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Objectives: To evaluate whether the use of screening instruments would improve the accuracy of referral to specialist ASD services for pre-school children, already referred to community child health services with developmental concerns.
Methods: In the first phase of the study, the Social Communication Questionnaire (SCQ) and Modified Checklist for Autism in Toddlers (M-CHAT) were administered to 540 children referred to second-tier health services. Information regarding clinicians’ concerns about possible ASD diagnoses/clinician’s decision to refer to ASD services was also collected. In the second phase, a stratified sample of children was seen for diagnostic research assessments. Stratification was based on SCQ and M-CHAT scores, and whether the child was referred to specialist ASD services. 120 children were seen by the research team, who remained blind to information collected in phase one. Assessment included the Autism Diagnostic Interview (ADI-R), Autism Diagnostic Observation Schedule (ADOS-G), and psychometrics. Cases were assigned a diagnosis of autism, ASD or non-ASD on the basis of information from the ADI-R, ADOS-G and ICD-10 criteria.
Results: A statistical weighting procedure will be used to evaluate whether the screening instruments were more accurate than clinicians’ decision-making in identifying ASD cases, using the recommended cut-offs on the two screens (M-CHAT, Robins et al 2001; SCQ, Berument et al, 1991). Receiver-operator-characteristic analyses will be conducted to compare the sensitivity and specificity of the M-CHAT versus the SCQ.
Conclusions: Comparison of diagnosis, scores on the screens, and clinicians' decisions will allow the sensitivity of all 3 to be evaluated. This will allow us to determine whether use of screens could improve second-tier clinicians’ decisions about which children to refer to specialist ASD services.