Screening strategies for autism spectrum disorders in pediatric primary care.
BACKGROUND
Two strategies have been proposed for early identification of children with autism spectrum disorders (ASD): (1) using a general screening tool followed by an ASD-specific screening tool for those who screen positive on the former or (2) using an ASD-specific tool for all children. The relative yield of these two strategies has not been examined.


OBJECTIVE
This study compared the number of children identified at risk for ASD at their well child visits between the ages of 18 and 30 months using a general developmental screening tool and an autism-specific screening tool.


METHODS
The Parents' Evaluation of Developmental Status (PEDS) was used as the general developmental screening tool and the Modified Checklist for Autism in Toddlers (M-CHAT) was used as the autism-specific tool. These tools were administered concurrently to 152 children.


RESULTS
Cross tabulations and chi tests were used to determine the utility of the PEDS as the first step of a two-part screen for ASD. Of those who screened positive for developmental concerns on the PEDS (n = 38), 16% screened positive for ASD on the M-CHAT; of those who did not screen positive for developmental concerns on the PEDS (n = 114), 14% screened positive for ASD on the M-CHAT (p = .79).


CONCLUSIONS
The PEDS missed the majority of children who screened positive for ASD on the M-CHAT, suggesting that these two tools tap into very different domains of developmental concerns. The findings support the use of an ASD-specific tool for all children in conjunction with regular standardized developmental screening.
Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA. pinto@nursing.upenn.edu
Jennifer A
JA
Pinto-Martin
Lisa M
LM
Young
David S
DS
Mandell
Lusine
L
Poghosyan
Ellen
E
Giarelli
Susan E
SE
Levy
D000293:Adolescent; D000328:Adult; D001321:Autistic Disorder / Q000175:diagnosis* / Q000523:psychology; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010290:Parents / Q000523:psychology; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult