Identification of Children with Autism Spectrum Disorders (ASDs) by the Ages and Stages Questionnaires (ASQ)

Background:   Several targeted screens for autism have been developed for use by primary care providers (PCPs), and American Academy of Pediatrics’ guidelines recommend use of a targeted screen at 18 months.  PCPs, however, do not use developmental screens regularly in their practices, have little familiarity with autism screens, and are unlikely to add a second formal screening test to well child visits. 

Objectives: Determine the accuracy of a general developmental screen, the ASQ, in identifying children with ASD in a referral sample.

Methods: Ongoing chart review of children 1-5 years of age who received a diagnosis of an ASD based on comprehensive evaluation including developmental assessment, ADOS and structured autism interview.  The Ages & Stages Questionnaire (ASQ), a parent-completed developmental screen, was completed by parents just prior to the autism or child development clinic appointment.  The ASQ, a series of questionnaires for children 4-60 months of age, contains questions on adaptive, communication, gross motor, fine motor and personal-social skills.

Results: 48 children had an ASD diagnosis and ASQ data, 13.5 to 51 months of age. 83% of children had autism, 17% other ASD, and 90%  DQ <70.  All of the children failed one or more areas on the ASQ; 95.8% failed the communication section; 87.5% personal-social and 83.3% problem solving.  A typical pattern on the ASQ for young children with ASD appeared to be delays in all skill areas except for passes in gross and/or fine motor skills.

Conclusions:   This study reports preliminary data that a developmental screen, the ASQ, has high sensitivity in the identification of children with ASD.  Limitations of this study are the referral sample, small sample size, few high-functioning children with ASD and few children ≤ 2 years of age.