Screening Questionnaire for Early Signs of Autism Spectrum Disorder: evidence of validity and internal consistency

ABSTRACT Objective Assess the evidence of validity and the internal consistency of the Questionnaire for Screening Early Signs of Autism Spectrum Disorder (QR-TEA). Methods Four healthcare professionals with more than five years of clinical experience in treating children diagnosed with ASD analyzed the content. A sample of 133 parents/guardians of children aged 24-36 months from all over Brazil participated in the internal structure and internal consistency study. Participants answered the questionnaire through interviews with healthcare professionals. An exploratory factor analysis technique verified the factor structure. Additionally, to assess the instrument’s internal consistency, the composite reliability was calculated. Results i-IVC = 1.00 was found for most items; Kappa between 0.51 and 0.94; p < 0.05; CCI = 0.90; p < 0.05. Exploratory factor analysis pointed to a two-factor solution for QR-TEA. Composite reliability was adequate (above 0.70) for both factors. The factor structure replicability measure suggested that the two factors are replicable in future studies (H > 0.80). Conclusions The data indicate initial evidence of validity and adequate internal consistency. The findings also support the psychometric adequacy of the QR-TEA in line with the DSM-5 two-factor model. It is recommended to conduct further studies to assess other evidence of validity and to verify the sensibility and specificity.摘要：目的 评估自闭症谱系障碍早期筛查问卷（Questionnaire for Screening Early Signs of Autism Spectrum Disorder, QR-TEA）的效度证据与内部一致性。方法 4名拥有5年以上儿童孤独症谱系障碍（Autism Spectrum Disorder, ASD）临床诊疗经验的医护人员对问卷内容进行了分析；同时招募来自巴西全境的133名24~36月龄儿童的家长/监护人参与内部结构与内部一致性研究，受试者通过医护人员访谈完成问卷填写。本研究采用探索性因子分析技术验证其因子结构，并通过计算组合信度评估该工具的内部一致性。结果 多数条目项目间内容相关性（item-Inter-Item Content Correlation, i-IVC）为1.00；Kappa值介于0.51至0.94之间（p<0.05）；组合一致性指数（Composite Congruence Index, CCI）为0.90（p<0.05）。探索性因子分析结果表明，QR-TEA存在双因子结构；两个因子的组合信度均达标（大于0.70）；因子结构可复制性指标显示该双因子结构在后续研究中具备可复制性（H>0.80）。结论 本研究数据表明该问卷具备初步的效度证据与良好的内部一致性，研究结果同时支持QR-TEA符合《精神障碍诊断与统计手册第五版》（Diagnostic and Statistical Manual of Mental Disorders 5th Edition, DSM-5）的双因子模型；建议后续开展进一步研究以评估其他效度证据，并验证该问卷的灵敏度与特异度。