International Meeting for Autism Research (London, May 15-17, 2008): Comparative Analysis of Three Screening Instruments for Autism Spectrum Disorder in Toddlers at High Risk
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Comparative Analysis of Three Screening Instruments for Autism Spectrum Disorder in Toddlers at High Risk

Friday, May 16, 2008
Champagne Terrace/Bordeaux (Novotel London West)
11:30 AM
I. J. Oosterling , Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
S. Swinkels , Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
R. J. Van der Gaag , Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
J. C. Visser , Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
C. Dietz , Department of Psychiatry, University Medical Center Utrecht, Netherlands
J. Buitelaar , Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Background: Several instruments have been developed to screen for autism spectrum disorders (ASD) in high-risk populations. However, little research has been completed on comparing the properties of different screening instruments at an early age in one and the same sample.

Objectives: To compare the properties of several screens and the value of their individual items in two age groups of high-risk children (8-24 months and 25-44 months). Instruments examined are: the Early Screening of Autistic Traits Questionnaire (ESAT; Dietz et al., 2006; Swinkels et al., 2006), the Social Communication Questionnaire (SCQ; Berument et al., 1999), the Communication and Symbolic Behavior Scales-Developmental Profile, Infant-Toddler Checklist (CSBS-DP; Wetherby & Prizant, 2002) and key items of the Checklist for Autism in Toddlers (CHAT; Baron-Cohen et al., 1992).

Methods: Data were gathered in 238 children (mean age=29.6 months, SD=6.4) at risk for ASD, because of either screen positive results on the ESAT 14-items (n=208) or, when screen negative, because of sufficient clinical concern (n=30). The SCQ and CSBS-DP were completed on average 2.6 months later (SD=1.7). Three questions that represent the main concepts of the CHAT were derived from the SCQ and CSBS-DP. Clinical diagnoses were made using golden standard diagnostic procedures. To compare discriminative power of instruments different test properties were calculated (Sensitivity, Specificity, PPV, NPV and ROC Area-Under-the-Curve analyses). To compare the usefulness of different screening items odds ratios per item were calculated.

Results: No instrument performs clearly better over another or meets standards for satisfactory prediction of ASD diagnosis, since the AUC’s are fair at the most. However, each instrument demonstrates specific strengths and many single items on joint attention and language and communication show high odds ratios.

Conclusions: Pros and cons of instruments will be discussed and directions for future research proposed.

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