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

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.

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.

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.

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 physician-reported 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

BACKGROUND

METHOD

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.

Developmental Screening Tools

Age (mos)

Level* Brief Description Administration Method

Time to Complete

Training Required Type (cost)

How to Access & Cost (kit)

Comm and Symbolic Beh Scales - Developmental Profile: Infant Toddler

Checklist (ITC)

6-24 1 or 2 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.

Parent-completed questionnaire

5-10 mins No Online download Free (Questionnaire,

scoring guide)

Modified Checklist for AuTism - Revised/ Follow-

up Interview (M-CHAT-R/F)

16-48 1 Two-Stage Screener 20 questions to assess childs risk level for ASD. Responses are assessed & scored by provider.

Level of risk determines need for follow-up interview by provider.

Parent-completed questionnaire; If child is at-risk, provider follow-

up interview

5-10 mins* *5-20 min follow-up

interview for at-risk child

No Online download Free (Questionnaire,

scoring guide)

Parent Observation of Early Markers Scale

(POEMS)

3-36 2 61 items to cover problem areas including core deficits of ASD based on parents observations. Responses assessed and scored by provider.

Parent-completed questionnaire

20 min No Available upon Request from Author (Scoring described in paper)

Parent Observation of Interaction (POSI)

16-36 1 7 item parent-rated checklist modeled from the critical items from the M-CHAT, as well as DSM-5.

Items scored in comparison to typical behavior. Responses are assessed & scored by provider.

Parent-completed questionnaire

5 mins No Online download Free

(Questionnaire, scoring guide)

Screening Test for Autism in Two-year-olds

(STAT)

12-36 2 12 item interactive assessment between child and provider to identify childs risk for autism

*STAT is validated as a screener for [DSM-IV] Autistic Disorder and not milder forms

Semi-structured observation by provider

20 mins Yes; Interactive online training (included in kit)

Order online Training conducted

online ~$500

Autism Detection in Early Childhood (ADEC)

12 - 36 2 16 item interactive assessment between child and provider to identify childs risk for autism and ASD *Earlier papers validate ADEC as a screener for

Autistic Disorder but more recent, ASD

Semi-structured observation by provider

15 mins Training comes with kit on DVD

Order online from Autstralia

~$500

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

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.

*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.

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 DisabilitiesNew York Medical College School of Health Science and Practice