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Autism screening with follow-up overidentifies autism spectrum disorder

Question clinique

What is the accuracy of a 2-step process for universal screening for autism spectrum disorder of children ages 16 months to 26 months?

L’Essentiel

Screening for autism spectrum disorder (ASD) with the Modified Checklist for Autism in Toddlers with follow-up interviews for children who screen positive is effective in screening out children who do not have ASD (negative predictive value 98.6% at 2.2% prevalence). The initial screening will identify approximately 10% of toddlers as possibly having ASD, though 94.8% of those children will be excluded in the follow-up interview. Overall, the positive predictive value is only 14.6%, meaning that 85% of the children who screen positive for ASD will be falsely positive. Although some groups recommend universal screening, the U.S. Preventive Services Task Force cites a lack of evidence to support the benefit of early identification. 1b

Référence

Guthrie W, Wallis K, Bennett A, et al. Accuracy of autism screening in a large pediatric network. Pediatrics 2019;144(4):e20183963.

Plan de l'etude: Cohort (prospective)

Financement: Foundation

Cadre: Outpatient (primary care)

Sommaire

This study evaluated the effect of universal screening in primary care for autism at a single hospital using Modified Checklist for Autism in Toddlers with Follow-Up (MCHAT-F). Over 4.5 years, they screened 25,999 children between the ages of 16 months and 26 months. At first screening, almost 1 in 10 children screened positive (9.1%). However, in the follow-up interview almost all of those children (94.8%) were no longer considered to have ASD and the final prevalence in the group was 2.2% by 4 years of age. The resulting positive predictive value was only 14.6%, with a negative predictive value of 98.6% (sensitivity 38.8%, specificity 94.9%). In other words, 85% of parents who have a child who initially screens positive will later be told the result was incorrect. The positive predictive value for girls was even lower (7.7%). For children correctly screened as positive, the time to diagnosis was an average 7.45 months earlier than those who screened negative. Whether this benefit results in faster access to treatment, with better results, is not known.

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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Commentaires

Roland Michael Grad

Screening for autism or developmental delay?

In line with this POEM, the Canadian Task Force on Preventive Health Care strongly recommends against screening for developmental delay in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no concerns about development.

janvier 1, 2020

Subject: Autism and Autistic Children of Our Society

Dear Respected CMA Team,
I have read the case /Poem
upon which is appeared by you to us /doctors /patients/all.
Autism is a great problem for children and children students. They need proper treatments or, prescribed medicine and counseling by doctors . But ,all Autistic children /children students must be under socialization elements by parents /school teachers /clinical counselor psychologists /doctors /disability practitioners /psychiatrists to become active /productive /good citizens of the nation.
Autistic children can face power of speaking/power of hearing /power of eye sights /power of walking /power of movement problems in life.
But ,they must be under socialization elements and treatments.
My best wishes to global Autistic children (male and female) ,best wishes and honour to global parents /teachers ,honour to global psychologists/doctors /school teachers /Autistic practitioners /Disability practitioners for their kind efforts for the development thoughts of good life to Autistic children.
Best wishes and Respectfully.
Dr.Muhammad Arif Rana
Global Family Doctor (LDM Roll-224)-WONCA at SIG Based in Manikganj-Bangladesh.
Health Professional Member -ID NO-52698-MDS-USA.
International Resident Member-CMAID-680777-CMA-Canada.
(Happy New Year-2020 to Dear Respected all towards peaceful life , happiness and prosperity )
Email:muhammadarifrana3@gmail.com
Date : January 09-2020-Thursday-05:07 PM.

janvier 9, 2020
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