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Which to Choose?

Feasibility Characteristic of Autism Screening Tools


Brittany Blumenthal, MPH, Patricia Towle, Ph.D., and Patricia Patrick, Ph.D.
Westchester Institute for Human Development LEND Program and University Center for Excellence in Developmental Disabilities
New York Medical College School of Health Science and Practice
RESULTS

BACKGROUND

The table outlines the five early screening tools for ASD selected through our literature search, categorized in terms of type, age, and feasibility constructs.

Early intervention for autism spectrum disorder (ASD), which


affects 1 in 68 children in the US, is important for positive behavioral
and health outcomes for children.

Developmental
Screening Tools

Screening tools are available to detect delays in development


caused by ASD, but they need to be considered in terms of predictive
validity, as measured by ROC statistics (e.g., sensitivity and specificity),
age of child at administration, and administration method.

Comm and Symbolic Beh


Scales - Developmental
Profile: Infant Toddler
Checklist (ITC)

Feasibility is a critical feature of screening tools to consider


because no matter how reliable and valid a screener is, it will only be
useful if it can be easily and effectively applied in a community setting.
Feasibility parameters have been established in response to physicianreported barriers around screening compliance, including: time,
administration method, cost, accessibility, and training time required
.Goal of Study
To describe current screening tool options for the early detection of ASD in terms
of their feasibility for community use.
ONLY TOOLS WITH PUBLISHED AND ACCEPTABLE LEVELS OF
SENSITIVITY AND SPECIFICITY AND THOSE DEVELOPED OR EVALUATED
IN NORTH AMERICA ARE PRESENTED

METHOD
Identification of screening tools for inclusion
Conducted literature review to determine available screening tools
Interpreted efficacy through reported statistical analyses of sensitivity,
specificity, and PPV; considered the number of research studies
conducted and quaity of methods
Categorization of screening tools
Use literature and access to screening tool manuals to provide a brief
description of tools and categorize by childs age at administration
Distinguish screening tools as developmental versus autism-specific
Feasibility studies & findings
Conduct literature review of existing feasibility studies
Establish feasibility parameters, based on physician-reported barriers, to
further categorize screening tools by as seen in the results table.

Age
(mos)
6-24

Level*

1 or 2

16-48
Modified Checklist for
AuTism - Revised/ Followup Interview
(M-CHAT-R/F)

3-36

Parent Observation
of Early Markers Scale
(POEMS)

16-36

Screening Test for Autism 12-36


in Two-year-olds
(STAT)

12 - 36

Parent Observation
of Interaction (POSI)

Autism Detection in Early


Childhood
(ADEC)

Brief Description

Administration
Method
Parent-completed
questionnaire

Time to Training Required


Complete
Type (cost)
5-10 mins
No

24 questions about childs social-communication,


language, and play behaviors. Responses are
scored by provider.
*ITC is valid as a broad-band screener for all
disabilities and not autism per se.
Two-Stage Screener
Parent-completed
5-10 mins*
20 questions to assess childs risk level for ASD. questionnaire; If child is *5-20 min
Responses are assessed & scored by provider. at-risk, provider followfollow-up
Level of risk determines need for follow-up
up interview
interview for
interview by provider.
at-risk child
61 items to cover problem areas including core
Parent-completed
20 min
deficits of ASD based on parents observations.
questionnaire
Responses assessed and scored by provider.
7 item parent-rated checklist modeled from the
Parent-completed
critical items from the M-CHAT, as well as DSM-5.
questionnaire
Items scored in comparison to typical behavior.
Responses are assessed & scored by provider.
12 item interactive assessment between child and
Semi-structured
provider to identify childs risk for autism
observation by provider
*STAT is validated as a screener for [DSM-IV]
Autistic Disorder and not milder forms
16 item interactive assessment between child and
Semi-structured
provider to identify childs risk for autism and ASD observation by provider
*Earlier papers validate ADEC as a screener for
Autistic Disorder but more recent, ASD

How to Access &


Cost (kit)
Online download
Free (Questionnaire,
scoring guide)

No

Online download
Free (Questionnaire,
scoring guide)

No

Available upon
Request from Author
(Scoring described in paper)

5 mins

No

20 mins

Yes; Interactive
online training
(included in kit)

15 mins

Training comes
with kit on DVD

Online download
Free
(Questionnaire,
scoring guide)
Order online
Training conducted
online
~$500
Order online from
Autstralia
~$500

*Level 1 denotes a screener intended for a general population of children and intends to detect children at risk for any disability, although some Level 1 screeners
are autism-specific. Level 2 denotes a screener intended to detect ASD in referred or high risk children. Its intent is to distinguish ASD from other types of early childhood disabilities.

CONCLUSIONS

No one tool is best.


Each of the screening tools has pros and cons, which can be
seen in the table. Each tool measures slightly different
developmental milestones and behaviors. The research for each
has its strength and weaknesses.

Feasibility constructs must be balanced.


Feasibility is important for both providers and caregivers, as both parties participation is required and
valued. For example, the M-CHAT-R/F is free, but may require a longer time commitment by the provider
and family for a follow-up phone call.. The STAT requires training, time, and money to acquire, but then
the provider is much better trained to assess autism risk from a clinical knowledge viewpoint.