Autism and Down syndrome: early identification and diagnosis

Diniz, Natália Lisce Fioravante; Parlato-Oliveira, Erika; Pimenta, Priscila Gonçalves Ayres; Araújo, Liubiana Arantes de; Valadares, Eugênia Ribeiro

doi:10.1590/0004-282X-ANP-2021-0156

Natália Lisce Fioravante Diniz

Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil.

https://orcid.org/0000-0003-0967-5269

Erika Parlato-Oliveira

Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil.

CRPMS, UFR Études Psychanalytiques, Université Paris Diderot, Paris, France

CRPMS, Université de Paris, Paris, France.

https://orcid.org/0000-0003-4500-8498

Priscila Gonçalves Ayres Pimenta

Instituto Langage, São Paulo, Brasil.

https://orcid.org/0000-0002-5605-8346

Liubiana Arantes de Araújo

Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil.

https://orcid.org/0000-0003-1826-9297

Eugênia Ribeiro Valadares

Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil.

https://orcid.org/0000-0001-8263-3300

Correspondence: Natália Lisce Fioravante Diniz; Email: natalialfd@gmail.com.

Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

NLFD: significant contribution to the conception and design of the study, scientific search, analysis of the data collected and writing of the final article; EPO: significant contribution to the conception and design of the study, analysis of the data collected and writing of the final article; PGAP: significant contribution to the scientific search, analysis of the data collected and writing of the final article; LAA: significant contribution to data analysis, critical review of the content and final writing of the article; ERV: significant contribution to the conception and design of the study, analysis of the data collected and writing of the final article

