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Cited by 252Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Accuracy of autism screening in a large pediatric network

Guthrie, Whitney, Wallis, Kate, Bennett, Amanda, Brooks, Elizabeth, Dudley, Jesse, Gerdes, Marsha, Pandey, Juhi, Levy, Susan E. +2 more·2019·Pediatrics
DOI 10.1542/peds.2018-3963
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Abstract

BACKGROUND: Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS: Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children’s Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS: Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F’s sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS: Universal screening in primary care is possible when supported by electronic administration. In this “real-world” cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.

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Authors
Guthrie, W., Wallis, K., Bennett, A., Brooks, E., Dudley, J., Gerdes, M., Pandey, J., Levy, S. E., Schultz, R. T., & Miller, J. S.
Affiliations
  • cCenter for Pediatric Clinical Effectiveness,
  • Children's Hospital of Philadelphia (US)
  • aDivision of Developmental and Behavioral Pediatrics,
  • bDepartment of Biomedical and Health Informatics,
  • dCenter for Autism Research, and
  • University of Pennsylvania (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2019-10-01
Volume
144
Issue
4
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2018-3963
OpenAlex
W2975755927
Semantic Scholar
007e563fef9e01228a9914065485bfe9744579ba
Cited by
252
References
29
Citations by year
2026: 24 · 2025: 27 · 2024: 41 · 2023: 41 · 2022: 35 · 2021: 52 · 2020: 30 · 2019: 2
FWCI
17.30
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R03MH116356)
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, universal screening, screening accuracy, primary care, electronic health records, autism prevalence, sensitivity and positive predictive value, screening disparities, children of color, low-income children, toddlers, well-child visits
MeSH terms
Autism Spectrum Disorder, Age Factors, Child, Preschool, Female, Follow-Up Studies, Hospitals, Pediatric, Humans, Infant, Male, Mass Screening, Minority Groups, Pediatrics, Predictive Value of Tests, Sensitivity and Specificity, Sex Factors, Socioeconomic Factors, Philadelphia, Prevalence, Checklist, Electronic Health Records

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