Developing Autism Screening Criteria for the Brief Infant Toddler Social Emotional Assessment (BITSEA).
Ivy Giserman Kiss, Melanie S Feldman, R Christopher Sheldrick and 1 others
PMID 28181053WHAT IT FOUND
BITSEA ASD-Competence score 11.5 or less flagged 91% of toddlers with ASD and 80% of toddlers without ASD; the 59 false positives, as a group, had lower language and developmental scores.
Key findings
01The ASD-Competence subscale cut-score of 11.5 or less identified 91% of children with ASD and 80% of children without ASD, was stable across 937 of 1000 bootstrap samples, and had the highest overall rates among the subscales.
02The ASD-Problem subscale cut-score of 4.5 or greater identified 76% of children with ASD and 72% of children without ASD, and was stable across 682 of 1000 bootstrap samples.
03Among 512 children, the ASD-Competence cut-score yielded 59 false positives and 21 false negatives; the false positives, as a group, had lower MSEL developmental scores, and the false negatives, as a group, had higher receptive language than true positives.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was a convenience sample pooled from three previous projects, and none of those projects was designed specifically to develop BITSEA ASD screening criteria. The cut-scores were developed in the same sample, so their external validity is uncertain until replicated in an independent sample. The ASD prevalence was much higher than in actual screening populations, so the ability to identify children with and without ASD may change in general or high-risk samples. The comparison group was enriched for non-ASD psychological problems and developmental delays, which may make specificity lower than in a general population. Some MSEL data were missing: 80% completed the four subtests needed for the Early Learning Composite, and 3% of missing MSEL data were imputed. False positives had lower language and developmental scores, so a positive screen may reflect general developmental or language concerns as well as ASD risk. False negatives had higher receptive language, which may conceal ASD symptoms on the parent-report screener.
Declared interests
The fourth author receives royalties related to the licensing of the BITSEA. The first three authors declare no conflict of interest.
The easy way to misread this
Do not treat these cut-scores as validated primary-care screening thresholds. They were developed in a convenience sample with much higher ASD prevalence than real-world screening, and the authors say external validity is uncertain until replicated in an independent sample.