Author, year	Location	Study design	Origin and sample size	Age range	Study outcome	Quality of evidence
Ortiz et al.2222. Effective Public Health Practice Project Hamilton [Internet]. R: quality assessment tool for quantitative studies. Canadá (CA): R Quality Assessment Tool for Quantitative Studies; [cited 2019 Jul 17]. Available from: Available from: https://www.ephpp.ca/quality-assessment-tool-for-quantitative-studies/ https://www.ephpp.ca/quality-assessment-... , 2017	Catalonia, Spain	Retrospective cohort	Down's Medical Centre (12)	0 to 5 years	Identification of early signs of ASD in DS	Weak
Starr et al.2323. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016 Dec 5;5(1):210. https://doi.org/10.1186/s13643-016-0384-4 https://doi.org/10.1186/s13643-016-0384-... , 2005	Manchester, Liverpool and Leeds, England	Cohort	Down Syndrome Association, UK (13)	7 to 31 years	Diagnosis of ASD in DS	Weak
Carter et al.2424. Ortiz B, Videla L, Gich I, Alcacer B, Torres D, Jover I, Videla S. Early warning signs of autism spectrum disorder in people with Down syndrome. Int Med Rev Down Syndr. 2017 Jan-Apr;21(1):3-11. https://doi.org/10.1016/j.sdeng.2017.01.001 https://doi.org/10.1016/j.sdeng.2017.01.... , 2006	USA	Cohort	Not informed (127)	2 to 24 years	Diagnosis of ASD in DS	Weak
Hepburn et al.66. Hepburn S, Philofsky A, Fidler DJ, Rogers S. Autism symptoms in toddlers with Down syndrome: a descriptive study. J Appl Res Intellect Disabil. 2008 Jan;21(1):48-57. https://doi.org/10.1111/j.1468-3148.2007.00368.x https://doi.org/10.1111/j.1468-3148.2007... , 2007	Denver, USA	Cohort	Mile High Down Syndrome Association (20)	2 to 3 years	Diagnosis of ASD in DS	Weak
Dressler et al.1818. Parlato-Oliveira E, Saint-Georges. Da clínica do bebê à avaliação do tratamento: uma microanálise transdisciplinar. In: Parlato-Oliveira E, Szejer M. O Bebê e os desafios da cultura. São Paulo (SP): Instituto Langage ; 2019 p. 69-79., 2011	Pisa, Livorno, Bologna and Pistoia, Italy	Cohort	IRCCS Stella Maris Foundation, University of Pisa (24)	6 to 34 years	Diagnosis of ASD in DS	Weak
Ji et al.2525. Starr EM, Berument SK, Tomlins M, Papanikolaou K, Rutter M. Brief report: autism in individuals with Down syndrome. J Autism Dev Disord. 2005 Oct;35(5):665-73. https://doi.org/10.1007/s10803-005-0010-0 https://doi.org/10.1007/s10803-005-0010-... , 2011	USA	Cohort	Kennedy Krieger Institute Down Syndrome Clinic (293)	2 to 13 years	Diagnosis of ASD in DS	Weak
Magyar et al.2626. Carter JC, Capone GT, Gray RM, Cox CS, Kaufmann WE. Autistic-spectrum disorders in Down syndrome: further delineation and distinction from other behavioral abnormalities. Am J Med Genet B Neuropsychiatr Genet. 2007 Jan 5;144B(1):87-94. https://doi.org/10.1002/ajmg.b.30407 https://doi.org/10.1002/ajmg.b.30407... , 2012	USA	Cohort	Participants in a prevalence study (71)	4 to 14 years	Diagnosis of ASD in DS	Weak
Pandolfi et al.77. Pandolfi V, Caroline IM, Charles A. Screening for autism spectrum disorder in children with Down syndrome: An evaluation of the Pervasive Developmental Disorder in Mental Retardation Scale. J Intellect Dev Dis 2017;43(1):61-72., 2017	USA	Cohort	Participants in a prevalence study (71)	3 to 15 years	Diagnosis of ASD in DS	Weak
Godfrey et al.2727. Ji NY, Capone GT, Kaufmann WE. Autism spectrum disorder in Down syndrome: cluster analysis of aberrant behaviour checklist data supports diagnosis. J Intellect Disabil Res. 2011 Nov;55(11):1064-77. https://doi.org/10.1111/j.1365-2788.2011.01465.x https://doi.org/10.1111/j.1365-2788.2011... , 2019	USA	Cohort	Parents’ association (18)	Born between 1996 and 2003	Diagnosis of ASD in DS	Weak
Oxelgren et al.2828. Magyar CI, Pandolfi V, Dill CA. An initial evaluation of the Social Communication Questionnaire for the assessment of autism spectrum disorders in children with Down syndrome. J Dev Behav Pediatr. 2012 Feb;33(2):134-45. https://doi.org/10.1097/DBP.0b013e318240d3d9 https://doi.org/10.1097/DBP.0b013e318240... , 2019	Uppsala, Sweden	Cohort	Uppsala University Children's Hospital (60)	5 to 17 years	Diagnosis of ASD in DS	Weak
Capone et al.2929. Godfrey M, Hepburn S, Fidler DJ, Tapera T, Zhang F, Rosenberg CR, et al. Autism Spectrum Disorder (ASD) symptom profiles of children with comorbid Down Syndrome (DS) and ASD: a comparison with children with DS-only and ASD-only. Res Dev Disabil. 2019 Jun;89:83-93. https://doi.org/10.1016/j.ridd.2019.03.003 https://doi.org/10.1016/j.ridd.2019.03.0... , 2005	Baltimore, USA	Cohort	Kennedy Krieger Institute (131)	2 to 21 years	Diagnosis of ASD in DS	Weak
DiGuiseppi et al.88. DiGuiseppi C, Hepburn S, Davis JM, Fidler DJ, Hartway S, Lee NR. Screening for autism spectrum disorders in children with Down syndrome: population prevalence and screening test characteristics. J Dev Behav Pediatr 2010;31:181–191., 2010	Colorado, USA	Cross-sectional	General population and the Mile High Down Syndrome Association (123)	2 to 11 years	Diagnosis of ASD in DS	Weak
Moss et al.³⁰, 2013	Birmingham and London, UK	Cross-sectional	Down Syndrome Association, UK (108)	4 to 62 years	Diagnosis of ASD in DS	Weak
Warner et al.3131. Capone GT, Grados MA, Kaufmann WE, Bernad-Ripoll S, Jewell A. Down syndrome and comorbid autism-spectrum disorder: characterization using the aberrant behavior checklist. Am J Med Genet A. 2005 May 1;134(4):373-80. https://doi.org/10.1002/ajmg.a.30622 https://doi.org/10.1002/ajmg.a.30622... , 2014	England and Wales	Cohort	Down Syndrome Association, UK (160)	4 to 40 years	Diagnosis of ASD in DS	Weak

