Development and validation of a streamlined autism case confirmation approach for use in epidemiologic risk factor research in prospective cohorts.
A 20-minute lay-administered autism screen works as well as a full clinic visit.
01Research in Context
What this study did
The team built two quick autism screens for big research studies. One is STAT-E, a 20-minute play test. The other is E-VAS plus ASI, two short parent forms given together.
Parents and lay staff gave the tools to toddlers already in a long-term study. The goal was to see if these brief tools could stand in for long clinic visits.
What they found
Both tools caught most autism cases and ruled out most non-cases. Results matched the longer gold-standard exams.
Total time per child was under 30 minutes, far less than a full evaluation.
How this fits with other research
Wang et al. (2022) added examiner ratings to STAT-E. They showed you can trade a little accuracy to catch even more cases. The 2017 paper keeps the simpler, lay-only version for speed.
Hartwell et al. (2025) looked at 37 screens and found none perfect. Their map helps you pick STAT-E when you need speed and telehealth options.
Meimei et al. (2022) reviewed remote autism tools. Their findings line up here: brief screens work over video, so rural teams can copy this model.
Why it matters
You can train a staff member in one afternoon and screen a whole preschool caseload the next day. Use STAT-E or E-VAS+ASI while families wait for the full clinic slot. You save months of delay and catch kids earlier, when ABA has the biggest punch.
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02At a glance
03Original abstract
The cost associated with incorporating standardized observational assessments and diagnostic interviews in large-scale epidemiologic studies of autism spectrum disorders (ASD) risk factors can be substantial. Streamlined approaches for confirming ASD case status would benefit these studies. We conducted a multi-site, cross-sectional criterion validity study in a convenience sample of 382 three-year olds scheduled for neurodevelopmental evaluation. ASD case classification as determined by three novel assessment instruments (the Early Video-guided Autism Screener E-VAS; the Autism Symptom Interview, ASI; the Screening Tool for Autism in Toddlers Expanded, STAT-E) each designed to be administered in less than 30 minutes by lay staff, was compared to ADOS scores and DSM-based diagnostic assessment from a qualified clinician. Sensitivity and specificity of each instrument alone and in combination were estimated. Alternative cutpoints were identified under different criteria and two-stage cross validation was used to avoid overfitting. Findings were interpreted in the context of a large, prospective pregnancy cohort study utilizing a two-stage approach to case identification. Under initial cutpoints, sensitivity ranged from 0.63 to 0.92 and specificity from 0.35 to 0.70. Cutpoints giving equal weight to sensitivity and specificity resulted in sensitivity estimates ranging from 0.45 to 0.83 and specificity ranging from 0.49 to 0.86. Several strategies were well-suited for application as a second-stage case-confirmation. These included the STAT-E alone and the parallel administration of both the E-VAS and the ASI. Use of more streamlined methods of case-confirmation in large-scale prospective cohort epidemiologic investigations of ASD risk factors appears feasible. Autism Res 2017, 10: 485-501. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1659