Accuracy of the Screening Tool for Autism in Toddlers and Young Children in the primary care setting.
Rebecca McNally Keehn, Noha F Minshawi, Qing Tang and 7 others
PMID 39503291WHAT IT FOUND
In a statewide primary care model, the STAT screening tool agreed with expert diagnosis in 78% of cases.
It missed autism in children with higher developmental skills and lower symptom severity, so a low score does not rule out autism in these children.
Key findings
01STAT classification matched expert best-estimate diagnosis in 78% of cases, with sensitivity of 81% and specificity of 72%.
02Children missed by the STAT (false negatives) were older and had higher verbal and nonverbal developmental quotients and adaptive skills than those correctly identified.
03Primary care providers agreed with STAT classification in 86% of cases, but when they agreed, the diagnosis matched expert judgment only 73% of the time.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was disproportionately weighted toward autism diagnoses, which may affect the reliability of specificity and negative predictive value estimates. Age-specific subgroups were small, limiting the certainty of accuracy differences between age bands. Exploratory analyses of clinical characteristics were not corrected for multiple comparisons. The study did not include autistic people in the design or interpretation of the results.
Declared interests
The authors declared no biomedical financial interests or conflicts of interest. The study was supported by the NIH and non-U.S. government research support.
The easy way to misread this
Do not interpret a 'Low Likelihood of Autism' STAT score as a definitive exclusion of autism, especially in children with higher developmental skills. The tool missed 19% of autism cases in this sample, and those missed cases tended to have better verbal and nonverbal abilities.