Author, year	Study design	Inclusion criteria	Sample size	Age range (years)	Autism assessment tools	Information source	Proportions of men/women
Ortiz et al.2222. Effective Public Health Practice Project Hamilton [Internet]. R: quality assessment tool for quantitative studies. Canadá (CA): R Quality Assessment Tool for Quantitative Studies; [cited 2019 Jul 17]. Available from: Available from: https://www.ephpp.ca/quality-assessment-tool-for-quantitative-studies/ https://www.ephpp.ca/quality-assessment-... , 2017	Retrospective cohort	Individuals with DS and with SD and autism	Down's Medical Centre (12)	0 to 5	Modified Checklist for Autism in Toddlers (M-CHAT) and Autism Diagnostic Interview-Revised (ADI-R)	Analysis of home videos	2:1

Author, year	Inclusion criteria	Sample size	Age range (years)	Autism assessment tools	Information sources	Reference criterion for diagnosis	Diagnostic benchmark prevalence	Proportions of men/women
Starr et al.2323. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016 Dec 5;5(1):210. https://doi.org/10.1186/s13643-016-0384-4 https://doi.org/10.1186/s13643-016-0384-... , 2005	Individuals with DS and severe intellectual disability	13	7 to 31	Autism Diagnostic Interview-Revised (ADI-R) and Adapted Pre-Linguistic Autism Diagnostic Observation Schedule (A-PL-ADOS)	Parents	DSM-IV and CID-10	-	1.16:1
Carter et al.2424. Ortiz B, Videla L, Gich I, Alcacer B, Torres D, Jover I, Videla S. Early warning signs of autism spectrum disorder in people with Down syndrome. Int Med Rev Down Syndr. 2017 Jan-Apr;21(1):3-11. https://doi.org/10.1016/j.sdeng.2017.01.001 https://doi.org/10.1016/j.sdeng.2017.01.... , 2006	Individuals with DS	127	2 to 24	Autism Behavior Checklist and Aberrant Behavior Checklist	Parents	DSM‐IV	-	2.33:1
Hepburn et al.66. Hepburn S, Philofsky A, Fidler DJ, Rogers S. Autism symptoms in toddlers with Down syndrome: a descriptive study. J Appl Res Intellect Disabil. 2008 Jan;21(1):48-57. https://doi.org/10.1111/j.1468-3148.2007.00368.x https://doi.org/10.1111/j.1468-3148.2007... , 2007	Children with SD	20	2 to 3	Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule-Generic	Parents	DSM-IV TR	-	2.45:1
Dressler et al.1818. Parlato-Oliveira E, Saint-Georges. Da clínica do bebê à avaliação do tratamento: uma microanálise transdisciplinar. In: Parlato-Oliveira E, Szejer M. O Bebê e os desafios da cultura. São Paulo (SP): Instituto Langage ; 2019 p. 69-79., 2011	Individuals with DS and/or autism living with their family	24	6 to 34	Childhood Autism Rating Scale (CARS)	Parents	DSM-IV TR	-	0.84:1
Ji et al.2525. Starr EM, Berument SK, Tomlins M, Papanikolaou K, Rutter M. Brief report: autism in individuals with Down syndrome. J Autism Dev Disord. 2005 Oct;35(5):665-73. https://doi.org/10.1007/s10803-005-0010-0 https://doi.org/10.1007/s10803-005-0010-... , 2011	Individuals with DS	293	2 to 13	Autism Behavior Checklist	Not informed	DSM-IIIR and DSM-IV	-	3.16:1
Magyar et al.2828. Magyar CI, Pandolfi V, Dill CA. An initial evaluation of the Social Communication Questionnaire for the assessment of autism spectrum disorders in children with Down syndrome. J Dev Behav Pediatr. 2012 Feb;33(2):134-45. https://doi.org/10.1097/DBP.0b013e318240d3d9 https://doi.org/10.1097/DBP.0b013e318240... , 2012	Individuals with DS	71	4 to 14	Archival Social Communication Questionnaire (SCQ), Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule	Not informed	DSM-IV	-	1.29:1
