LILYA-T (Lively Autism Screening Test in Young Children)
Early Detection: A next-generation Level 2 autism screening measure for young children
LILYA-T
(Lively Autism Screening Test in Young Children)
What is LILYA-T?
LILYA-T (Lively Autism Screening Test in Young Children) represents the next generation of autism screening, developed by Dr. Roula Choueiri, the pioneer behind the Rapid Interactive Screening for Autism in Toddlers.
LILYA-T is an interactive, observational Level 2 screening measure used to assess Autism Spectrum Disorder (ASD) risk in toddlers and young children until age 3 years.
What does the LILYA-T evaluate?
Developmental Constructs
The LILYA-T includes nine semi-structured play-based activities that evaluates developmental early signs observed in young children with ASD. Each play-based activity allows the observation of the child’s response. LILYUA-T evaluates:-
- Joint Attention (JA)
- Human Agency (HA) that is the precursor for the Theory of Mind
- Social Awareness (SA)
- Communication
- Self-Awareness, and there is an element of visual reception assessment
How do you score the LILYA-T?
Each activity is coded and scored depending on the child’s response: the lower the score, the more typical the response. A total score is calculated by adding the scores of the 9 individual activities.
Do you need to buy scoring sheets?
No. A LILYA-T manual and a LILYA-T scoring sheet have been developed and validated. The LILYA-T manual describes the administration and scoring of each one of the items. The manual and the LILYA-T scoring sheet can be obtained and downloaded from the LILYA-T online course package
When do you use the LILYA-T?
LILYA-T can be administered when a child has a high score on a Level 1 or universal screener such as the MCHAT-R (Modified Checklist for Autism in Toddlers – Revised) that may or may not have been administered before the LILYA-T.
But also can be administered in young children at risk for ASD such as : siblings of a child already diagnosed with ASD, children born with higher risks for neurodevelopmental disorders such as: prematurely born children, children already identified with other delays and in Early Intervention Programs, or those with genetic disorders known to be associated with ASD (such as Trisomy 21).
This interactive measure can be administered to this group of high-risk children to differentiate between ASD and other delays (See figure below that depicts a Two-Level ASD Screening Model). An interactive Level 2 test is preferred in this age group (18 months-36 months) as it allows the direct observation of the early signs we are looking for rather than relying on history, as they may be hard to recognize.
FAST FACTS
LILYA-T Details
01. Can be administered 18 months and up to 3 years of age
- Designed for toddlers and young children from 18 months through 3 years.
- An ideal age range for early identification of autism risk.
02. Easy to train on and learn: 3 hours to train reliably
- LILYA-T is simple to learn and easy to implement in practice.
- Reliable administration and scoring can be achieved with about 3 hours of training.
03. Can be administered and scored in approximately 15-20 minutes
- The LILYA-T fits easily into busy clinical and early intervention settings.
- Administration and scoring can be completed in approximately 15–20 minutes.
04. Consistent cut off autism risk scores that differentiate between young children with ASD and toddlers with Developmental Delay (DD)/Non-ASD such as:
- Scores >16 are highly associated with ASD and a PPV of 98-99%
- Scores 12-16 are considered medium risk range but still have a PPV of 95-98% for ASD
- Scores below 12 are considered low risk for ASD
- As for any interactive measure, clinical judgement still prevails
05. The LILYA-T correlates well with established diagnostic measures of ASD such as DSM-5 ASD criteria:
- The Autism Diagnostic Observation Schedule – second edition (ADOS-2) and modules Toddler and 1; the Childhood Autism Rating Scale-2 ST (CARS-2ST)
Who can train to use it?
- Early Childhood providers in different specialties have trained on the LILYA-T: primary care providers (MD, NP, PA), psychologists, developmental behavioral pediatricians, neurologists, child psychiatrists, early intervention and therapists such as developmental specialists, speech therapists, occupational therapists, social workers.
- Fits well into a busy practice flow.
- The LILYA-T does not rely on language so it can be used in non-English speaking children.
- We have translated and validated scoring sheets and manuals in Turkish, French, and Arabic.
- We have translated material to Spanish and Portuguese.
- Tele-LILYA-T and PILOT data is also available.
Frequently asked questions
The LILYA-T training has been validated and reliable administration and scoring of the LILYA-T is easily accomplished in about 3 hours.
Various early childhood providers have been trained on the administration and scoring of the LILYA-T: Early intervention providers, speech therapists, developmental specialists, social workers, pediatricians, nurses, nurse practitioners, pediatric residents and psychologists.
The LILYA-T can be administered and scored within about 10 minutes. Making it very easy to fit in busy practices.
The LILYA-T differentiates extremely well between toddlers with ASD and toddlers with Developmental Delay (DD) /Non-ASD. Toddlers with no apparent developmental delay and toddlers with developmental or language delays, but with intact social communication skills, score comparably on the LILYA-T.
Different systems have been developed that integrate the LILYA-T and those are described in the LILYA-T online course: -Integration of the LILYA-T as part of triaging of referrals ages 18 months - 36 months in a tertiary referral center (Integration of the LILYA-T in triaging system such as the Developmental and Behavioral Pediatrics Division in Calgary, Alberta). -Integration of LILYA-T in screening for ASD in high risk groups (Early Intervention model with THOM EI Program in Worcester).
