Autism Screening in the First Year and Beyond: Comparison of Multiple Measures.
Devon N Gangi, Chandni Parikh, Monique Moore Hill and 5 others
PMID 42631533WHAT IT FOUND
These autism screeners did not work well at 6, 9, and 12 months.
At 18 and 24 months, using the M-CHAT-R and ITC together, and treating a positive on either as enough, identified more children later diagnosed with autism.
Key findings
01At 6, 9, and 12 months, the screeners had AUC values of 0.49 to 0.65, which is poor or failing.
02At 24 months, broader combinations of screeners had AUC values in the good range, identified 66% to 78% of children with autism, and did not identify 92% to 94% of children without autism.
03For the M-CHAT-R and ITC at 18 and 24 months, a positive on either measure at either age had an AUC of 0.85 and identified 88% of children with autism, compared with an AUC of 0.74 and 51% identified when a positive was required at both ages.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Most families lived in California (94%), and California has the highest autism prevalence among monitoring network sites. The autism rate was 6%, which is higher than the national estimate of 3% for 4-year-old children, although it matches recent California estimates. Some children had genetic or medical conditions (1%) or elevated familial likelihood (4%), which may have raised the autism rate. The M-CHAT-R follow-up interview was not used to define screen positivity, so specificity may not match usual clinical use. The ITC was added partway through data collection, so it was missing for more participants than other screeners. Final analyses included 1641 children with study outcome determinations, not all 2005 recruited children. Children who screened negative were not all seen for full diagnostic evaluation; many Non-ASD outcomes were assigned from 36-month surveys.
The easy way to misread this
Do not conclude that autism can be diagnosed in the first year of life with these tools. The screeners performed poorly at 6, 9, and 12 months, and children still needed diagnostic evaluation after a positive screen.