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    Twenty-six toddlers (21 %) continued to screen positive; 19 received full evaluations, which assessed for ASD with the Autism Diagnostic Observation Schedule and developmental delays with the Parents Assessment of Developmental Status-Developmental Milestones.

    All evaluated children had significant delays; 17 of the 19 met criteria for Autism/ASD. Although Albania and the US are quite different in culture and language, key features of ASD appeared very similar.

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    There are several possible explanations for this: milder cases of ASD (PDD-NOS and Asperger's in DSM-IV), or ASD without intellectual or language impairment or requiring only some support (in DSM-V) might not be detectable at 18 months, because these children might meet early social and language milestones on time.

    The Modified Checklist for Autism in Toddlers Revised-Albanian screener (M-CHAT-R-A) was used to screen 2594 toddlers, aged 16-30 months, at well-child visits.

    Two hundred fifty-three (9.75 %) screened positive; follow up on failed items were conducted by phone with 127 (50 %); the remainder were lost to follow-up.

    The ASD global burden of disease is estimated to account for 4.2% (3.2-5.3%) of all disability-adjusted life years (DALY), a measure of overall disease burden (Whiteford et al., 2013). estimates suggest that 1 out of 68 children carry an ASD diagnosis (Center for Disease Control, 2014).

    While prevalence rates are well-established in North America and Europe, studies investigating the prevalence of ASD in LMICs are fewer and vary dramatically in approach (Elsabbagh, Divan, Koh, Kim, Kauchali, Marcín et al., 2012; Patel et al., 2008; Wallace, Fein, Rosanoff, Dawson, Hossain, Brennan et al., 2012). Recent global ASD prevalence estimates indicate 62 out of 10,000 children meet criteria for ASD; however, large regions such as South East Asia, Africa, and eastern areas of the Mediterranean were not represented in this estimate (Elsabbagh et al., 2012).

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