Autism spectrum disorder screening in Chinese-language preschools.
Kathy Kar-Man Shum, Rose Mui-Fong Wong, Angel Hoe-Chi Au and 1 others
PMID 34399605WHAT IT FOUND
Trained observers using the Chinese COS identified children likely to have ASD about a year later with good accuracy.
Teacher ratings were less accurate than observer ratings, possibly due to less training or cultural differences in behavior expectations.
Key findings
01Observer ratings (COS-Researcher) significantly predicted ASD diagnosis one year later with an AUC of 0.80, indicating good screening accuracy.
02Teacher ratings (COS-Teacher) did not significantly distinguish ASD from non-ASD groups using the original 5-point scale (p=0.12), though they showed modest accuracy with binary scoring (AUC 0.67).
03Using a simplified binary scoring system (0 or 1) improved the ability of teacher ratings to differentiate between groups compared to the original detailed scale.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 130 of the 534 screened children underwent clinical assessment, so the true prevalence and the test's performance in the full population are unknown. Teacher ratings were less accurate than observer ratings, and the study did not determine if this was due to lack of training, cultural differences in behavior expectations, or teacher-student ratios. The binary scoring system was a post-hoc adaptation based on observed difficulties in using the 5-point scale, not a pre-registered primary analysis.
Declared interests
The authors declared no potential conflicts of interest. The work was supported by the Research Grants Council of Hong Kong and a named professorship.
The easy way to misread this
Do not assume that standard teacher reports using this checklist are as accurate as trained observer reports. Teacher ratings showed poor discrimination in this study unless a simplified binary scoring method was used, suggesting teachers may need more training or a different scoring approach to be effective screeners.