Sensitivity and specificity of early screening for autism

doi:10.1192/bjo.2019.34

. 2019 May 17;5(3):e41.

doi: 10.1192/bjo.2019.34.

Sensitivity and specificity of early screening for autism

Affiliations

¹ Physician and Researcher, Norwegian Institute of Public Health, Norway.
² Psychologist and Researcher, Norwegian Institute of Public Health; Nic Waals Institute, Lovisenberg Hospital, Norway; and MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK.
³ Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University; and New York State Psychiatric Institute, USA.
⁴ Physician and Researcher, National Institute of Neurological Disorders and Stroke, USA.
⁵ Associate Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, USA.
⁶ Professor, Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine, USA.
⁷ Department Director and Professor, Norwegian Institute of Public Health; and Institute of Clinical Medicine, University of Oslo, Norway.
⁸ Psychologist and Researcher, Norwegian Institute of Public Health, Norway.
⁹ Psychologist and Researcher, Norwegian Institute of Public Health;and Nic Waals Institute, Lovisenberg Hospital, Norway.
¹⁰ Center Director and Professor, Norwegian Institute of Public Health, Norway.
¹¹ Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University; and New York State Psychiatric Institute, USA.
¹² Center Director and Professor, Center for Infection and Immunity, Mailman School of Public Health, Columbia University; and Vagelos College of Physicians and Surgeons, Columbia University, USA.
¹³ Director General and Professor, Norwegian Institute of Public Health; and Department of Global Public Health and Primary Care, University of Bergen, Norway.

PMID: 31530312
PMCID: PMC6537444
DOI: 10.1192/bjo.2019.34

Sensitivity and specificity of early screening for autism

Pål Surén et al. BJPsych Open. 2019.

. 2019 May 17;5(3):e41.

doi: 10.1192/bjo.2019.34.

Authors

Affiliations

¹ Physician and Researcher, Norwegian Institute of Public Health, Norway.
² Psychologist and Researcher, Norwegian Institute of Public Health; Nic Waals Institute, Lovisenberg Hospital, Norway; and MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK.
³ Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University; and New York State Psychiatric Institute, USA.
⁴ Physician and Researcher, National Institute of Neurological Disorders and Stroke, USA.
⁵ Associate Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, USA.
⁶ Professor, Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine, USA.
⁷ Department Director and Professor, Norwegian Institute of Public Health; and Institute of Clinical Medicine, University of Oslo, Norway.
⁸ Psychologist and Researcher, Norwegian Institute of Public Health, Norway.
⁹ Psychologist and Researcher, Norwegian Institute of Public Health;and Nic Waals Institute, Lovisenberg Hospital, Norway.
¹⁰ Center Director and Professor, Norwegian Institute of Public Health, Norway.
¹¹ Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University; and New York State Psychiatric Institute, USA.
¹² Center Director and Professor, Center for Infection and Immunity, Mailman School of Public Health, Columbia University; and Vagelos College of Physicians and Surgeons, Columbia University, USA.
¹³ Director General and Professor, Norwegian Institute of Public Health; and Department of Global Public Health and Primary Care, University of Bergen, Norway.

PMID: 31530312
PMCID: PMC6537444
DOI: 10.1192/bjo.2019.34

Abstract

Background: Early identification and diagnosis is beneficial for children with autism spectrum disorder (ASD). Universal early screening is recommended by many experts, but disputed because evidence is limited, and sensitivity and specificity in general populations are largely unknown.

Aims: To estimate the sensitivity and specificity of early population-based screening for ASDs.

Method: The study was based on the Norwegian Mother and Child Cohort Study. The 36-month cohort questionnaire included the Social Communication Questionnaire (SCQ), a 40-item screening instrument for ASD.

Results: A total of 58 520 mothers (58%) responded to the questionnaire. By the end of follow-up on 31 December 2015, 385 (0.7%) individuals with ASD had been identified among the responders' children. The distributions of SCQ scores in those with ASD and other children had large degrees of overlap. With the cut-off of 15 recommended in the SCQ manual, screening sensitivity was 20% (95% CI 16-24) for ASD overall. For children with ASD who had not developed phrase speech at 36 months, sensitivity was 46% (95% CI 35-57%), whereas it was 13% (95% CI 9-17) for children with ASD with phrase speech. Screening specificity was 99% (95% CI 99-99). With the currently recommended cut-off of 11, sensitivity increased to 42% for ASD overall (95% CI 37-47), 69% (95% CI 58-79) for ASD without phrase speech and 34% (95% CI 29-40) for ASD with phrase speech. Specificity was then reduced to 89% (95% CI 89-90).

Conclusions: Early ASD screening with a parent checklist had low sensitivity. It identified mainly individuals with ASD with significant developmental delay and captured very few children with ASD with cognitive skills in the normal range. Increasing sensitivity was not possible without severely compromising specificity.

Declaration of interest: C.L. receives royalty for the Social Communication Questionnaire, which she has co-authored.

Keywords: Autistic spectrum disorders; developmental disorders; epidemiology.

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Figures

**Fig. 1**
Receiver operating characteristic (ROC) curves for the Social Communication Questionnaire (SCQ): autism spectrum disorder (ASD) without phrase speech at 36 months.

**Fig. 2**
Receiver operating characteristic (ROC) curves for the Social Communication Questionnaire (SCQ): autism spectrum disorder (ASD) with phrase speech at 36 months.

See this image and copyright information in PMC

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References

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[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – DSM-IV (4th edn). American Psychiatric Association, 2013.

[2] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – DSM-IV (4th edn). American Psychiatric Association, 2013.

[3] Johnson CP, Myers SM. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007; 120: 1183–215. - PubMed

[4] Johnson CP, Myers SM. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007; 120: 1183–215. - PubMed

[5] National Institute for Health and Care Excellence (NICE). Autism Spectrum Disorder in Under 19s: Recognition, Referral and Diagnosis. NICE, 2011. (https://www.nice.org.uk/guidance/cg128). - PubMed

[6] National Institute for Health and Care Excellence (NICE). Autism Spectrum Disorder in Under 19s: Recognition, Referral and Diagnosis. NICE, 2011. (https://www.nice.org.uk/guidance/cg128). - PubMed

[7] Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D. Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics 2014; 133: 37–45. - PMC - PubMed

[8] Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D. Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics 2014; 133: 37–45. - PMC - PubMed

[9] McPheeters ML, Weitlauf A, Vehorn A, Taylor C, Sathe NA, Krishnaswami S, et al. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Screening for Autism Spectrum Disorder in Young Children: A Systematic Evidence Review for the US Preventive Services Task Force. Agency for Healthcare Research and Quality, 2016. - PubMed

[10] McPheeters ML, Weitlauf A, Vehorn A, Taylor C, Sathe NA, Krishnaswami S, et al. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Screening for Autism Spectrum Disorder in Young Children: A Systematic Evidence Review for the US Preventive Services Task Force. Agency for Healthcare Research and Quality, 2016. - PubMed

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Sensitivity and specificity of early screening for autism

Affiliations

Sensitivity and specificity of early screening for autism

Authors

Affiliations

Abstract

Figures

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References

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