Testing two screening instruments for autism spectrum disorder in UK community child health services
Open accessAbstract
Aim: The aim of this study was to test the accuracy of two screening instruments in UK Community health services: Modified Checklist for Autism in Toddlers (M‐CHAT) and Social Communication Questionnaire (SCQ) for autism spectrum disorder (ASD). A two‐stage screening and in‐depth assessment procedure, combined with sampling stratification and statistical weighting, allowed the accuracy of the screens to be estimated in the entire population of referred children. Method: The study included all referrals of children aged 18 to 48 months to community paediatric and speech and language therapy services in two London districts over a 12‐month period between September 2004 and September 2005. Parents of 808 children were approached; screen data were obtained on 543 children (67.2%). A stratified subsample of 120 children received an in‐depth assessment for ASD as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Community clinician judgement of likely ASD was available for 98 out of the 120 children. Results: The sensitivity and specificity were 64% (95% confidence intervals; range 51–80%) and 75% (63–85%) for the SCQ, and 82% (72–92%) and 50% (33–64%) for M‐CHAT. There was no evidence that the area under the curve differed between the two screening instruments. There was also no evidence that clinician judgement of likely ASD differed from either of the screening tests. The screening tests did not perform well to confirm preliminary clinical judgement to refer (in series), nor as an alternative indicator for referral (in parallel). Interpretation: While screening tests may provide useful information, their accuracy is moderate. Screening information in isolation should not be used to make referral decisions regarding specialized ASD assessment.
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Most screening studies validate diagnoses only once, usually at approximately the age of screening, leaving unclear the degree to which an initial diagnosis persists at later ages.
“yet most screening studies9,10,41,42 validate diagnoses only once, usually at approximately the age of screening, leaving unclear the degree to which an initial diagnosis persists at later ages.”
From Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months (2019) · cites this paper as [41]
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Self-citationValidation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
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A Screening Instrument for Autism at 18 Months of Age: A 6-Year Follow-up Study
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Self-citationA Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
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Self-citationLarge-Scale Use of the Modified Checklist for Autism in Low-Risk Toddlers
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Prevalence and characteristics of autistic spectrum disorders in the ALSPAC cohort
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Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., et al. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0138-4 · Cited by 1,859 · see citing works
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- Authors
- Charman, T., Baird, G., Simonoff, E., Chandler, S., Davison‐Jenkins, A., Sharma, A., O'Sullivan, T., & Pickles, A.
- Affiliations
- King's College London (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- University College London (GB)
- Kaleidoscope, Lewisham Centre for Children & Young People Lewisham Healthcare London UK
- Corresponding author
- Charman, Tony
- Venue
- Developmental Medicine & Child Neurology
- Publisher
- Wiley
- Published
- 2015-08-25
- Volume
- 58
- Issue
- 4
- Pages
- 369-375
- ISSN
- 0012-1622 (ISSN-L)
- 1469-8749
- OpenAlex
- W1923677884
- Cited by
- 43
- References
- 11
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 5 · 2019: 8 · 2018: 6 · 2017: 4 · 2016: 3 · 2015: 1
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Developmental Medicine & Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Health Foundation
- National Institute for Health Research
- King’s College London
- 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, M-CHAT, Social Communication Questionnaire, screening accuracy, sensitivity and specificity, referral decisions, speech and language therapy services, toddlers
- MeSH terms
- Autism Spectrum Disorder, Child Health Services, Child, Preschool, Community Health Services, Female, Humans, Infant, London, Male, Neuropsychological Tests, Sensitivity and Specificity
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