Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months

Raymond Sturner; Barbara Howard; Paul Bergmann; Tanya Morrel; Rebecca Landa; Kejuana Walton; Danielle Marks

doi:10.1007/s10803-017-3231-0

Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months

J Autism Dev Disord. 2017 Oct;47(10):3296-3310. doi: 10.1007/s10803-017-3231-0.

Authors

Raymond Sturner^{1

2

3}, Barbara Howard^{4

5}, Paul Bergmann^{6

7}, Tanya Morrel⁵, Rebecca Landa^{4

8}, Kejuana Walton^{5

9}, Danielle Marks^{4

10

11}

Affiliations

¹ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. rsturner@childhealthcare.org.
² Center for Promotion of Child Development through Primary Care, Baltimore, MD, 21210, USA. rsturner@childhealthcare.org.
³ , 6017 Altamont Place, Baltimore, MD, 21210, USA. rsturner@childhealthcare.org.
⁴ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
⁵ Total Child Health, Baltimore, MD, 21210, USA.
⁶ Foresight Logic, Inc., Saint Paul, MN, USA.
⁷ PrairieCare Institute, Minneapolis, MN, USA.
⁸ Kennedy Krieger Institute, Baltimore, MD, 21287, USA.
⁹ Baltimore Healthy Start, Baltimore, MD, 21218, USA.
¹⁰ Sinai Hospital, Baltimore, MD, 21215, USA.
¹¹ Maternal and Child Health Unit, Public Health Division, Wyoming Department of Health, Evanston, WY, USA.

Abstract

Accuracy of autism screening using M-CHAT plus the follow-up interview (M-CHAT/F) for children screened positive at 18-months was compared to screening at 24-months. Formal ASD testing was criterion for a community sample of M-CHAT positive children (n = 98), positive predictive value (PPV) was 0.40 for the M-CHAT and 0.58 for the M-CHAT/F. MCHAT/F PPV was 0.69 among children 20+ months compared to 0.36 for <20 months. Multivariate analyses incorporating data from the Ages and Stages Questionnaire, MacArthur-Bates Communicative Development Inventory, M-CHAT and M-CHAT/F results, and M-CHAT items suggest language variables carry greatest relative importance in contributing to an age-based algorithm with potential to improve PPV for toddlers <20 months to the same level as observed in older toddlers.

Keywords: Autism screening; Developmental screening; M-CHAT; Toddler development.

MeSH terms

Age Factors
Algorithms
Autistic Disorder / diagnosis*
Autistic Disorder / psychology*
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Interview, Psychological / methods*
Interview, Psychological / standards
Male
Mass Screening / methods*
Mass Screening / standards
Physical Examination / methods*
Physical Examination / standards
Surveys and Questionnaires

Abstract

MeSH terms

Grants and funding