CHAT-R and BISQ are superior to the standard M-CHAT-R in predicting ASD diagnoses.

Results: The final sample comprised 1552 children. The standard M-CHAT-R had a sensitivity of 44% (95% CI: 34, 55), specificity of 92% (95% CI: 91, 94), and AUROC of 0.726 (95% CI: 0.663, 0.790). A higher proportion of children with ASD had difficulty falling asleep or resisted bedtime during infancy/toddlerhood. However, LASSO models revealed parental reports of sleep problems did not improve the accuracy of the M-CHAT-R in predicting ASD diagnosis.

Conclusion: While children with ASD had higher rates of sleep problems during infancy/toddlerhood, there was no improvement in ASD developmental screening through the incorporation of parent-report sleep metrics.

Impact: Parental-reported sleep problems are common in autism spectrum disorder (ASD). We investigated whether the inclusion of parental-reports of infant/toddler sleep patterns enhanced the effectiveness of developmental screening for autism. We reported higher rates of difficulty falling asleep and resisting bedtime during infancy and toddlerhood among children later diagnosed with ASD; however, we did not find an improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. In our sample, the standard M-CHAT-R had a sensitivity of 39% among children of mothers with government insurance compared with a sensitivity of 53% among children of mothers with employer-based insurance.

Abstract

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