Use of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months: an exploratory study.
STAT works best after 14 months; use it then to catch autism early without too many false alarms.
01Research in Context
What this study did
The team wanted to know if the STAT works for babies younger than two. They gave the play-based screener to toddlers who were 12-24 months old.
Doctors watched how the kids played, pointed, and talked. They used a cut score of 2.75 to flag possible autism.
What they found
STAT caught almost every child later diagnosed with autism. It rarely missed a case, even in the youngest babies.
The trade-off: some 12-13-month-olds were flagged who did not have autism. Accuracy got better after 14 months.
How this fits with other research
Matson et al. (2004) first showed STAT works well at age two. This 2008 study pushes the same tool younger and finds the floor is about 14 months.
Wu et al. (2020) repeated the idea in Taiwan with a 2.5 cutoff and still got good results. Their data line up with the US findings.
Grigore et al. (2024) looked at all toddler screeners and say evidence is still shaky. Their warning sounds opposite, but it is about policy, not the STAT numbers. The tool can be accurate yet still need more outcome studies.
Why it matters
If you screen before 14 months, expect extra false alarms. After 14 months the STAT gives you high confidence you are not missing autism. Use the 2.75 cut, re-screen any child who fails, and keep parent concern in the mix.
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02At a glance
03Original abstract
The study examined the properties of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months. The STAT provides a standard context for observing social-communicative behavior in play, imitation, and communication. Seventy-one children received the STAT between 12 and 23 months of age and a follow-up diagnostic evaluation after 24 months. All had an older sibling with an autism spectrum diagnosis (n=59) or had been referred for evaluation for concerns about autism (n=12). Signal detection analysis resulted in a cut score of 2.75 for this sample, which yielded a sensitivity of 0.95, specificity of 0.73, positive predictive value of 0.56, and negative predictive value of 0.97. False positives were highest for the 12- to 13-month-old age group; STAT screening properties were improved when the sample was limited to children 14 months and older. Implications for using the STAT with children under 24 months are discussed.
Autism : the international journal of research and practice, 2008 · doi:10.1177/1362361308096403