Primary Care Autism Screening with the Parent's Observations of Social Interactions

Area of Science:

• Developmental Pediatrics
• Autism Spectrum Disorder Research
• Screening Tool Validation

Background:

• Early identification of autism spectrum disorder (ASD) is crucial for timely intervention.
• Parental reporting of social interaction behaviors can provide valuable insights into developmental trajectories.
• The Parent's Observations of Social Interactions (POSI) is a screening tool designed to assess social interaction skills in young children.

Purpose of the Study:

• To evaluate the results of the Parent's Observations of Social Interactions (POSI) screening tool.
• To determine the association between POSI results and referrals for developmental evaluations.
• To investigate the relationship between POSI outcomes and the subsequent diagnosis of autism.

Main Methods:

• Analysis of electronic health records from 6669 children screened with POSI at 18- and 24-month well-child visits.
• Utilized descriptive statistics and regression models to analyze screening results, referrals, and autism diagnoses.
• Data collected between July 2018 and July 2022.

Main Results:

• POSI identified 25.2% of 18-month-olds and 17.4% of 24-month-olds as positive screeners.
• Among children with positive POSI screens, 21% were referred for developmental evaluation.
• Autism was diagnosed in 2.8% of all children; a positive POSI significantly increased the likelihood (aOR 5.21 at 18 months, 10.21 at 24 months) and led to earlier diagnosis (13 months sooner).

Conclusions:

• The POSI demonstrates high sensitivity for autism screening but a low positive predictive value, highlighting the need for careful interpretation.
• A positive POSI result is strongly associated with an increased likelihood and earlier diagnosis of autism spectrum disorder.
• The findings support the utility of POSI in identifying children who may benefit from further developmental assessment for autism.