A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children: recommendations for use in low- and middle-income countries.
Pick M-CHAT or RITA for quick, free autism screens, but tweak the language so local families understand.
01Research in Context
What this study did
Marlow et al. (2019) looked at every brief, cheap screening tool for autism and developmental delay.
They wanted tools that community helpers with little training could use in low- and middle-income countries.
The team mapped ten tools, including M-CHAT and RITA, that take under 15 minutes and cost almost nothing.
What they found
The review shows you can spot risk early without doctors or fancy gear.
M-CHAT, RITA, and CHAT-23 rose to the top because they are short, free, and easy to score.
How this fits with other research
Scarpa et al. (2013) seems to disagree: M-CHAT gave lots of false alarms in poor, rural U.S. families.
The difference is culture and setting. Marguerite still backs M-CHAT, but only if you adapt the words and cut-off for local families.
Li et al. (2018) and Eussen et al. (2016) prove it works in real life. They trained daycare staff in China and the U.S. and doubled the number of kids flagged for help.
Hartwell et al. (2025) later checked 37 tools and agreed: no single winner, so pick the briefest one that fits your site.
Why it matters
If you work in Head Start, rural clinics, or global projects, you now have a vetted shortlist. Grab a ten-item tool, teach a community helper in one hour, and start catching kids earlier without blowing the budget.
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02At a glance
03Original abstract
Without intervention, developmental delay (DD) and autism spectrum disorders (ASDs) severely restrict children from reaching their developmental potential. Monitoring child development through the use of screening tools can help identify children who need further assessment or intervention. Screening has been widely encouraged to identify children with ASD or DD, and a large variety of screening instruments are suggested in the literature. There is a lack of consensus around which screening tools are most effective, especially where tools are used in cultures other than those in which they were created. We conducted a review of the literature for screening tools for DD and autism to make recommendations for tool selection and use in low- and middle-income countries (LMIC). We included 99 screening tools in the review and created profiles for each tool to evaluate their properties and determine which tools could be effectively used in various LMIC. Our review identified a substantial number (35 for DD and 6 for ASD) of screening tools from LMIC. We identified 10 tools which show promise for use across settings; these tools are brief, low-cost and can be implemented by paraprofessionals or lay community health workers. Routine screening is an important first step toward addressing the need for services in LMIC, but high-quality tools take time to be conceptualized, developed, piloted, and validated, before implementation can happen. A focus on improving the scientific rigor of early detection approaches and on enhancing the reach to underserved populations should be prioritized. Autism Res 2019, 12: 176-199 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Screening tools are short questionnaires or brief assessments used to identify children at risk of a developmental disability such as autism. Many screening tools exist, but there is uncertainty about which tools work best in non-Western cultures or low-resource settings. We reviewed over 90 screening tools to identify which tools can be easily used in these settings. Selecting tools that are affordable and easy to use will make it easier to identify and support children with developmental difficulties.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.2033