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Trial registered on ANZCTR


Registration number
ACTRN12619001200178
Ethics application status
Approved
Date submitted
19/07/2019
Date registered
27/08/2019
Date last updated
27/08/2019
Date data sharing statement initially provided
27/08/2019
Type of registration
Prospectively registered

Titles & IDs
Public title
Early detection of autism in toddlers within General Practice in Australia
Scientific title
A multistate trial of an early surveillance program for autism within General Practices in Australia
Secondary ID [1] 298757 0
Nil known
Universal Trial Number (UTN)
Trial acronym
GPSfA
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Autism 313692 0
Condition category
Condition code
Mental Health 312106 312106 0 0
Autistic spectrum disorders
Public Health 312348 312348 0 0
Health service research

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Intervention: ASD (Autism Spectrum Disorder) surveillance pathway

Initially a parent of the participant aged between 18 and 24 months will complete the following ‘surveillance’ instruments in the General Practice waiting room using either an online link on a tablet or on paper based questionnaires (if internet is not available): Participant Information and Consent form, brief demographics, Learn The Signs. Act Early (LTSAE) developmental check from Centres for Disease Control and Prevention (CDC), The Parents’ Evaluation of Developmental Status (PEDS) and the Quantitative Checklist for Autism in Toddlers-10 item (Q-CHAT-10). These questionnaires will take approximately 10-15 minutes.

Then during a consultation on the same day, the General Practitioner (GP) or Practice Nurse (PN) will complete a face to face observational ‘surveillance’ instrument: the Social Attention and Communication Surveillance – online (SACS Online), which takes approximately 3-5 minutes. The assessor completing the SACS Online (GP or PN) will be noted.

Parents of participants who are identified as 'at developmental risk' on both the LTSAE and PEDS or 'at risk' of autism using the SACS Online or Q-CHAT-10 will then complete the Ages and Stages Questionnaire (ASQ) which will take approximately 10 minutes to complete (there will be the option to complete this at home).

Participants identified 'at risk' on the ASQ or 'at risk' of autism on the SACS Online or Q-CHAT and 10% of those determined 'not at risk' (randomly selected) will be invited to undergo a “Gold Standard” diagnostic confirmation assessment at approximately 24 months of age. This assessment will take approximately 3-4 hours and will occur at the local university by research staff trained in the administration of the assessment. This assessment will include the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview-Revised (ADI-R), Mullen Scales of Early Learning (MSEL) and the Vineland Adaptive Behavior Scales, Third Edition (VABS-3) (care giver self-report form).
At 30 months of age the parents of all trial participants in both arms will complete the Social Responsiveness Scale (SRS-2) at home.

All components of the intervention will be provided individually.

GPs and PNs will undergo professional training on the surveillance program and the National Autism Guideline implementation. An eLearning program is available as an online educational resource designed to provide online training for GPs and PNs to carry out health and developmental screening and ongoing surveillance. The GP training will be available through RANZGP website as a 6 hour CPD for the full Personal Health Record checks from birth to start of school and a stand alone developmental surveillance module as a 1 hour CPD. The participating practices will be informed about the availability of the module.
As the training is delivered in an online format it can be freely accessed by the GPs and broken down into the intensity or dose that suits their schedule.
Intervention code [1] 315020 0
Early detection / Screening
Comparator / control treatment
Control: Surveillance as usual

General Practitioners will be asked to log the methods and tools by which they assessed children to be 'at developmental risk', and note referrals, using a standard template developed for the project.

Participants identified as 'at developmental risk' and 10% of those determined 'not at risk' (randomly selected) will be invited to undergo a “Gold Standard” diagnostic confirmation assessment at approximately 24 months of age. This assessment will take approximately 3-4 hours and will occur at the local university by research staff trained in the administration of the assessment. This assessment will include the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview-Revised (ADI-R), Mullen Scales of Early Learning (MSEL) and the Vineland Adaptive Behavior Scales, Third Edition (VABS-3) (care giver self-report form).
At 30 months of age the parents of all trial participants in both arms will complete the Social Responsiveness Scale (SRS-2) at home.
Control group
Active

