Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits

Zhang, Ying; Zhou, Zhaoe; Xu, Qiong; Li, Huiping; Lv, Yujing; Zhu, Guowei; Dong, Ping; Li, Dongyun; Wang, Yi; Tang, Xinrui; Xu, Xiu

doi:10.3389/fpsyt.2022.879625

Cited by 6 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Design choices were generally justified by the complexity of the diagnostic evaluation for ASD, making it time and resource intensive. Consequently, children who were deemed screen-negative either did not have a diagnostic evaluation, 36 , 40 , 42 , 44 , 49 - 51 only had an evaluation if they were screen-positive on another tool(s) and/or a health professional raised a concern for possible ASD diagnosis, 28 , 33 , 38 , 41 , 46 - 48 , 52 - 54 had their medical records checked for a diagnosis of ASD at a later date (after 10 months, 39 after 24 months, 31 , 32 or at an unknown time-point 55 ). In 4 studies, a sample of children who were deemed to be screen-negative received a diagnostic evaluation, 37 , 43 , 45 , 56 while Suren et al 57 took a number of different approaches.…”

Section: Resultsmentioning

confidence: 99%

“…The sensitivity estimates for other tools spanned the range of possible estimates from 0.07 (0.03, 0.14) for PEDS 40 to 1.0 (0.72, 1.0) for Q-CHAT. 28 Where only PPVs could be estimated with confidence (ie, ASD diagnoses in screen negative children was not undertaken or assumed), these ranged from <0.10 (for the ASQ 44 and M-CHAT-R 38 ) to ≥0.80 for TIDOS, 43 M-CHAT/F, and/or JA-OBS 47 (see Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence

Grigore,

Peters,

Williams

et al. 2024

J Prim Care Community Health

View full text Add to dashboard Cite

Background: Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. Methods: We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. Results: A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. Conclusions: Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence

Grigore,

Peters,

Williams

et al. 2024

J Prim Care Community Health

View full text Add to dashboard Cite

show abstract

“…Studies have shown that implementing active screening programs can greatly aid in the early diagnosis of autistic children (17,19,54). Therefore, it is recommended that children undergo regular well-child care during the preschool period.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is considerable variation in the age at which ASD is diagnosed across different countries. Although experienced clinicians are capable of diagnosing ASD in children before they reach the age of 2, the average age of diagnosis (AOD) reported internationally is between 4 and 5 years, indicating a signi cant delay in diagnosis (17)(18)(19)(20)(21)(22)(23)(24)(25). Despite these efforts, con icts and obstacles still exist in this eld (26,27).…”

Section: Introductionmentioning

confidence: 99%

Delay of diagnosis in autism spectrum disorder and its influencing factors

Zhu,

Ji,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Although experienced clinicians are capable of diagnosing autism spectrum disorders (ASD) in children before they reach the age of 2, the average age of diagnosis reported internationally is between 4 and 5 years, indicating a significant delay in diagnosis. The objective of this study was to determine the factors influencing the diagnosis delay time (DDT) in children with ASD and to shorten the diagnosis period. Methods We employed the Cox proportional hazard model to examine the effects of individual, family, sociodemographic, and healthcare system indicators on DDT in a retrospective survey involving ASD children and their families. Results This study included a total of 560 subjects. The findings revealed that the median DDT in children with ASD was 8.16 (15.99) months, and the mean DDT was 13.68 (17.11) months. Language development level of children (RR = 0.521, 95%CI 0.400 ~ 0.680, P < 0.001), enrollment in school (RR = 1.950, 95%CI 1.552 ~ 2.450, P = < 0.001), experience of previous misdiagnosis (RR = 1.637, 95%CI 1.249 ~ 2.146, P < 0.001), degree of caregiver's concern about initial symptoms (RR = 0.781, 95%CI 0.635 ~ 0.960, P = 0.019), and whether the initial symptom is a core defect of ASD (RR = 1.758, 95%CI 1.210 ~ 2.553, P = 0.003) were identified as independent risk factors for delayed diagnosis of ASD in children under the age of six. Conclusions In China, there is a significant delay in the diagnosis of ASD among children. Children at risk of delayed ASD diagnosis include those with normal language abilities and early-onset non-autistic core difficulties, whose parents neglect their children’s atypical symptoms, those who have already started school, and those with a history of misdiagnosis. We urge parents, educators, and healthcare providers to closely monitor atypical child development during early childhood, enhance growth monitoring for preschool and school-aged children, and be attentive to children with normal language skills.

show abstract

Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

et al. 2023

View full text Add to dashboard Cite

ImportanceThe Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F)—henceforth referred to as M-CHAT(-R/F)—are the most commonly used toddler screeners for autism spectrum disorder (ASD). Their use often differs from that in the original validation studies, resulting in a range of estimates of sensitivity and specificity. Also, given the variability in reports of the clinical utility of the M-CHAT(-R/F), researchers and practitioners lack guidance to inform autism screening protocols.ObjectiveTo synthesize variability in sensitivity and specificity of M-CHAT(-R/F) across multiple factors, including procedures for identifying missed cases, likelihood level, screening age, and single compared with repeated screenings.Data SourcesA literature search was conducted with PubMed, Web of Science, and Scopus to identify studies published between January 1, 2001, and August 31, 2022.Study SelectionArticles were included if the studies used the M-CHAT(-R/F) (ie, original or revised version) to identify new ASD cases, were published in English-language peer-reviewed journals, included at least 10 ASD cases, reported procedures for false-negative case identification, screened children by 48 months, and included information (or had information provided by authors when contacted) needed to conduct the meta-analysis.Data Extraction and SynthesisThe systematic review and meta-analysis was conducted within the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality Assessment of Diagnostic Accuracy Studies–2 tool evaluated bias in sample selection. Data extraction and quality assessment were performed by 2 authors independently. The overall diagnostic accuracy of the M-CHAT(-R/F) was assessed with the hierarchic summary receiver operating characteristic (HSROC) model.Main Outcomes and MeasuresSensitivity, specificity, diagnostic odds ratios, and HSROC curves of M-CHAT(-R/F).ResultsThe review included 50 studies with 51 samples. The pooled sensitivity of M-CHAT(-R/F) was 0.83 (95% CI, 0.77-0.88), and the pooled specificity was 0.94 (95% CI, 0.89-0.97). Heterogeneity analyses revealed greater diagnostic accuracy for low- vs high-likelihood samples, a concurrent vs prospective case confirmation strategy, a large vs small sample size, use of M-CHAT(-R/F) Follow-up, and non-English vs English only.Conclusions and RelevanceOverall, results of this study suggest the utility of the M-CHAT(-R/F) as an ASD screener. The wide variability in psychometric properties of M-CHAT(-R/F) highlights differences in screener use that should be considered in research and practice.

show abstract

Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits

Cited by 6 publications

References 31 publications

Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence

Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence

Delay of diagnosis in autism spectrum disorder and its influencing factors

Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

Contact Info

Product

Resources

About