Sensitivity and Specificity of Developmental Surveillance and Autism Screening in an Australian Multicultural Cohort: The Watch Me Grow Study.
Charmaine Bernie, Alicia Montgomery, Louise Sealy and 7 others
PMID 40372565WHAT IT FOUND
No single screening tool or combination accurately identified developmental concerns in this multicultural cohort.
The most sensitive approach missed 9 children, while tiered systems missed up to 21. Specificity remained low, risking over-referral. Repeated surveillance with clinician input is necessary for reliable detection.
Key findings
01The PEDS alone had moderate sensitivity (72%) but low specificity (58%), meaning it missed some children with concerns and flagged many who did not have them.
02Adding the ASQ-3 to the PEDS increased specificity to 87% but dropped sensitivity to 51%, resulting in 21 children with probable developmental disability being missed by the tiered system.
03Combining the PEDS with the M-CHAT-R/F achieved the highest sensitivity (79%) but retained low specificity (57%), missing 9 children and generating 53 false positives.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted in a specific region (South West Sydney) with high cultural diversity, which may limit generalisability to other populations. Diagnoses were based on probable developmental disability or autism likelihood from assessment tools (MSEL/ADOS-2) rather than confirmed clinical diagnoses. There was substantial attrition, with only 165 of the original 2025 recruited children having complete data for analysis. The sample size of children with confirmed developmental concerns was small (22 identified by tiered surveillance, plus 21 missed), which affects the precision of sensitivity estimates. The study excluded families who did not speak English sufficiently to complete assessments, potentially biasing the sample towards those with higher English proficiency.
Declared interests
The study was funded by the National Health and Medical Research Council and the University of New South Wales. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the high specificity of the tiered PEDS and ASQ-3 system as evidence of safety. It missed 21 children with probable developmental disability, which is a significant number of false negatives. A negative screen in this context does not rule out the need for further assessment if clinical concerns remain.