Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months.
Raymond Sturner, Barbara Howard, Paul Bergmann and 4 others
PMID 28762159WHAT IT FOUND
For younger toddlers, the follow-up interview did not much improve the chance a positive screen meant autism, but for older toddlers it did.
A positive screen at the earlier visit was less likely to mean autism.
Key findings
01The chance a positive screen meant autism after the follow-up interview was 0.69 for older toddlers and 0.36 for younger toddlers.
02The follow-up interview raised the chance a positive screen meant autism overall from 0.40 to 0.58, and in older toddlers from 0.48 to 0.69, but in younger toddlers it went from 0.31 to 0.36 and the change was not significant.
03Language variables carried the largest relative importance in exploratory models based on 98 children with complete data.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only children who screened positive were evaluated, so the study cannot show how well the screen works for children who screened negative. The analysed group was small and not fully representative because many parents declined the evaluation. Many pediatricians did not join the study, and many positive screens were not evaluated. The autism evaluators knew the initial screen was positive, although they did not know the follow-up interview result. The exploratory decision-tree models were overfitted and cannot be used clinically.
Declared interests
The study was conducted by the Center for Promotion of Child Development through Primary Care and its for-profit subsidiary, Total Child Health. The online screening tool used in the study, CHADIS, was developed by authors who direct or lead the entities and are paid consultants to the entities.
The easy way to misread this
Do not treat the follow-up interview as a fix for younger toddler screening. It did not substantially improve the chance a positive screen meant autism in that group.