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Validity of Autism Diagnostic Tools in Medically Complex Young Children: The Toddler Autism Symptom Inventory, TAP,

Lauren E Miller1, Danielle M Glad2

  • 1Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA. laurmiller@mcw.edu.

Journal of Autism and Developmental Disorders
|October 10, 2025
PubMed

Insights

Accurate autism screening is crucial for medically complex toddlers. The Toddler Autism Symptom Inventory (TASI), play assessment (TAP), and rating scale (CARS2-ST) show high sensitivity, aiding early diagnosis in at-risk children.

Area of Science:

  • Pediatric Neurodevelopmental Disorders
  • Autism Spectrum Disorder Diagnostics
  • Medical Complexity in Early Childhood

Background:

  • Children born prematurely or with medical/neurological complications face a higher risk of autism.
  • Early screening and accurate diagnosis are vital for timely intervention in these vulnerable populations.
  • Limited autism diagnostic tools are validated for medically complex young children.

Purpose of the Study:

  • To evaluate the validity of the Toddler Autism Symptom Inventory (TASI), play assessment (TAP), and Childhood Autism Rating Scale, Second Edition (CARS2-ST) in medically complex toddlers.
  • To determine the diagnostic accuracy of these tools in identifying autism spectrum disorder (ASD) in a high-risk pediatric group.
  • To support a comprehensive diagnostic approach for autism in young children with complex medical histories.

Main Methods:

  • Eighty-eight children (mean age 25.8 months) underwent an autism-specific caregiver interview (TASI), a semi-structured play assessment (TAP), and a clinician rating scale (CARS2-ST).
  • These assessments were administered as part of a targeted diagnostic consultation for autism.
  • Data were analyzed to determine the sensitivity and specificity of each tool, considering factors like age, sex, and co-occurring conditions.

Main Results:

  • All three tools (TASI, TAP, CARS2-ST) demonstrated high sensitivity (90-100%) for autism detection.
  • Specificity varied, with CARS2-ST showing 100%, TAP 50-100%, and TASI 40-75%.
  • Factors such as age, prematurity, and co-occurring conditions influenced the validity of the TASI and TAP, though symptoms accurately differentiated autistic and non-autistic children.

Conclusions:

  • The TASI, TAP, and CARS2-ST show initial validity for diagnosing autism in medically complex young children.
  • A clinical best estimate approach, integrating TASI history and TAP observations to inform CARS2-ST ratings, is recommended.
  • Varied specificity highlights the importance of using multiple data sources for accurate and timely autism identification in this population.
Abstract

Keywords:
AutismDiagnosisMedicalNICU follow-upPrematureToddlers

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