Outcomes
Primary outcome [1] 320752 0
The proportion of children between 18 and 24 months identified as ‘at risk’ of developmental concerns or autism using the developmental surveillance assessments. The surveillance assessments included as a composite screen are Parents’ Evaluation of Developmental Status (PEDS), Learn The Signs. Act Early (LTSAE), Quantitative Checklist for Autism in Toddlers-10 item (Q-CHAT-10), Social Attention and Communication Surveillance – online (SACS Online), Ages and Stages Questionnaire (ASQ) & ASQ– Social Emotional scale (ASQ-SE)).
Timepoint [1] 320752 0
Baseline
Primary outcome [2] 321138 0
The proportion of children previously identified as ‘at risk’ of developmental concerns or autism using the developmental surveillance assessments who are later diagnosed with autism using the Autism Diagnostic Observation Schedule (ADOS).
Timepoint [2] 321138 0
24 months of age
Secondary outcome [1] 372734 0
The proportion of children aged 18-24 months attending a participating primary health care General Practice clinic during the study duration who complete the developmental surveillance assessments ('uptake').

This outcome will be assessed using General Practice records to identify the number of children between 18 and 24 months attending the practice during the study and the number of children who undergo the developmental surveillance assessments.
Timepoint [1] 372734 0
Duration of study
Secondary outcome [2] 372735 0
The proportion of children previously identified as ‘at risk’ of developmental concerns or autism using the developmental surveillance assessments who are later diagnosed with autism using the Autism Diagnostic Interview-Revised (ADI-R).
Timepoint [2] 372735 0
24 months of age.
Secondary outcome [3] 373778 0
The proportion assigned as 'at probable risk' of autism using the Social Responsiveness Scale, Second Edition (SRS-2), Preschool form (2.5 to 4.5 years) compared with the proportion of children who were diagnosed with autism using the ADOS.


Timepoint [3] 373778 0
30 months of age
Secondary outcome [4] 373779 0
To compare the intervention arm who received assessments and recommendations using the National Autism Guideline with those in the comparator arm who received routine care. This composite outcome will be assessed using a study-specific, written semi structured questionnaire to evaluate the uptake of recommendations from doctors at the baseline visit, experience of assessment/service use including National Disability Insurance Scheme (NDIS), disability supports, early intervention received and parental satisfaction with the services.
Timepoint [4] 373779 0
30 months of age
Secondary outcome [5] 374113 0
The proportion of children previously identified as ‘at risk’ of developmental concerns using the screening assessments who are later confirmed as being developmentally delayed using the Mullen Scales of Early Learning (MSEL)
Timepoint [5] 374113 0
24 months of age
Secondary outcome [6] 374114 0
The proportion of children previously identified as ‘at risk’ of developmental concerns using the screening assessments who are later confirmed as having developmental delays using the Vineland Adaptive Behavior Scales, Third Edition (VABS-3) (care giver self-report form)
Timepoint [6] 374114 0
24 months of age
Secondary outcome [7] 374115 0
The proportion of children who received referrals following identification of at risk of developmental concerns or autism. GP Practice records will be used to determine those who received referrals.
Timepoint [7] 374115 0
Baseline

Eligibility
Key inclusion criteria
Any toddler between the ages of approximately 18-24 months taken to their General Practitioner for any reason, including for an immunisation, will be part of the trial (a “universal approach”).
Parents of participating toddlers are also included for the purpose of completing screening instruments and questionnaires about their toddler, and an evaluation survey at follow-up when toddler is 30 months of age.
Minimum age
18 Months
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
Yes
Key exclusion criteria
None

Study design
Purpose of the study
Diagnosis
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Who is / are masked / blinded?



Intervention assignment
Other design features
Phase
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
NSW,VIC

Funding & Sponsors
Funding source category [1] 303315 0
Other
Name [1] 303315 0
Autism Cooperative Research Centre (Autism CRC)
Address [1] 303315 0
The University of Queensland
Long Pocket Precinct, Level 3, Foxtail Building
80 Meiers Road,
Indooroopilly Qld 4068
Country [1] 303315 0
Australia
Primary sponsor type
Other
Name
Autism Cooperative Research Centre (Autism CRC)
Address
The University of Queensland
Long Pocket Precinct, Level 3, Foxtail Building
80 Meiers Road,
Indooroopilly Qld 4068
Country
Australia
Secondary sponsor category [1] 303342 0
University
Name [1] 303342 0
UNSW Sydney
Address [1] 303342 0
Sydney NSW 2052
Country [1] 303342 0
Australia
Secondary sponsor category [2] 303369 0
University
Name [2] 303369 0
La Trobe University
Address [2] 303369 0
Melbourne
Victoria 3086
Country [2] 303369 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 303849 0
University of New South Wales Human Research Ethics Committee B
Ethics committee address [1] 303849 0
UNSW Sydney
Sydney NSW 2052
Ethics committee country [1] 303849 0
Australia
Date submitted for ethics approval [1] 303849 0
Approval date [1] 303849 0
24/04/2019
Ethics approval number [1] 303849 0