Pandolfi et al.77. Pandolfi V, Caroline IM, Charles A. Screening for autism spectrum disorder in children with Down syndrome: An evaluation of the Pervasive Developmental Disorder in Mental Retardation Scale. J Intellect Dev Dis 2017;43(1):61-72., 2017	Individuals with DS	71	3 to 15	Pervasive Developmental Disorder in Mental Retardation Scale (PDD- MRS), Social Communication Questionnaire - Lifetime Version (SCQ-L) and Autism Diagnostic Interview-Revised (ADI-R)	Parents	DSM-IV- TR	-	1.15:1
Godfrey et al.2828. Magyar CI, Pandolfi V, Dill CA. An initial evaluation of the Social Communication Questionnaire for the assessment of autism spectrum disorders in children with Down syndrome. J Dev Behav Pediatr. 2012 Feb;33(2):134-45. https://doi.org/10.1097/DBP.0b013e318240d3d9 https://doi.org/10.1097/DBP.0b013e318240... , 2019	Individuals with DS born between January 1, 1996, and December 21, 2003, and who had a caregiver who spoke English or Spanish fluently	33	born between 1996 and 2003	Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R)	Parents	DSM-V	-	2.01:00
Oxelgren et al.2929. Godfrey M, Hepburn S, Fidler DJ, Tapera T, Zhang F, Rosenberg CR, et al. Autism Spectrum Disorder (ASD) symptom profiles of children with comorbid Down Syndrome (DS) and ASD: a comparison with children with DS-only and ASD-only. Res Dev Disabil. 2019 Jun;89:83-93. https://doi.org/10.1016/j.ridd.2019.03.003 https://doi.org/10.1016/j.ridd.2019.03.0... , 2019	Individuals with DS	60	5 to 17	Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS)	Parents	Not informed	-	1.8:1
Capone et al.2949. Gomes PTM, Lima LHL, Bueno MKG, Araújo LA, Souza NM. Autismo no Brasil, desafios familiares e estratégias de superação: revisão sistemática. J Pediatr (Rio J). 2015 Mar-Apr;91(2):111-21. https://doi.org/10.1016/j.jped.2014.08.009 https://doi.org/10.1016/j.jped.2014.08.0... , 2005	Individuals with DS	131	2 to 21	Behavior questionnaires, semi-structured neurological development assessment and observation during play or social interactions	Parents	DSM-IV	12.9%	2.7:1
DiGuiseppi et al.88. DiGuiseppi C, Hepburn S, Davis JM, Fidler DJ, Hartway S, Lee NR. Screening for autism spectrum disorders in children with Down syndrome: population prevalence and screening test characteristics. J Dev Behav Pediatr 2010;31:181–191., 2010	Individuals with DS born between January 1, 1996, and December 21, 2003, and who had a caregiver who spoke English or Spanish fluently	123	2 to 21	Behavior questionnaires, semi-structured neurological development assessment and observation during play or social interactions	Parents	DSM-IV TR	AUT 6.4% TEA 11.8% Total 18.2%	1.86:1
Moss et al.3030. Oxelgren UW, Myrelid Å, Annerén G, Ekstam B, Göransson C, Holmbom A, et al. Prevalence of autism and attention-deficit-hyperactivity disorder in Down syndrome: a population-based study. Dev Med Child Neurol. 2017 Mar;59(3):276-83. https://doi.org/10.1111/dmcn.13217 https://doi.org/10.1111/dmcn.13217... , 2013	Participants were included if there was information on the date of birth and diagnosis of DS from a professional (physician, clinical geneticist, pediatrician or other), if at least 75% of the SCQ (Rutter et al., 2003) had been completed and if the participant with SD was at least 4 years of age.	108	4 to 62	Social Communication Questionnaire (SCQ)	Parents	Not informed	19%	0.7:1
Warner et al.3131. Capone GT, Grados MA, Kaufmann WE, Bernad-Ripoll S, Jewell A. Down syndrome and comorbid autism-spectrum disorder: characterization using the aberrant behavior checklist. Am J Med Genet A. 2005 May 1;134(4):373-80. https://doi.org/10.1002/ajmg.a.30622 https://doi.org/10.1002/ajmg.a.30622... , 2014	Individuals with DS	160	4 to 40	Lifetime version of the Social Communication Questionnaire (SCQ) and Strengths and Difﬁculties Questionnaire	Parents	Not informed	AUT 16,5% TEA 37.7%	1.2:1

