Comparison of Available Tools to Screen for Autism at 12 and 15 Months
Katelynn S Porto1, Andrea Trubanova Wieckowski2, Deborah A Fein3
1Center for Neuropsychology, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
This study evaluated autism screeners at 12 and 15 months, finding moderate sensitivity but low positive predictive values for tools like the Infant/Toddler Checklist (ITC) and Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Repeat screening is crucial for early autism detection.
Area of Science:
- Developmental Pediatrics
- Autism Spectrum Disorder Diagnosis
- Early Childhood Screening
Background:
- Early detection of autism spectrum disorder (ASD) is critical for timely intervention.
- Current screening practices vary, necessitating evaluation of tool performance at different developmental stages.
Purpose of the Study:
- To assess the diagnostic performance of autism screening tools at 12 and 15 months of age.
- To identify effective screeners for early identification of ASD in primary care settings.
Main Methods:
- A cohort of children (n=1473 at 12 months, n=1227 at 15 months) underwent screening using validated tools.
- Screeners included the Infant/Toddler Checklist (ITC), First Year Inventory-Lite (FYI-L), and Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F).
- Children with positive screens or clinical concerns received diagnostic evaluations.
Main Results:
- All screeners demonstrated high specificity (>0.94) for autism.
- Sensitivity was low for ITC (0.26) and moderate for FYI-L (0.67) at 12 months.
- At 15 months, FYI-L and M-CHAT-R/F showed moderate sensitivity (0.60-0.61) but low positive predictive values (PPV) (0.16-0.31).
Conclusions:
- While screeners show high specificity, their moderate sensitivity and low PPV at 12 and 15 months suggest limitations for universal screening.
- These tools can aid in identifying potential cases, but do not identify all children with autism.
- Repeated screening at 18 months and beyond is recommended for comprehensive early autism detection.
Objective:
To determine the performance of autism screeners at 12 and 15 months of age.
Methods:
Children were screened either at 12- (n = 1473) or 15-month (n = 1227) primary care visits. Children were screened with both the Infant/Toddler Checklist (ITC) and the First Year Inventory-Lite (FYI-L) at 12 months and FYI-L and the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) at 15 months. After a positive screen and/or clinical concern, families were offered a no-cost diagnostic evaluation.
Results:
Of the 1473 toddlers screened at 12 months, 223 screened positive and 107 attended a diagnostic evaluation. Of the 1227 children screened at 15 months, 252 screened positive and 94 attended the evaluation. Overall, specificity for autism was high (>0.94) for all screeners at 12 and 15 months. At 12-month screening, sensitivity for autism was low on the ITC (0.26) and moderate on the FYI-L (0.67). Positive predictive value (PPV) was low for both screeners (0.24 for ITC and FYI-L). At 15 months, both the FYI-L and the M-CHAT-R/F demonstrated moderate sensitivity (0.61 for FYI-L and 0.60 for the M-CHAT-R/F) and low PPV (0.16 for FYI-L and 0.31 for M-CHAT-R/F).
Conclusion:
Although data do not support universal screening at younger ages, the study identifies tools that can be used at 12 and 15 months. Importantly, screening at these ages does not identify all cases of autism, and repeat screening at 18 months and beyond is essential to support autism detection as early as possible.
