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A Screening Instrument for Autism at 18 Months of Age: A 6-Year Follow-up Study

BAIRD, GILLIAN, CHARMAN, TONY, BARON-COHEN, SIMON, COX, ANTONY, SWETTENHAM, JOHN, WHEELWRIGHT, SALLY, DREW, AURIOL·2000·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/00004583-200006000-00007

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Abstract

Objectives A population of 16,235 children aged 18 months was screened using the Checklist for Autism in Toddlers (CHAT) to identify childhood autism (CA). Two further screening procedures were conducted at age 3 and 5 years. The population was followed up at age 7 years in order to establish the sensitivity, specificity, and positive predictive value of the instrument.Method A brief checklist assessing joint attention and pretend play behaviors was administered by primary health care practitioners when the children were 18 months old. Follow-up methods included screening through parents and health practitioners and checking medical and educational records.Results Nineteen cases of CA were successfully identified by the CHAT at 18 months. At follow-up a total of 50 cases of CA were identified via all surveillance methods. Thus, the CHAT has a sensitivity of 38% and a specificity of 98% for identifying CA. The positive predictive value of the instrument was maximized by concentration on the highest-risk group. Repeated screening 1 month later increased the positive predictive value to 75% for identification of CA but reduced the sensitivity to 20%, although the specificity was close to 100%. The screen also identified cases of pervasive developmental disorder as well as children with language and other developmental disorders.Conclusions The CHAT can be used to identify cases of autism and related pervasive developmental disorders at 18 months of age. It is emphasized that the CHAT is not a diagnostic instrument but can identify potential cases of autism spectrum disorders for a full diagnostic assessment.

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Authors: BAIRD, G., CHARMAN, T., BARON-COHEN, S., COX, A., SWETTENHAM, J., WHEELWRIGHT, S., & DREW, A.
Affiliations: Guy's Hospital (GB)
University of Cambridge (GB)
Corresponding author: CHARMAN, TONY
ORCID: BAIRD, GILLIAN
CHARMAN, TONY
SWETTENHAM, JOHN
WHEELWRIGHT, SALLY
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 2000-06
Volume: 39
Issue: 6
Pages: 694-702
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/00004583-200006000-00007
OpenAlex: W2018786179
Cited by: 804
References: 26
Citations by year: 2026: 4 · 2025: 2 · 2024: 4 · 2023: 11 · 2022: 11 · 2021: 19 · 2020: 31 · 2019: 21 · 2018: 23 · 2017: 26 · 2016: 23 · 2015: 30 · 2014: 30 · 2013: 33 · 2012: 42
FWCI: 18.78
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: MRC (S.B.C., A.C., and G.B. (1992-95, 1995-96, and 1996-99))
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords: autism spectrum disorder, autism screening, toddlers, screening sensitivity and specificity, positive predictive value, joint attention, pretend play, pervasive developmental disorders, primary care screening, case finding
MeSH terms: Autistic Disorder, Developmental Disabilities, Child Development Disorders, Pervasive, Child, Preschool, Diagnosis, Differential, England, Female, Follow-Up Studies, Humans, Infant, Male, Mass Screening, Population Surveillance, Predictive Value of Tests, Psychiatric Status Rating Scales, Sensitivity and Specificity, Confounding Factors, Epidemiologic, Prevalence

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A Screening Instrument for Autism at 18 Months of Age: A 6-Year Follow-up Study

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