Standard Screening Fails to Detect Autism in Many Children

The accuracy of standard screening for children with autism spectrum disorder (ASD) is lacking, particularly among minority children from lower-income households, according to a study published in the journal Pediatrics.

“Universal screening is recommended to reduce the age of diagnosis for ASD,” the research authors wrote. “However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years.”

In this study, researchers conducted primary care-based screenings on 25,999 children at a Children’s Hospital of Philadelphia (CHOP) site using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F), following the initiation of universal electronic health record (EHR) screening. The patients of interest were between 16 and 26 months and underwent a well-child visit between January 2011, and July 2015.

According to the results of the study, universal screening was achieved in 91% of patients using EHR screening, and ASD prevalence was 2.2%. Overall, the M-CHAT/F’s sensitivity was less than 40% (38.8%), and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Overall, the M-CHAT/F’s specificity and PPV were lower in minority children from poor households.

Results Highlight Disparities

“Universal screening in primary care is possible when supported by electronic administration,” the authors further wrote. “In this “real-world” cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.”

“The importance of early intervention for toddlers with ASD is undeniable. Universal screening helps us make decisions about which children are at risk,” said Wendy Stone, PhD, director of the University of Washington’s Research in Early Autism Detection and Intervention Lab, who wasn’t involved in the study in a Healthline article about the study.

Diana Robins, PhD, interim director and professor at the A.J. Drexel Autism Institute in Philadelphia, who wasn’t involved in the study spoke on the disparity in screening by saying: “Even when you try to make it equal, there are still disparities in how families are treated by healthcare providers.”

Robins emphasized in the article that ongoing monitoring should be done along with standardized screenings — with parents playing an important role.

“Parents should be proactive and recognize that they are the expert on their child. When they see something that’s concerning, they should bring it to the attention of a professional,” Robins added.

Moreover, if a child’s physician doesn’t listen and a parent is still concerned, Robins urged that the parent “should go ahead and seek a specialist who can help determine if the child really does have a diagnosis or need some early intervention.”