The utility of parent-report screening tools in differentiating autism versus attention-deficit/hyperactivity disorder in school-age children.
Sara Guttentag, Somer Bishop, Rebecca Doggett and 6 others
PMID 34219504WHAT IT FOUND
Three parent screeners separated autism from ADHD without autism only moderately well in 176 verbally fluent school-age children.
The SCQ-L performed best, but none was good enough to diagnose alone; clinicians still need full assessment.
Key findings
01The ASI, SRS-2, and SCQ-L all separated best-estimate autism from ADHD without autism only moderately well, and the SCQ-L had the highest discrimination.
02At the recommended cutoffs, the ASI total score of 38 had sensitivity 0.73 and specificity 0.74; the SRS-2 T-score of 65 had sensitivity 0.64 and specificity 0.78; and the SCQ-L total score of 15 had sensitivity 0.41 and specificity 0.91.
03Misclassification was linked to parent-reported symptom severity, not to age, IQ, medication use, or ADOS-2 severity.
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 convenience recruited and limited to verbally fluent school-age children with average or above-average IQ, so it does not tell us how these screeners work for younger, nonverbal, or intellectually disabled children. Most children were male, so the effect of sex on screener accuracy is unknown. The autism group had a high rate of ADHD comorbidity, so the tools were not tested in autism without ADHD. The diagnostic standard was partly based on parent interviews and questionnaires, so it was not fully independent from the screeners being tested. The analyses comparing correctly and incorrectly classified children were smaller and exploratory.
Declared interests
The authors declared potential conflicts: C.L. and S.B. receive royalties for the sale of diagnostic instruments they co-authored, including ADOS-2 and/or SCQ. The article is marked as NIH extramural research support.
The easy way to misread this
Do not treat these parent screeners as diagnostic tests. The best tool still had only moderate discrimination, and the authors said multisource assessments may be needed for more accurate classification.