Summary
Brief summary
This project will synergise and build on existing State and Federal programs to identify barriers and develop mechanisms for accurate early detection of developmental problems including autism spectrum disorders (ASD) in Australia. The project will also evaluate an integrated model of care for ASD surveillance within the primary care setting of General Practice followed by standardised assessment and care pathways incorporating the national guideline for the assessment and diagnosis of ASD in Australia (National Guideline) for further assessment and early intervention. Developed and published by Autism CRC with the support of the National Disability Insurance Agency, the National Guideline aims to create greater consistency in diagnostic practices across Australia.

Aims of the project
1. To work with key stakeholders to:
(a) develop a method for ‘universal’ surveillance of ASD in 18- to 24-month-olds across Australia, and
(b) carry out a “real life” evaluation of a care pathway for children at ‘high likelihood’ for ASD using the National Guideline.
2. To examine the Autism Surveillance Pathway (ASP) with regard to uptake and completion of the surveillance program and the accurate diagnosis of ASD against the current program (Surveillance as Usual [SaU]).
3. To determine acceptability, feasibility, and effectiveness of this surveillance protocol.

A major outcome of this project will be the cooperation of various agencies and organisations, which will enable the embedding of the surveillance program within the existing health system and facilitate the long-term sustainability of the program. In addition, this project will allow the evaluation of the National Guideline. Currently, many children are missing early intervention opportunities. In this regard, it is noteworthy that the mean age of diagnosis for ASD in Australia is 49 months which urgently requires addressing. This is in part due to the extremely low uptake of the existing surveillance programs contributing to lack of access and opportunity for early detection with flow on effect on delay in intervention and consequent long-term effects. The significance of the project is highlighted by the fact that there is escalating economic impact of ASD both from health care and from a socio-economic perspective. Early identification and early intervention can provide significant buffers to assist children with ASD to reach their optimum potential and enhance school readiness in addition to preventing the cascade of a negative developmental trajectory and these difficulties becoming entrenched with secondary consequences such as academic failure, school absence, social dysfunction and forensic involvement. Long term, this work will undoubtedly be of enormous benefit to not only children with ASD and their families, but also to the wider society in terms of increasing human capital and reducing health, social and economic impacts.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 95014 0
Prof Valsamma Eapen
Address 95014 0
Chair, Infant Child and Adolescent Psychiatry, University of New South Wales
Head, Academic Unit of Child Psychiatry, South West Sydney (AUCS)
Stream Director, Early Life Determinants of Health, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
Director, Program 1, Co-operative Research Centre for Autism (CRC)
Director, BestSTART-SW (Systems Transformation and Research Translation - South West Sydney) Academic Unit
Level 1, 30 Botany Street, Randwick,
UNSW Sydney 2052
Country 95014 0
Australia
Phone 95014 0
+61 02 9616 4205
Fax 95014 0
Email 95014 0
v.eapen@unsw.edu.au
Contact person for public queries
Name 95015 0
Dr Josephine Barbaro
Address 95015 0
Senior Research Fellow
Olga Tennison Autism Research Centre
School of Psychology and Public Health
College of Science, Health, and Engineering
La Trobe University
Melbourne, Victoria, 3083
Country 95015 0
Australia
Phone 95015 0
+61 03 94791283
Fax 95015 0
Email 95015 0
J.Barbaro@latrobe.edu.au
Contact person for scientific queries
Name 95016 0
Prof Valsamma Eapen
Address 95016 0
Chair, Infant Child and Adolescent Psychiatry, University of New South Wales
Head, Academic Unit of Child Psychiatry, South West Sydney (AUCS)
Stream Director, Early Life Determinants of Health, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
Director, Program 1, Co-operative Research Centre for Autism (CRC)
Director, BestSTART-SW (Systems Transformation and Research Translation - South West Sydney) Academic Unit
Level 1, 30 Botany Street, Randwick,
UNSW Sydney 2052
Country 95016 0
Australia
Phone 95016 0
+61 02 96164205
Fax 95016 0
Email 95016 0
v.eapen@unsw.edu.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment
What supporting documents are/will be available?
Ethical approval
How or where can supporting documents be obtained?
Type [1] 3260 0
Ethical approval
Citation [1] 3260 0
Link [1] 3260 0
Email [1] 3260 0
Other [1] 3260 0
Summary results
No Results