How useful are screening instruments for toddlers to predict outcome at age 4? General development, language skills, and symptom severity in children with a false positive screen for autism spectrum disorder
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Screening instruments for autism spectrum disorder (ASD) often generate many false positives. It is argued that these children may have other developmental difficulties and are also in need of thorough assessment and early intervention. The current study looked at the predictive validity of positive screens on the Checklist for Early Signs of Developmental Disorders (CESDD) and the Early Screening of Autistic Traits questionnaire (ESAT) at age 2 towards language, cognitive function, and symptom severity at age 4. Children who screened positive on the ESAT scored lower for both language and cognitive functioning at age 4 compared with children who screened negative on the ESAT. Also, the more signs of ASD that were recognized on the CESDD or ESAT, the lower the scores for language and cognitive functioning at age 4. False positive screens could be differentiated from true positive screens on the CESDD only in symptom severity score on the Autism Diagnostic Observation Schedule (ADOS). It seems that early screeners for ASD also detect children with other developmental disorders and that diagnostic instruments such as the ADOS are warranted to differentiate between children with ASD and other developmental problems.
KeywordsAutism spectrum disorder Screening Toddlers Language General development Symptom severity
Partial funding for this research was provided by support from Steunpunt Expertisenetwerken and Vlaamse Vereniging Autisme. We thank the day-care centres, the children and their families for their participation to the study. Special thanks goes to the participating diagnostic centra across Flanders (COS and RCA Gent, COS and RCA Antwerpen, COS and RCA Brussel, COS and ECA Leuven).
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the ethics committee of the Faculty of Psychology and Educational Sciences of Ghent University, where the study was conducted.
- 1.Dietz C, Swinkels S, van Daalen E, van Engeland H, Buitelaar JK (2006) Screening for autistic spectrum disorder in children aged 14 to 15 months. II: Population screening with the Early Screening of Autistic Traits questionnarie (ESAT). Design and general findings. J Autism Dev Disord 36:713–722. doi: 10.1007/s10803-006-0114-4 PubMedCrossRefGoogle Scholar
- 2.Swinkels SHN, Dietz C, van Daalen E, Kerkhof IHGM, van Engeland H, Buitelaar JK (2006) Screening for autistic spectrum in children aged 14 to 15 months. I: The development of the Early Screening of Autistic Traits questionnaire (ESAT). J Autism Dev Disord 36:723–732. doi: 10.1007/s10803-006-0115-0 PubMedCrossRefGoogle Scholar
- 3.Dereu M, Warreyn P, Raymaekers R, Meirsschaut M, Pattyn G, Schietecatte I, Roeyers H (2010) Screening for autism spectrum disorders in Flemish day-care centres with the Checklist for Early Signs of Developmental Disorders. J Autism Dev Disord 40:1247–1258. doi: 10.1007/s10803-010-0984-0 PubMedCrossRefGoogle Scholar
- 6.Matson JL, Wilkins J, Sharp B, Knight C, Sevin JA, Boisjoli JA (2009) Sensitivity and specificity of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): validity and cutoff scores for autism and PDD-NOS in toddlers. Res Autism Spectr Disord 3:924–930. doi: 10.1016/j.rasd.2009.04.001 CrossRefGoogle Scholar
- 9.Allison C, Baron-Cohen S, Wheelwright S, Charman T, Richler J, Pasco G, Brayne C (2008) The Q-CHAT (Quantitative Checklist for Autism in Toddlers): a normally distributed quantitative measure of autistic traits at 18–24 months of age: preliminary report. J Autism Dev Disord 38:1414–1425. doi: 10.1007/s10803-007-0509-7 PubMedCrossRefGoogle Scholar
- 12.Jacobson JW, Mulick JA, Green G (1998) Cost-benefit estimates for early intensive behavioral intervention for young children with autism-general model and single state case. Behav Interv 13:201–226. doi: 10.1002/(SICI)1099-078X(199811)13:4<201::AID-BIN17>3.0.CO;2-R CrossRefGoogle Scholar
- 13.National Research Council (2001) Educating children with autism. National Academy Press, Washington DCGoogle Scholar
- 15.Kleinman JM, Robins DL, Ventola PE, Pandey J, Boorstein HC, Esser EL et al (2008) The Modified Checklist for Autism in Toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord 38:827–839. doi: 10.1007/s10803-007-0450-9 PubMedCrossRefGoogle Scholar
- 17.American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn, text rev). American Psychiatric Association, Washington DCGoogle Scholar
- 18.ZERO TO THREE: National Center for Infants, Toddlers and Families (1994) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. ZERO TO THREE, Washington DCGoogle Scholar
- 23.Dereu M, Raymaekers R, Warreyn P, Schietecatte I, Meirsschaut M, Roeyers H (2012) Can child care workers contribute to the early detection of autism spectrum disorders? A comparison between screening instruments with child care workers versus parents as informants. J Autism Dev Disord 42:781–796. doi: 10.1007/s10803-011-1307-9 Google Scholar
- 24.Lord C, Rutter M, DiLavore P, Risi S (1999) Autism Diagnosic Observation Schedule: manual. Western Psychological Services, Los AngelesGoogle Scholar
- 25.Rutter M, LeCouteur A, Lord C (2003) Autism Diagnostic Interview Revised: manual. Western Pscyhological Services, Los AngelesGoogle Scholar
- 28.Mullen EM (1995) Mullen Scales of Early Learning. American Guidance Service, Circle PinesGoogle Scholar
- 36.Schaerlaekens A, Zink I, van Ommeslaeghe K (2003) Reynell Taalontwikkelingsschalen. Handleiding-Tweede versie. Swets & Zeitlinger, LisseGoogle Scholar
- 37.Rutter M, Bailey A, Lord C (2003) Social Communication Questionnaire (SCQ). Western Psychological Services, Los AngelesGoogle Scholar