Screening strategies for autism spectrum disorders in pediatric primary care

J Dev Behav Pediatr. 2008 Oct;29(5):345-50. doi: 10.1097/DBP.0b013e31818914cf.


Background: Two strategies have been proposed for early identification of children with autism spectrum disorders (ASD): (1) using a general screening tool followed by an ASD-specific screening tool for those who screen positive on the former or (2) using an ASD-specific tool for all children. The relative yield of these two strategies has not been examined.

Objectives: This study compared the number of children identified at risk for ASD at their well child visits between the ages of 18 and 30 months using a general developmental screening tool and an autism-specific screening tool.

Methods: The Parents' Evaluation of Developmental Status (PEDS) was used as the general developmental screening tool and the Modified Checklist for Autism in Toddlers (M-CHAT) was used as the autism-specific tool. These tools were administered concurrently to 152 children.

Results: Cross tabulations and chi tests were used to determine the utility of the PEDS as the first step of a two-part screen for ASD. Of those who screened positive for developmental concerns on the PEDS (n = 38), 16% screened positive for ASD on the M-CHAT; of those who did not screen positive for developmental concerns on the PEDS (n = 114), 14% screened positive for ASD on the M-CHAT (p = .79).

Conclusion: The PEDS missed the majority of children who screened positive for ASD on the M-CHAT, suggesting that these two tools tap into very different domains of developmental concerns. The findings support the use of an ASD-specific tool for all children in conjunction with regular standardized developmental screening.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Autistic Disorder / diagnosis*
  • Autistic Disorder / psychology
  • Child, Preschool
  • Cost-Benefit Analysis / statistics & numerical data
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Male
  • Mass Screening / economics
  • Mass Screening / methods*
  • Middle Aged
  • Parents / psychology
  • Primary Health Care / methods*
  • Primary Health Care / statistics & numerical data
  • Psychiatric Status Rating Scales / standards
  • Reproducibility of Results
  • Risk Assessment / methods
  • Sensitivity and Specificity
  • Surveys and Questionnaires
  • Young Adult