Screening for Autism Spectrum Disorder in High-Risk Younger Siblings.
Kathryn Bradbury, Diana L Robins, Marianne Barton and 4 others
PMID 32576788WHAT IT FOUND
The M-CHAT-R identified autism in high-risk siblings with much higher accuracy than in the general population.
Because parents of high-risk children reported concerns consistently, the follow-up interview added little value. High-risk toddlers who screen positive should be referred for evaluation immediately.
Key findings
01The positive predictive value for autism was significantly higher in the high-risk group at the initial screen compared to the low-risk group, but the difference disappeared after the follow-up interview.
02High-risk toddlers had a much higher rate of positive screens than low-risk toddlers at both the initial stage and after follow-up.
03Parents of high-risk children changed fewer item responses during the follow-up interview than parents of low-risk children, suggesting their initial reports were more stable.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study only screened children at one time point, which may miss children who develop symptoms later. Follow-up on children who screened negative was limited, so the study could not calculate sensitivity or specificity. The high-risk and low-risk groups were recruited differently, which may have influenced demographics and the time between screening and follow-up. The high-risk group had a higher proportion of males and non-Hispanic White children compared to the low-risk group. The study could not separate the effect of parents' experience with autism from the actual characteristics of the children on screening results.
Declared interests
The research was supported by grants from the National Institute of Mental Health and the National Institute of Child Health and Human Development.
The easy way to misread this
Do not assume the follow-up interview is unnecessary for all children. The finding that follow-up adds little value applies specifically to siblings of children with autism, where the initial screen is already highly predictive. In the general population, the follow-up interview significantly improves the accuracy of the screening.