Tool	Description	Age	Sensitivity	Specificity	Amount of use (n = 15)
Autism Diagnostic Interview- Revised (ADI-R)3434. Randall M, Egberts KJ, Samtani A, Scholten RJ, Hooft L, Livingstone N, et al. Diagnostic tests for Autism Spectrum Disorder (ASD) in preschool children. Cochrane Database Syst Rev. 2018 Jul 24;7(7):CD009044. https://doi.org/10.1002/14651858.CD009044.pub2 https://doi.org/10.1002/14651858.CD00904...	[Diagnosis] Standardized questionnaire in accordance with DSM-IV criteria. This is an early childhood evaluation that checks social relationships, communication and repetitive behaviors.	from 18 months	0.52	0.84	8
Autism Diagnostic Observation Schedule (ADOS)3434. Randall M, Egberts KJ, Samtani A, Scholten RJ, Hooft L, Livingstone N, et al. Diagnostic tests for Autism Spectrum Disorder (ASD) in preschool children. Cochrane Database Syst Rev. 2018 Jul 24;7(7):CD009044. https://doi.org/10.1002/14651858.CD009044.pub2 https://doi.org/10.1002/14651858.CD00904... ^, 3535. Lombardo MV, Lai M-C, Baron-Cohen S. Big data approaches to decomposing heterogeneity across the autism spectrum. Mol Psychiatry. 2019 Oct;24(10):1435-50. https://doi.org/10.1038/s41380-018-0321-0 https://doi.org/10.1038/s41380-018-0321-...	[Diagnosis] This is a semi-structured evaluation tool that enables observation of four areas: social interaction, communication, play and repetitive behaviors.	from 12 months	0.94	0.80	5
Adapted Pre-Linguistic Autism Diagnostic Observation Schedule (A-PL-ADOS)3636. Lord C, Rutter M, Goode S, Heemsbergen J, Jordan H, Mawhood L, et al. Autism diagnostic observation schedule: a standardized observation of communicative and social behavior. J Autism Dev Disord. 1989 Jun;19(2):185-212. https://doi.org/10.1007/BF02211841 https://doi.org/10.1007/BF02211841...	[Diagnosis] Tool developed for diagnosing autism that enables observation of children and adults with severe/profound cognitive impairments	from 3 years	0.82	0.85	1
Autism Behavior Checklist (AutBC)3737. Berument SK, Starr E, Pickles A, Tomlins M, Papanikolauou K, Lord C, et al. Pre-linguistic autism diagnostic observation schedule adapted for older individuals with severe to profound mental retardation: a pilot study. J Autism Dev Disord. 2005 Dec;35(6):821-9. https://doi.org/10.1007/s10803-005-0027-4 https://doi.org/10.1007/s10803-005-0027-...	[Screening] Tool based on parents’ responses that evaluates behaviors associated with autism, in five subscales: sensory; interaction; body and object use; language; and social and self-help.	from 24 months	0.77	0.91	2
Aberrant Behavior Checklist (ABC)3838. Eaves RC, Campbell HA, Chambers D. Criterion‐Related and construct validity of the pervasive developmental disorders rating scale and the autism behavior checklist. Psychol Sch. 2000 Jul;37(4):311-21. https://doi.org/10.1002/1520-6807(200007)37:4<323::AID-PITS2>3.0.CO;2-S https://doi.org/10.1002/1520-6807(200007...	[Screening] This is a 58-item questionnaire that evaluates the severity of behaviors on five subscales: irritability; lethargy/social impairment; stereotyping; hyperactivity; and inadequate speech.	from 5 years	0.4-0.74	0.3-0.75	1
Childhood Autism Rating Scale (CARS)3434. Randall M, Egberts KJ, Samtani A, Scholten RJ, Hooft L, Livingstone N, et al. Diagnostic tests for Autism Spectrum Disorder (ASD) in preschool children. Cochrane Database Syst Rev. 2018 Jul 24;7(7):CD009044. https://doi.org/10.1002/14651858.CD009044.pub2 https://doi.org/10.1002/14651858.CD00904...	[Diagnosis] This is an tool for behavioral observations. It evaluates 15 items taking into account the symptoms for diagnosing ASD that are described in the DSM-IV	from 24 months	0.80	0.88	2
