Utilizing two-tiered screening for early detection of autism spectrum disorder.
Meena Khowaja, Diana L Robins, Lauren B Adamson
PMID 28905644WHAT IT FOUND
A second clinician-administered play screen after a positive parent questionnaire reduced false alarms with published scoring, but missed more children.
In 109 toddlers, a revised seven-item version caught more children while still reducing false alarms.
Key findings
01Among STAT-positive children, 30 of 39 had ASD (PPV .77), while STAT sensitivity was .47, specificity was .80, and NPV was .51.
02A seven-item alternative STAT score had sensitivity .81, specificity .59, PPV .74, and NPV .68 in the first sample, and sensitivity .78, specificity .57, PPV .71, and NPV .65 in the validation sample.
03All 30 children with ASD who screened positive using published STAT cutoffs also screened positive using the alternative score.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The analysed sample was 109 children, and the alternative STAT scoring was developed and checked in halves of 54 and 55 children. Secondary screening and evaluation took place at a university research visit, not in the pediatric offices where the first screen was done. Of 442 children who screened positive on the M-CHAT-R/F, 24% completed both the STAT and evaluation, 32% completed evaluation only, 2% completed STAT only, and 42% completed neither; the paper states attrition between Level 1 screening and evaluation was 44%. Attrition was correlated with lower maternal education and racial/ethnic minority status, so families who did not complete follow-up may differ from those who did. The alternative STAT scoring was exploratory, not the main aim, and needs cross-validation in larger independent samples. The published STAT cutoffs had lower sensitivity than expected in this screening sample.
Declared interests
The article text does not include a conflict-of-interest or funding declaration. The supplied publication types list research support from N.I.H., Extramural, and Non-U.S. Gov't sources.
The easy way to misread this
Do not conclude that two-tiered STAT screening is ready for routine community use. The sample was only 109 children, the STAT and evaluation were done at a university research visit, and 42% of the screen-positive children in the larger project completed neither the STAT nor the evaluation.