Comparison of the Yield from an Autism-specific and General Developmental Screener in an Urban Pediatric Population

Abstract

Background: It has been demonstrated that both general developmental screening and autism specific screening have value in the early identification of toddlers with neurodevelopmental issues in pediatric primary care. Few studies have considered the marginal benefit of adding autism specific screening to an existing regimen of general developmental screening. Objective: To determine if the addition of an autism specific screener, the Modified Checklist for Autism in Toddlers (M-CHAT), to a pediatric primary care visit where a general developmental screener, the Ages and Stages Questionnaire version II (ASQ II), is occurring identifies additional children at risk for neurodevelopmental issues and to explore factors associated with a positive M-CHAT screening result in a sample of children seen at four, urban pediatric primary care clinics. Methods: Existing data from a randomized trial of developmental screening conducted in 4 urban pediatric clinics from December 2008 to June 2010 were reanalyzed. Of the 2092 subjects in the trial arms, they were categorized as failing the M-CHAT only, failing the ASQ-II only, failing both, or failing neither and the proportion of children who failed the M-CHAT who did not fail the ASQ-II was estimated. In addition, the time to Early Intervention referrals and referral completion were compared among screening groups with Kaplan Meier estimates. Finally, we explored the association between demographic, environmental, and maternal child health factors with M-CHAT failure using logistic regression. Results: The proportion of children who failed the M-CHAT were missed by the ASQ-II was 32.61% (95% CI: 19.06% - 46.16%). Children who failed both were got EI referrals and EI referral completions faster and at an earlier age compared to children who failed one. Those who failed only the M-CHAT tended to be poorer than children who failed the ASQ-II only (61.54% and 23.10% having a household income of less than $5,000 a year, respectively). Children of a parent who felt depressed were 2.39 times as likely to fail the M-CHAT compared to parent who weren't (OR: 2.93, 95% CI: 1.28-4.48) and children who have helpful neighbors were 3.57 times as likely to fail the M-CHAT compared to children without helpful neighbors (OR: 3.57, 95% CI: 1.58-8.09). Conclusions: This study provides initial support for the administration of the M-CHAT in addition to general developmental screening is necessary because the ASQ-II may miss one third of the children who screen positive for autism. However, the final diagnostic status of children in this study was not known and should be considered when making a final determination about joint screening. Children who fail the M-CHAT are more likely to be poor, not have helpful neighbors, and have parents who may feel depressed compared to children who did not fail.%%%%M.P.H., Public Health – Drexel University, 2013