The validation of three screening instruments for toddlers and pre-schoolers to accurately detect children with Autism Spectrum Disorders.
Land, D.M. van 't
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Early detection and intervention of ASD in young children has been shown to be effective for the development of social interaction, communication and a decrease of problems in the future. That is why in this study several screening instruments in detecting ASD in young children were examined. A population of 64 children, aged 18 to 30 months was screened using the Modified Checklist for Autism in Toddlers (M-CHAT) and 19 of them were also screened with a newly developed version of the Social Responsiveness Scale, for special use in toddlers (SRS18-30). A population of 84 children, aged 30 to 48 months was screened using another newly developed version of the SRS, for special use in pre-schoolers (SRS30-48). The brief nature of the three screenings instruments makes it user friendly and provides quick assessment of functioning. The main purpose of this study was to validate these Dutch translated screening instruments by establishing the reliability, sensitivity, specificity, predictive value and convergent validity. The questionnaires were filled out by parents of young children referred for various problems to several mental health centers in the South-West of the Netherlands. The M-CHAT had a sensitivity of 0.71 and specificity of 0.58. The PPV was 0.45 and the NPV 0.80. For the SRS18-30, using a cut-off score of 68, the sensitivity was 0.57 and the specificity and PPV were 1. The NPV was 0.8. The SRS30-48 missed a lot of children later diagnosed with an ASD. The sensitivity for this screen was 0.45, the specificity 0.61. More research into the diagnostic validity of the SRS30-48 showed that a screen result on the SRS30-48 is not significantly related towards an ASD diagnosis or not. The PPV was 0.42 and the NPV was 0.64. The conclusion of this study was that the screening instruments used in the age group of toddlers from 18-30 months, the M-CHAT and SRS18-30, can be used to identify cases of ASD. Care must be taken to the high amount of false positives for the M-CHAT and false negatives for the SRS18-30. The SRS30-48 is not that accurate, possibly due to other symptoms of ASD for pre-schoolers in comparison with children in the age of 4 to 18 (the age group for the original SRS).