Use of the Social Responsiveness Scale as a Screening Tool for Children Referred for Evaluation of Developmental Disabilities

Background: Clinicians conducting diagnostic assessments of children at risk for developmental disabilities face the challenge of obtaining both a broad overview of functioning, as well as specific information to aid in differential diagnosis. Moreover, often children are referred with general developmental concerns, but present to clinic as requiring more specialized assessment, such as for Autism Spectrum Disorders (ASD). Very few well-validated screening tools are available for identifying children, especially school-aged, in need of ASD-specific evaluations. Yet with increased awareness and recognition of the symptoms of ASD in the general population, evaluation requests are increasing.

Objectives: To evaluate the utility of the Social Responsiveness Scale (SRS) in an interdisciplinary tertiary care clinic serving school-aged children and to determine its utility for:
·         identifying children referred to a general developmental clinic who were in need of more specific ASD evaluations,
·         assisting clinicians in either ruling in or ruling out a diagnosis of ASD

Methods: The SRS was completed in both a general developmental interdisciplinary clinic (IDC) (as a screening tool) and an interdisciplinary Autism Clinic (AC) (as a supplement to the ADOS and ADI-R). Final diagnoses were determined by members of the interdisciplinary team based on all available data and clinical impressions.

Results: The SRS has been completed on 40 children across both clinics, with final diagnosis available on 23 children (mean age = 7 years) at present. Seven of the children received diagnoses of ASD, with other children receiving diagnoses of language disorders, intellectual disability, mixed developmental delays, learning disabilities, anxiety or mood disorders, and disruptive behavior disorders. Using a Total raw score cutoff of 85 (appropriate for clinical populations with increased likelihood of ASD), 11 children exceeded the cutoff for significant difficulties in reciprocal social behavior. Eight of these children were receiving ASD-specific evaluations, while the remaining 3 were undergoing general developmental evaluations. Positive predictive value of the SRS in the combined clinical sample was 36%, while negative predictive value was 75%. Notably, positive predictive value of the children evaluated through IDC was 0%, as none of the three children (despite their caregivers suspecting ASD) actually received this diagnosis. Evaluations and analyses are ongoing and will allow for further exploration of the use of the SRS in an anticipated clinical sample of at least 60 children.

Conclusions: Based on preliminary data, a number of children without ASD are being identified as exhibiting significant difficulties in reciprocal social behavior within this tertiary care setting, with nearly half of the sample screening positive for likely ASD, but only 30% receiving a clinical diagnosis of ASD. Further analyses will investigate factors that influence the predictive value of the SRS, including initial referral question, as well as cognitive and adaptive functioning.