Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

Abstract

Objective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts. Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments. Results: Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%. Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.

Two-stage window screening and development trajectories in early identification of autism spectrum disorder among Han Chinese children

“…In the traditional method of positive or negative two-stage screening, all those scoring higher than the cutoff point need testing at the second stage. Fewer people need to be assessed in the second stage using the two-stage window screening, which decreases the cost of testing [ 7 ] and the number of false positives [ 8 ]. Although both TBCS-DI and PCC are parental reports of their children’s development, however, while the PCC deals with parental concerns, the TBCS-DI is focused on children’s developmental milestones.…”

“…Community screening instruments are not only helpful to the public in heightening understanding of their children’s developmental condition, they may also aid doctors in their decision-making process. Furthermore, for clinicians to interpret positive predictive values (PPV) and negative predictive values (NPV) appropriately, they have to know the estimated prevalence of the condition in their particular population [ 7 ]. Hence, to understand the idea of a spectrum in the ASD diagnosis in the DSM-5 , we need to understand not only the etiology of ASD, but also the trajectory and norm of children’s development.…”

“…A two-stage screening process involves the use of a more inexpensive, less invasive test at the first stage (e.g., Modified Checklist of Autism in Toddlers [M-CHAT]), and a more expensive or more invasive, but more sensitive and specific test at the second stage [e.g., Autism Diagnostic Inventory-Revised (ADI-R)] [ 6 ]. Chien, Huang and Lung proposed the two-stage window screening method, which is more efficient than other methods [ 7 ]. This screening method can be used in settings where the screening sample is large, such as in community or primary care settings [ 7 ].…”

“…Chien, Huang and Lung proposed the two-stage window screening method, which is more efficient than other methods [ 7 ]. This screening method can be used in settings where the screening sample is large, such as in community or primary care settings [ 7 ]. Two cutoff points are needed in the first stage of the two-stage window screening, yielding three groups.…”

“…Participants in the middle group, between the two cutoff points, have the highest probability of being misclassified and need to be screened further using a more specific screening instrument. Fewer people therefore need to be screened in the second stage using this method, which reduces the cost of the testing [ 6 , 7 ]. Lung and colleagues found that the Parental Concern Checklist (PCC) and Taiwan Birth Cohort Study Developmental Instrument (TBCS-DI) are efficient first-stage broadband screening instruments for ASD in community-based settings [ 8 , 9 ].…”