Abstract
Targeted screening of children at increased likelihood of autism is recommended. However, autism screening tools are usually validated for use mainly in low-likelihood populations. This study compared the accuracy of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), the ASDetect app, and the Social Attention and Communication Surveillance, Revised (SACS-R). Siblings of autistic children underwent autism screening at 12, 18 and 30 months old. At each visit, caregivers completed the M-CHAT-R/F and ASDetect while trained nurses tested the siblings using the SACS-R. At 36 to 48 months, the siblings underwent an Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) assessment. 189 siblings were screened, 141 completed the study, and 32 were confirmed to have autism. Although not validated for use at 12 months, the M-CHAT-R/F had the best sensitivity among the three tools for this age group, suggesting that early signs are already apparent to caregivers. The M-CHAT-R/F had overall better sensitivity (0.72–0.83) across all age groups, but with overall lower specificity (0.55–0.77). The SACS-R and ASDetect had better positive predictive values at 18 and 30 months (0.60–0.68), while the M-CHAT-R/F was 0.43–0.48. Negative predictive values were generally high across all three tools across all age groups (0.78–0.93). Targeted screening of children at high likelihood of autism yielded a detection rate of 22.7% and should therefore be implemented routinely to facilitate early detection and intervention. The performance of autism screening tools should be examined in higher-likelihood populations for targeted screening of these children.
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Acknowledgments
The study team would like to sincerely thank all the children and caregivers who participated in this study, the nurses who conducted the screening programme, and the funding agencies (Temasek Foundation Cares and the SingHealth Duke-NUS Paediatrics Academic Clinical Programme) who made the study possible. The study team would also like to thank Assistant Professor Lee Chun Fan of the Duke-NUS Medical School Centre for Quantitative Medicine for his invaluable advice on statistical analysis of the results.
Funding
This study was funded by Temasek Foundation Cares [no grant number]; and the SingHealth Duke-NUS Paediatrics Academic Clinical Programme (ACP) Clinical Innovation Support Programme Grant [02/FY2017/P2/02-A46].
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CMW is the Principal Investigator and conceived, designed, obtained funding and IRB approval, and conducted data analysis. NMZ, HHF and LHSL were involved in data acquisition and/or data analysis. LMD was involved in designing the study and obtaining funding. HCK was involved in designing the study, data acquisition, and data analysis. The first draft of the manuscript was written by CMW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This study was approved by SingHealth’s Centralised Institutional Review Board (CIRB) (SingHealth CIRB Ref. No. 2017/2890). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Written informed consent was obtained prior to participation.
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This study was approved by SingHealth’s Centralised Institutional Review Board (CIRB) (SingHealth CIRB Ref. No. 2017/2890). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Written informed consent was obtained prior to participation.
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Wong, C.M., Mohd Zambri, N., Fan, H.H. et al. A Direct Comparison of Three Screening Methods for Autism Spectrum Disorder in a High-Likelihood Sibling Population. J Autism Dev Disord (2024). https://doi.org/10.1007/s10803-024-06294-6
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DOI: https://doi.org/10.1007/s10803-024-06294-6