P2.057: The RITA-T (Rapid Interactive Screening Test for Autism in Toddlers) identifies Autism Risk in Preschoolers aged 3-5 years old.

Background: The RITA-T (Rapid Interactive screening Test for Autism in Toddlers) is validated for those 18-36 months with clear ASD (autism spectrum disorder) risk cut off scores such as a score > 16 is associated with substantial risk for ASD; a score between 12-16 is associated with moderate risk for ASD and a score below 12 is low risk for ASD. This RITA-T helps the earlier identification of autism in this age group. There is currently no interactive screening measure for preschoolers aged 3-5 years old. In this study, we are evaluating the psychometric properties of the RITA-T in preschoolers at risk for autism. Our hypothesis is that the RITA-T ASD risk cut off scores in preschoolers are similar to risk cut off scores in toddlers.

Methods: We have integrated the RITA-T in the evaluation for ASD in young children aged 5 years and below and referred to the Early Autism Diagnostic Program (EADP) with concerns of autism. The evaluation includes history, behavioral observations, administration of the RITA-T to inform and structure the observation of developmental constructs delayed in ASD, and the administration of autism diagnostic measures such as the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Childhood Autism Rating Scale –2 (CARS-2ST) and the DSM-5 autism checklist. The best estimate clinical diagnosis is then based on all those components and overall clinical impressions. For this study, we reviewed the charts of those evaluated in this program between November 2023 and September 2024. We collected demographic data, RITA-T scores, and diagnosis. We then correlated the RITA-T scores to final clinical diagnosis and evaluated ASD risk cut off scores.

Results: During this time, 250 children were evaluated for concerns of ASD. Of those, 88 were aged 3-5y. The RITA-T was not administered in 9 and was incomplete in 12. From those 67 where the RITA-T was administered fully, 63 received a diagnosis of autism. Fifty-one (80.9%) were males and 12 (19%) were females. Racial mix was Black/African American: 41.2%; White:22.22%; Hispanic:9.5%; Asian: 8%; Multiracial:8% and unknown:11%. The average age (in months) was 43.2 months (36 - 59 months). Average RITA-T total score was 19.6 (11-27) and distributed as: 62/63 scored in the medium or high-risk range for ASD on the RITA-T (48 scored in high-risk range and 14 scored in moderate risk range). Only 1 scored an 11 which is directly below cut off score.

Conclusion: The application of the RITA-T in preschoolers aged 3-5 years old with concerns for autism shows consistent autism risk cut off scores than in toddlers aged 18 months – 3 years. This has important clinical and public health implications and potential use to improve access for diagnosis and services in preschoolers. Further validation is underway.