The LILYA-T has been found to correlate well with established diagnostic measures of ASD (earlier study in 2015; study from Calgary; ongoing project).
The LILYA-T has been validated on toddlers ages 18 months to 36 months. We are currently validating it on younger toddlers (12 months to 18 months). We are also validating a telehealth version of the LILYA-T for 18 to 36-month-olds.
Initial study found a cut off score of more than 14 to be associated with ASD. Following studies found that cut off scores of 12 and higher should be looked at carefully. Current consensus is that: -Score below 12: most probably non ASD -Score 12-16: grey area and needs further testing; higher percentage of ASD. -Score over 16: highly associated with ASD.
However, please do keep in mind that this is a screening test and that even if a child scores below the risk area however you still have concerns about the history, presentation or other risk factors, you have to still rely on your clinical impressions and judgment and make appropriate referrals.
Research & Collaboration
Publications
Choueiri R, DeMeo M, Tokatli V, Zhu G, Zhang B. Demographic and socioeconomic characteristics of patients diagnosed with autism through the Rapid Interactive screening Test for Autism in Toddlers. Pediatr Investig. 2024; 8: 209–214. https://doi.org/10.1002/ped4.12453
Kadak, M. T., Serdengeçti, N., Seçen Yazıcı, M., Sandıkçı, T., Aydın, A., Koyuncu, Z., Meral, Y., Haşimoğlu, A., Çalışkan, Y., Bayraktar, G., Can Öztürk, E., Gökler, M. E., Choueiri, R., & Tarakçıoğlu, M. C. (2023). Turkish Validation of the Rapid Interactive Screening Test for Autism in Toddlers. Autism: the international journal of research and practice, 13623613231217801. Advance online publication. https://doi.org/10.1177/13623613231217801
AAP Fact Sheet – Autism Diagnosis in Primary Care
Hyman, S. L., Levy, S. E., Myers, S. M., & Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics (2020). Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447
McCarty, P., & Frye, R. E. (2020). Early Detection and Diagnosis of Autism Spectrum Disorder: Why Is It So Difficult? Seminars in Pediatric Neurology, 35, 100831. https://doi.org/10.1016/j.spen.2020.100831
Choueiri R, Garrison WT, Tokatli V, et al. The RITA-T (Rapid Interactive Screening Test for Autism in Toddlers) Community Model to Improve Access and Early Identification of Autism in Young Children. Child Neurology Open. 2023;10. doi:10.1177/2329048X231203817
Choueiri, R., Garrison, W.T. & Tokatli, V. Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities. Indian J Pediatr (2022).
Kong XJ, Sherman HT, Tian R, et al. Validation of Rapid Interactive Screening Test for Autism in Toddlers Using Autism Diagnostic Observation Schedule™ Second Edition in Children at High-Risk for Autism Spectrum Disorder. Front Psychiatry. 2021;12:737890. Published 2021 Oct 1. doi:10.3389/fpsyt.2021.737890
Choueiri R, Lindenbaum A, Ravi M, Robsky W, Flahive J, Garrison W. Improving Early Identification and Access to Diagnosis of Autism Spectrum Disorder in Toddlers in a Culturally Diverse Community with the Rapid Interactive screening Test for Autism in Toddlers. Journal of Autism and Developmental Disorders. Published online 2021:1-9. doi:10.1007/s10803-020-04851-3
Yassin R, Abbas LA, Krayem M, Salame E, Choueiri R, et al. (2020) The Rapid Interactive Screening Test for Autism in Toddlers (RITA-T): Validity in a Lebanese Cross-Cultural Pilot Study. Int J Autism & Relat Disabil: IJARD-136. DOI: 10.29011/2642-3227.000036
Lemay J, Amin P, Langenberger S, McLeod S. Experience with the Rapid Interactive Test for Autism in Toddlers in an Autism Spectrum Disorder Diagnostic Clinic. J Dev Behav Pediatr. 2019 Sept. 00:1–9, 2019 DOI: 10.1097/DBP.0000000000000730
Roula N. Choueiri and Andrew W. Zimmerman. New Assessments and Treatments in ASD. Review paper. March. Curr Treat Options Neurol 2017. 19:6. DOI: 10.1007/s11940-017-0443-8.
Lemay J, Meridith Yohemas M, Langenberger S. Redesign of the autism spectrum screening and diagnostic process for children aged 12 to 36 months. Pediatrics & Child Health. 2017 Jan; pxx 187
Zwaigenbaum L, Bauman ML, Choueiri R, et al. Early Identification and Interventions for Autism Spectrum Disorder: Executive Summary. Pediatrics. 2015 Oct; 136 Suppl 1:S1-9.
Choueiri R, Wagner S. A New Interactive Screening Test for Autism Spectrum Disorder in Toddlers. Journal of Pediatrics. 2015 Aug; 167(2):460-6. DOI: 10.1016/j.jpeds.2015.05.029. PMID:26210844
