Early and Repeated Screening Detects Autism Spectrum Disorder. J Pediatr 2021 Jul;234:227-235
Date
03/13/2021Pubmed ID
33711288Pubmed Central ID
PMC8238814DOI
10.1016/j.jpeds.2021.03.009Scopus ID
2-s2.0-85103217285 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
OBJECTIVE: To evaluate timing and accuracy of early and repeated screening for autism spectrum disorder (ASD) during well-child visits.
STUDY DESIGN: Using a longitudinal study design, toddlers (n = 5784) were initially screened at 12 (n = 1504), 15 (n = 1228), or 18 (n = 3052) months during well-child visits, and rescreened at 18, 24, and 36 months. Of those screened, 368 toddlers attended an ASD evaluation after a positive screen and/or a provider concern for ASD at any visit.
RESULTS: Screens initiated at 12 months yielded an ASD diagnosis significantly earlier than at 15 months (P = .003, d = 0.99) and 18 months (P < .001, d = 0.97). Cross-group overall sensitivity of the initial screen was .715 and specificity was .959. Repeat screening improves sensitivity (82.1%), without notably decreasing specificity (all >93.5%). Screening at 18 months resulted in significantly higher positive predictive value than at 12 months (X2 (1, n = 221) = 9.87, P = .002, OR = 2.60) and 15 months (X2 (1, n = 208) = 14.57, P < .001, OR = 3.67). With repeat screening, positive predictive value increased for all screen groups, but the increase was not significant.
CONCLUSIONS: Screening as early as 12 months effectively identifies many children at risk for ASD. Children screened at 12 months receive a diagnosis of ASD significantly earlier than peers who are first screened at later ages, facilitating earlier intervention. However, as the sensitivity is lower for a single screen, screening needs to be repeated.
Author List
Wieckowski AT, Hamner T, Nanovic S, Porto KS, Coulter KL, Eldeeb SY, Chen CA, Fein DA, Barton ML, Adamson LB, Robins DLAuthor
Katelynn S. Porto MA Instructor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Age FactorsAutism Spectrum Disorder
Child, Preschool
Early Diagnosis
Female
Humans
Infant
Longitudinal Studies
Male
Mass Screening
Neuropsychological Tests
Psychometrics
Sensitivity and Specificity