A systematic review of screening tools for the detection of autism spectrum disorder in mainland China and surrounding regions.
China still leans on un-checked DSM checklists for autism screening—switch to validated, culturally adapted tools like the Chinese PEP-3.
01Research in Context
What this study did
Wang et al. (2020) hunted for every autism screening paper used in mainland China, Hong Kong, and Taiwan. They found 22 studies that described how doctors or teachers first spot signs of autism.
The team compared the tools side-by-side. Most were simple DSM checklists, not the long, play-based tests you see in the United States.
What they found
Almost every clinic relied on short checklists instead of gold-standard tools like the ADOS or ADI-R. Few tests had been checked for accuracy with Chinese kids.
The review says China needs a two-step system: a quick screen for everyone, then a deeper, culturally tuned tool for those who flag red.
How this fits with other research
Zhang et al. (2019) already answered part of the call. They proved the simplified Chinese PEP-3 is reliable for kids with ASD in mainland China. Ji’s review shows why that work matters; most places still lack a validated option.
Zou et al. (2025) looked at national autism policy after 2020. They found China poured money into diagnosis, yet workforce and community supports lag. Ji’s screening gap helps explain the bottleneck: without good tools, even new policies can’t move kids into services quickly.
Saunders et al. (1988) warned that the old Autism Behavior Checklist gives both false positives and false negatives. Ji’s findings echo the warning; many Chinese screens have the same flaw because they were never re-tested locally.
Why it matters
If you assess Mandarin-speaking children, push for the PEP-3 or another validated tool instead of a quick DSM tally. Ask your clinic which screen they use and request proof it works with local kids. Swapping in a checked tool can cut wait time and stop families from traveling hours to big-city hospitals for a firm diagnosis.
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02At a glance
03Original abstract
Screening for autism spectrum disorder is the first step toward early detection and diagnosis, thereby impacting the likelihood of children accessing early intervention and, importantly, improving long-term outcomes. This systematic review aimed to (a) establish a clear baseline of autism spectrum disorder screening tools currently used throughout mainland China and surrounding regions, (b) identify the strengths and limitations of these instruments, and (c) develop specific recommendations regarding screening for autism spectrum disorder throughout Chinese-speaking countries. Databases were searched for recent (2015-2018) articles published in Chinese or English languages. Twenty-two studies (13 Chinese, 9 English) met inclusion criteria; two from Taiwan and the remainder from mainland China. Studies varied greatly in the extent of psychometric analyses and reported autism spectrum disorder prevalence. The majority of diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. (DSM-IV) or 5th ed. (DSM-5)) criteria, although a small number of studies utilized gold-standard diagnostic assessment instruments. It is recommended that a systematic, multi-tiered, screening network be established to improve the identification of autism spectrum disorder in China and surrounding regions. Assessment and diagnosis need to be culturally appropriate, and amenable to low-resource settings. In addition, increased public awareness programs to reduce stigma will be important in improving outcomes for children with autism spectrum disorder.
Autism : the international journal of research and practice, 2020 · doi:10.1177/1362361319871174