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Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder
Published on: April 22, 2015
Can a broadband developmental-behavioral screening test identify children likely to have autism spectrum disorder?
Frances Page Glascoe1, Michelle M Macias, Lynn M Wegner
1Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA. Frances.P.Glascoe@Vanderbilt.edu
Insights
This study shows that analyzing parent concerns on the Parents' Evaluation of Developmental Status (PEDS) can significantly reduce unnecessary autism spectrum disorder (ASD) evaluations for young children. This improves efficiency in accessing specialized services.
Area of Science:
- Developmental Pediatrics
- Child Psychology
- Screening and Diagnostics
Background:
- Autism spectrum disorder (ASD) services are limited, necessitating accurate screening to identify children needing further evaluation.
- Broadband developmental screening tools, like the Parents' Evaluation of Developmental Status (PEDS), are often used, but their ability to differentiate ASD requires examination.
- Overreferral to specialized ASD services can strain resources and cause parental anxiety.
Purpose of the Study:
- To evaluate the effectiveness of the Parents' Evaluation of Developmental Status (PEDS) in identifying children with probable autism spectrum disorder (ASD).
- To determine if analyzing patterns of parental concerns on PEDS can reduce overreferrals identified by the Modified Checklist of Autism in Toddlers (M-CHAT).
- To assess the impact of using PEDS concern patterns on the sensitivity and specificity of ASD screening.
Main Methods:
- A cohort of 427 children aged 18-59 months with elevated risk scores on PEDS was studied.
- Parents completed both PEDS and the autism-specific Modified Checklist of Autism in Toddlers (M-CHAT).
- Parental concerns documented on PEDS were analyzed to predict M-CHAT outcomes, focusing on the number and type of concerns.
Main Results:
- Of 427 children screened positive on PEDS, 34% (N=144) passed the M-CHAT, indicating potential overreferral.
- Identifying three or more distinct types of parental concerns on PEDS predicted M-CHAT failure, while fewer concerns predicted passing.
- Analyzing PEDS concern patterns reduced overreferrals by 70% while maintaining 81% sensitivity for detecting probable ASD.
Conclusions:
- Performance patterns on broadband screening tools like PEDS can significantly decrease overreferrals to autism specialty services.
- While adhering to screening recommendations is crucial, nuanced analysis of broadband screen data enhances diagnostic accuracy.
- This approach optimizes the allocation of scarce resources for children with autism spectrum disorder.
Abstract:
Because services for children with autism spectrum disorder (ASD) are scarce, when children fail a broadband screening measure, providers need to carefully discern which children need ASD evaluations and which do not. This research considers how well a broadband screening test sorts those with and without probable ASD. The subjects were 427 children between 18 and 59 months of age with elevated risk scores on broadband screening, ie, Parents' Evaluation of Developmental Status (PEDS), a 10-item measure eliciting parents' concerns. Parents also completed the Modified Checklist of Autism in Toddlers (M-CHAT), an autism specific screen. The results showed that of the 427 children at risk on PEDS, 34% (N = 144) passed the M-CHAT. To determine whether these potential overreferrals could be reduced, parents' concerns on PEDS were used to predict M-CHAT results. Three or more discrete types of concerns, varying by age, characterized children who failed the M-CHAT while fewer than 3 were associated with passing. This reduced overreferrals by 70% while maintaining high levels of sensitivity (81%). Although compliance with the American Academy of Pediatrics recommendations for both broadband and autism-specific screening at 18 and 24 months is still recommended, viewing performance patterns on a broadband screening test can substantially reduce overreferrals to autism specialty services.
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