Archival Social Communication Questionnaire (SCQ)39039. Rojahn J, Aman MG, Matson JL, Mayville E. The Aberrant Behavior checklist and the behavior problems inventory: convergent and divergent validity. Res Dev Disabil. 2003 Sep-Oct;24(5):391-404. https://doi.org/10.1016/s0891-4222(03)00055-6 https://doi.org/10.1016/s0891-4222(03)00...	[Screening] This is a tool for evaluating individuals who are considered at risk of autism. It evaluates qualitative deficiencies in reciprocal social interaction and communication, as well as repetitive and stereotyped behavior	from 4 years	0.88	0.72	6
Social Communication Questionnaire - Lifetime Version (SCQ-L)4040. Chandler S, Charman T, Baird G, Simonoff E, Loucas T, Meldrum D, et al. Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2007 Oct 1;46(10):1324-32. https://doi.org/10.1097/chi.0b013e31812f7d8d https://doi.org/10.1097/chi.0b013e31812f...	[Screening] This version of the SCQ focuses on the child's development history, providing a total score that identifies individuals who may have autism and should be referred for a more thorough evaluation. The evaluation is practically unaffected by age, gender, language level and IQ performance	from 4 years	0.78	0.47	1
Pervasive Developmental Disorder in Mental Retardation Scale PDD- MRS4141. Sappok T, Diefenbacher A, Gaul I, Bölte S. Validity of the social communication questionnaire in adults with intellectual disabilities and suspected autism spectrum disorder. Am J Intellect Dev Disabil. 2015 May 1;120(3):203-14. https://doi.org/10.1352/1944-7558-120.3.203 https://doi.org/10.1352/1944-7558-120.3....	[Screening] This is an ASD assessment tool that was developed for people with DS based on the DSM-IV-R criteria. It assesses the quality of social interactions with adults and colleagues, language and speech problems and aspects of behavior	from 2 years	0.92	0.92	1
Modified Checklist for Autism in Toddlers (M-CHAT)4242. Kraijer D, Bildt A. The PDD-MRS: an instrument for identification of autism spectrum disorders in persons with mental retardation. J Autism Dev Disord. 2005 Aug;35(4):499-513. https://doi.org/10.1007/s10803-005-5040-0 https://doi.org/10.1007/s10803-005-5040-...	[Screening] This is a tool that is easy to apply and accessible, and it assesses psychometric properties. The caregiver responds to 23 yes/no items. Failure in three items or 2 out of 6 critical items (focus on joint attention, social orientation and imitation) indicates a risk of autism.	18 to 24 months	0.34	0.93	1
Strengths and Difﬁculties Questionnaire (SDQ)4343. Stenberg N, Bresnahan M, Gunnes N, Hirtz D, Hornig M, Lie KK, et al. Identifying children with autism spectrum disorder at 18 months in a general population sample. Paediatr Perinat Epidemiol. 2014 May;28(3):255-62. https://doi.org/10.1111/ppe.12114 https://doi.org/10.1111/ppe.12114...	[Screening] This is an evaluation of 25 items that assesses the psychological condition of children and young people. It generates scores for emotional symptoms, behavioral problems, hyperactivity, peer problems and social behavior.	3 to 16 years	0.63	0.94	1

[1] Correspondence: Natália Lisce Fioravante Diniz; Email: natalialfd@gmail.com.

Brasil

Brasil

Autism and Down syndrome: early identification and diagnosis

Autismo e síndrome de Down: identificação precoce e diagnóstico

ABSTRACT

Background: