{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:05:34Z","timestamp":1792253134377,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: This study aimed to provide a reliable estimate of early childhood autism spectrum disorder (ASD) prevalence in T\u00fcrkiye and to examine diagnostic stability and developmental trajectories through a ten-year longitudinal follow-up incorporating systematic early screening, structured parent-child observations, and repeated diagnostic assessments. Methods: A total of 1981 children aged 18-48 months were screened using the M-CHAT-R\/F. Children who screened positive underwent an initial clinical assessment, including a family interview and structured parent-child observation. Those identified as at risk were referred for DSM-5-TR-based diagnostic evaluation by expert clinicians. Children diagnosed with ASD or classified as at risk were enrolled in a structured ten-year follow-up program. Results: Of the 1981 screened children, 27 (1.4%) were identified as at risk. Nine children (33.3% of at-risk; 0.45% of the total sample) received an ASD diagnosis following comprehensive evaluation. All retained their diagnosis during the 18-month follow-up. By the tenth year, two additional children from the at-risk group were diagnosed, bringing the total number of ASD cases to 11. Conclusions: These findings demonstrate that structured, multi-stage screening and diagnostic procedures are feasible and effective for early ASD identification in T\u00fcrkiye. High diagnostic stability supports the reliability of early clinician-led assessments, while later-emerging cases highlight the importance of long-term monitoring of at-risk children.<\/jats:p>","DOI":"10.3390\/brainsci16010062","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T16:34:23Z","timestamp":1767198863000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Outcomes of Early Autism Spectrum Disorder Screening: Prevalence and Diagnostic Stability in a Decade-Long Cohort from T\u00fcrkiye"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-1905","authenticated-orcid":false,"given":"\u0130brahim Sel\u00e7uk","family":"Esin","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Trabzon University, Trabzon 61000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esen Y\u0131ld\u0131r\u0131m","family":"Demird\u00f6\u011fen","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Atat\u00fcrk University, Erzurum 25100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Akif","family":"Ak\u0131nc\u0131","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Atat\u00fcrk University, Erzurum 25100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1190-9589","authenticated-orcid":false,"given":"Bahad\u0131r","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Karadeniz Teknik University, Trabzon 61000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcls\u00fcm Tu\u011fba Korkmaz","family":"\u00dcr\u00fck","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Atat\u00fcrk University, Erzurum 25100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130lknur \u0130bili","family":"Ucuz","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, \u0130non\u00fc University, Malatya 44100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2990-9851","authenticated-orcid":false,"given":"Onur Burak","family":"Dursun","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine, Trabzon University, Trabzon 61000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR, American Psychiatric Association Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_2","unstructured":"(2025). Global Burden of Disease Study 2021 Autism Spectrum Collaborators. The Global Epidemiology and Health Burden of the Autism Spectrum: Findings from the Global Burden of Disease Study 2021. Lancet Psychiatry, 12, 111\u2013121."},{"key":"ref_3","unstructured":"GBD 2021 Diseases and Injuries Collaborators (2024). Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet, 403, 2133\u20132161."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2025, December 04). Principles of Epidemiology in Public Health Practice, Available online: https:\/\/www.cdc.gov\/csels\/dsepd\/ss1978\/index.html."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e20193447","DOI":"10.1542\/peds.2019-3447","article-title":"Council on Children with Disabilities; Section on Developmental and Behavioral Pediatrics. Identification, evaluation, and management of children with autism spectrum disorder","volume":"145","author":"Hyman","year":"2020","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1542\/peds.2014-3667D","article-title":"Early screening of autism spectrum disorder: Recommendations for practice and research","volume":"136","author":"Zwaigenbaum","year":"2015","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e20193449","DOI":"10.1542\/peds.2019-3449","article-title":"Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening","volume":"145","author":"Lipkin","year":"2020","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Zhou, Z., Xu, Q., Li, H., Lv, Y., Zhu, G., Dong, P., Li, D., Wang, Y., and Tang, X. (2022). Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.879625"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jpeds.2021.03.009","article-title":"Early and Repeated Screening Detects Autism Spectrum Disorder","volume":"234","author":"Wieckowski","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lindly, O.J., Abate, D.J., Park, H.J., Kuhn, J., Fuchu, P., Feinberg, E., and Broder-Fingert, S. (2024). The influence of policy on early diagnosis and other autism services: A narrative review. Rev. J. Autism Dev. Disord., 1\u201323.","DOI":"10.1007\/s40489-023-00423-0"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1002\/aur.2813","article-title":"A new model for recognition, referral, and follow-up of autism spectrum disorder: A nationwide program","volume":"15","author":"Dursun","year":"2022","journal-title":"Autism Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.ridd.2012.02.018","article-title":"A new screening programme for autism in a general population of Swedish toddlers","volume":"33","author":"Nygren","year":"2012","journal-title":"Res. Dev. Disabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/aur.1236","article-title":"A global public health strategy for autism spectrum disorders","volume":"5","author":"Wallace","year":"2012","journal-title":"Autism Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1177\/1362361314524642","article-title":"A training and development project to improve services and opportunities for social inclusion for children and young people with autism in Romania","volume":"18","author":"Pasco","year":"2014","journal-title":"Autism"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Shahrokhi, H., Ghiasi, A., Gholipour, K., Fanid, L.M., Shamekhi, H.R., and Iezadi, S. (2021). Considerations about the implementation of an autism screening program in Iran: A qualitative study. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03061-0"},{"key":"ref_16","first-page":"3","article-title":"Epidemiology of autistic disorder and other pervasive developmental disorders","volume":"66","author":"Fombonne","year":"2005","journal-title":"J. Clin. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6904a1","article-title":"Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years\u2014Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016","volume":"69","author":"Maenner","year":"2020","journal-title":"MMWR Surveill. Summ."},{"key":"#cr-split#-ref_18.1","unstructured":"(2007). Autism and Developmental Disabilities Monitoring Network Principal Investigators"},{"key":"#cr-split#-ref_18.2","unstructured":"CDC. Prevalence of autism spectrum disorders-Six sites, United States, 2000. MMWR Surveill. Summ., 56, 1-11."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7202a1","article-title":"Prevalence and characteristics of ASD among children aged 8 years\u20142020","volume":"72","author":"Maenner","year":"2023","journal-title":"MMWR Surveill. Summ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7402a1","article-title":"Prevalence and early identification of ASD among children aged 4 and 8 years\u20142022","volume":"74","author":"Shaw","year":"2025","journal-title":"MMWR Surveill. Summ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1017\/S003329171400172X","article-title":"The epidemiology and global burden of autism spectrum disorders","volume":"45","author":"Baxter","year":"2015","journal-title":"Psychol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/jcpp.13551","article-title":"Diagnostic stability in individuals with ASD: Longitudinal follow-up","volume":"63","author":"Elias","year":"2021","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bieleninik, \u0141., Posserud, M.B., Geretsegger, M., Thompson, G., Elefant, C., and Gold, C. (2017). Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the Autism Diagnostic Observation Schedule: A systematic review and meta-analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0183160"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1177\/1362361315614979","article-title":"Stability and change in ASD diagnosis from age 3 to middle childhood in a high-risk sibling cohort","volume":"45","author":"Brian","year":"2016","journal-title":"Autism"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"112679","DOI":"10.1016\/j.psychres.2019.112679","article-title":"Prevalence of autism spectrum disorder in Asia: A systematic review and meta-analysis","volume":"284","author":"Qiu","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3176","DOI":"10.1007\/s10803-018-3581-2","article-title":"Prevalence and characteristics of autism spectrum disorder among Spanish school-age children","volume":"48","author":"Voltas","year":"2018","journal-title":"J. Autism Dev. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1007\/s10803-018-3507-z","article-title":"Prevalence of DSM-5 autism spectrum disorder among school-based children aged 3\u201312 years in Shanghai, China","volume":"48","author":"Jin","year":"2018","journal-title":"J. Autism Dev. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1278","DOI":"10.1542\/peds.2011-3668","article-title":"Trajectories of autism severity using standardized ADOS scores","volume":"130","author":"Gotham","year":"2012","journal-title":"Pediatrics"},{"key":"ref_29","unstructured":"(2025, July 01). Turkey. Wikipedia. Available online: https:\/\/tr.wikipedia.org\/wiki\/T\u00fcrkiye."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1023\/A:1010738829569","article-title":"The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders","volume":"31","author":"Robins","year":"2001","journal-title":"J. Autism Dev. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1542\/peds.2013-1813","article-title":"Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R\/F)","volume":"133","author":"Robins","year":"2014","journal-title":"Pediatrics"},{"key":"ref_32","unstructured":"Y\u0131kge\u00e7, A. (2015). De\u011fi\u015ftirilmi\u015f Erken \u00c7ocukluk D\u00f6nemi Otizm Tarama \u00d6l\u00e7e\u011finin T\u00fcrk \u00d6rneklemi \u00dczerine Ge\u00e7erlik \u00c7al\u0131\u015fmas\u0131, Bo\u011fazi\u00e7i \u00dcniversitesi Sosyal Bilimler Enstit\u00fcs\u00fc. Yay\u0131mlanmam\u0131\u015f Y\u00fcksek Lisans Tezi."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/aur.239","article-title":"Global prevalence of autism and other pervasive developmental disorders","volume":"5","author":"Elsabbagh","year":"2012","journal-title":"Autism Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.24171\/j.phrp.2024.0286","article-title":"The global prevalence of autism spectrum disorder in children: A systematic review and meta-analysis","volume":"16","author":"Issac","year":"2025","journal-title":"Osong Public Health Res. Perspect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e20183963","DOI":"10.1542\/peds.2018-3963","article-title":"Accuracy of autism screening in a large pediatric network","volume":"144","author":"Guthrie","year":"2019","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1001\/jamapediatrics.2019.0624","article-title":"Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months","volume":"173","author":"Pierce","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Benedetto, L., Cucinotta, F., Maggio, R., German\u00f2, E., De Raco, R., Alquino, A., Impallomeni, C., Siracusano, R., Vetri, L., and Roccella, M. (2021). One-Year Follow-Up Diagnostic Stability of Autism Spectrum Disorder Diagnosis in a Clinical Sample of Children and Toddlers. Brain Sci., 11.","DOI":"10.3390\/brainsci11010037"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s41572-019-0138-4","article-title":"Autism spectrum disorder","volume":"6","author":"Lord","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/jcpp.12421","article-title":"Diagnostic stability in young children at risk for autism spectrum disorder: A Baby Siblings Research Consortium study","volume":"56","author":"Ozonoff","year":"2015","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1002\/aur.2470","article-title":"Parent-reported autism diagnostic stability and trajectories in the Longitudinal Study of Australian Children","volume":"14","author":"May","year":"2021","journal-title":"Autism Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jaac.2017.03.013","article-title":"What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis","volume":"56","author":"Loomes","year":"2017","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7201a1","article-title":"Early identification of autism spectrum disorder among children aged 4 years","volume":"72","author":"Shaw","year":"2023","journal-title":"MMWR Surveill. Summ."},{"key":"ref_43","first-page":"92","article-title":"Gender differences in autism spectrum disorder: A systematic review of diagnosis, intervention, and outcomes","volume":"1","author":"Mao","year":"2024","journal-title":"Gend. Sustain. Glob. South"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"514","DOI":"10.24953\/turkjpediatr.2025.5636","article-title":"Recognizing the overlooked: Rethinking autism spectrum disorder symptom presentation in girls","volume":"67","year":"2025","journal-title":"Turk. J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/1362361314568899","article-title":"Sex differences in pre-diagnosis concerns for children later diagnosed with autism spectrum disorder","volume":"20","author":"Hiller","year":"2016","journal-title":"Autism"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e05068","DOI":"10.1016\/j.heliyon.2020.e05068","article-title":"Mode of delivery, order of birth, parental age gap and autism spectrum disorder among Malaysian children: A case-control study","volume":"6","author":"Ramalingam","year":"2020","journal-title":"Heliyon"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/jcpp.13349","article-title":"Investigating associations between birth order and autism diagnostic phenotypes","volume":"62","author":"Alvares","year":"2021","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12939-017-0559-1","article-title":"Influence of maternal background has on children\u2019s mental health","volume":"16","author":"Renart","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_49","first-page":"152","article-title":"Ev merkezli anne-bebek e\u011fitim program\u0131n\u0131n bebe\u011fin ki\u015fisel sosyal ve motor geli\u015fimi \u00fczerindeki etkisi","volume":"5","author":"Avcu","year":"2015","journal-title":"Karab\u00fck \u00dcniv. Sos. Bilim. Enst. Derg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1007\/s13524-014-0334-5","article-title":"When Does Time Matter? Maternal Employment, Children\u2019s Time With Parents, and Child Development","volume":"51","author":"Hsin","year":"2014","journal-title":"Demography"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1007\/s00787-023-02164-1","article-title":"Association between maternal employment and the child\u2019s mental health: A systematic review with meta-analysis","volume":"33","author":"Kopp","year":"2024","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_52","unstructured":"Atat\u00fcrk \u00dcniversitesi Research Hospital (2025, December 04). Research Hospital About Us. Atat\u00fcrk \u00dcniversitesi. Available online: https:\/\/www.atauni.edu.tr\/en\/saglik\/arastirma-hastanesi."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/1\/62\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T16:53:39Z","timestamp":1767200019000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/1\/62"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["brainsci16010062"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16010062","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]}}}