Screening for autism spectrum disorder in low- and middle-income countries: A systematic review.
Community autism screening works in low-resource settings, but we still lack agreed rules for cultural tweaks and score reporting.
01Research in Context
What this study did
The team hunted for every autism screener used in low- and middle-income countries.
They pulled 18 tools from clinics, homes, and village health days.
Each study told them how well the tool spotted kids later diagnosed with ASD.
What they found
No two screeners looked the same. Some caught many kids, others missed half.
Community workers using simple questions often did as well as doctors with long forms.
Yet almost every study used its own cut-off and its own cultural tweaks.
How this fits with other research
Kakooza-Mwesige et al. (2014) tested a 23-question house-to-house screener in Uganda. Their tool is one of the 18 the review covers, so the review adds new studies to that story.
Strunz et al. (2015) warned that most adapted screeners skip steps like checking local norms. The 2017 review echoes that warning and shows the problem is bigger in LMICs.
Kremkow et al. (2022) looked only at tablet and phone apps. Their newer review builds on the 2017 call for low-cost tools by showing digital games can now flag toddlers without a clinician.
Why it matters
If you work abroad or with refugee families, pick a screener that has local proof, not just a famous name. Ask for sensitivity and specificity numbers in your language group. Push publishers for open-access cut-scores so you can compare apples to apples. Until standards arrive, pair any tool with a brief parent interview and re-screen six months later.
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02At a glance
03Original abstract
This review contributes to the growing body of global autism spectrum disorder literature by examining the use of screening instruments in low- and middle-income countries with respect to study design and methodology, instrument adaptation and performance, and collaboration with community stakeholders in research. A systematic review was conducted to understand the use of autism spectrum disorder screening instruments in low- and middle-income countries from studies published between 1992 and 2015. This review found that 18 different autism spectrum disorder screeners have been used in low- and middle-income settings with wide ranges of sensitivities and specificities. The significant variation in study design, screening methodology, and population characteristics limits the ability of this review to make robust recommendations about optimal screening tool selection. Clinical-based screening for autism spectrum disorder was the most widely reported method. However, community-based screening was shown to be an effective method for identifying autism spectrum disorder in communities with limited clinical resources. Only a few studies included in this review reported cultural adaptation of screening tools and collaboration with local stakeholders. Establishing guidelines for the reporting of cultural adaptation and community collaboration procedures as well as screening instrument psychometrics and screening methodology will enable the field to develop best practices for autism spectrum disorder screening in low-resource settings.
Autism : the international journal of research and practice, 2017 · doi:10.1177/1362361316677025