Comparative analysis of three screening instruments for autism spectrum disorder in toddlers at high risk.
No single toddler ASD screener is accurate enough to rule-in or rule-out diagnosis—plan for multi-stage assessment.
01Research in Context
What this study did
The team tested three toddler screeners for autism. They looked at kids already flagged as high risk. Each child took all tools in one clinic visit.
What they found
No tool, and no single question, clearly split ASD from non-ASD. Sensitivity and specificity were both too low for a pass-fail decision.
How this fits with other research
Koh et al. (2014) later showed the M-CHAT can work—if you use the right scoring rules. Their Singapore sample proved the toddler age cut-off matters.
Garwood et al. (2021) agrees. An Ontario health-data algorithm also missed half of ASD youth. Both papers warn that one-step screening under-counts cases.
Reiss et al. (1993) saw the same problem years earlier. Standard cognitive tasks missed subtle signs in siblings. The theme is steady: quick tools alone are not enough.
Why it matters
Do not let a single screener decide referral. Use the M-CHAT critical items for kids under 30 months and always follow with a full assessment. Build a two-step path: flag, then evaluate. This lowers false positives and catches kids the first tool misses.
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02At a glance
03Original abstract
Several instruments have been developed to screen for autism spectrum disorders (ASD) in high-risk populations. However, few studies compare different instruments in one sample. Data were gathered from the Early Screening of Autistic Traits Questionnaire, Social Communication Questionnaire, Communication and Symbolic Behavior Scales-Developmental Profile, Infant-Toddler Checklist and key items of the Checklist for Autism in Toddlers in 238 children (mean age = 29.6 months, SD = 6.4) at risk for ASD. Discriminative properties are compared in the whole sample and in two age groups separately (8-24 months and 25-44 months). No instrument or individual item shows satisfying power in discriminating ASD from non-ASD, but pros and cons of instruments and items are discussed and directions for future research are proposed.
Journal of autism and developmental disorders, 2009 · doi:10.1007/s10803-009-0692-9