Beyond pass‐fail: Examining the potential utility of two thresholds in the autism screening process

Abstract

Access to early intervention as early in development as possible is critical to maximizing long-term outcomes for children with autism spectrum disorders (ASD). However, despite the fact that ASD can be reliably diagnosed by 24 months, the average age of diagnosis is 2 years later. Waitlists for specialized developmental evaluations are one barrier to early diagnosis. The purpose of this study was to examine one potential approach to reducing wait time for an ASD diagnostic evaluation by examining the utility of using more than one threshold for an autism screening tool, the Screening Tool for Autism in Toddlers and Young Children (STAT). Participants included 171 children between 24 and 36 months of age who received a medical diagnostic evaluation through Illinois' Early Intervention Program. This study directly compared the performance of the STAT when scored: (a) using the original single threshold, (b) using seven equally weighted items using a single threshold, and (c) using all items differentially weighted based on how strongly that item predicts a later ASD diagnosis. In addition, this study explored the potential utility of using two thresholds rather than a single threshold for each scoring method. Results of this study suggest that using a two-threshold logistic regression method has potential psychometric advantages over a single threshold and categorical scoring. Using this approach may reduce the wait time for specialty ASD diagnostic evaluations by maximizing true negatives and true positives, such that specialty evaluations may be reserved for those cases that are more ambiguous or more complex.Lay Summary: This study examined the benefits of using two versus one cutoff score when screening for autism. Results indicate that having two scores and weighting test items based on predictive association with an autism diagnosis is better than using a single score and weighting each item equally. Using such an approach may reduce the wait time for specialty autism diagnostic evaluations, such that specialty evaluations may be reserved for those cases that are more ambiguous or more complex.

Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis

“…Screening practices for autism must be streamlined within medical homes to best identify the needs for early intervention, optimize parent access to early intervention, and identify needs toward addressing parent stress and quality of life during this critical developmental period. Novel methods toward improving observational screening practices may optimize this process in pediatric care (Hampton, Curtis, & Roberts, 2019; Roberts, Stern, et al, 2019; Talbott et al, 2020). Furthermore, underlying medical conditions should be screened and examined more thoroughly at the onset of concern such that early intervention models can be leveraged with an understanding of underlying conditions and associated characteristics (Whitehouse, 2017).…”

Autism Screening in Early Childhood: Discriminating Autism From Other Developmental Concerns

“…The STAT was first described in an unpublished manual [see (21)] as a brief interactive measure that did not demand language comprehension and could be used by health-care workers and related professionals. A number of published evaluation studies have emanated from laboratories led by researchers from four different US institutions and from one Taiwanese university (21,(43)(44)(45)(46)(47)(48).…”

“…Whether the administrator was blind to referral reasons and diagnosis of the child in the studies cited above is sometimes clear (21,43,46,48), but not always (45). Administrator training is usually carefully described, but inter-rater reliability data are presented meticulously in some papers (44,46), quite vaguely (i.e., difficult to interpret) in some (43,48) and not at all in others (45)-although reference to other published reliability data (46) or the meeting of online training criteria may be present (44,47).…”

Functional Connectivity Underlying Symptoms in Preschool Boys With Autism: A Resting-State Functional Magnetic Resonance Imaging Study

“…This means that using single-sex subjects in early childhood is one of the most promising ways to explore a more pure, uncompensated model of typical ASD developmental disorders. However, despite the fact that ASD can be early diagnosed by 24 months, the average age of diagnosis is 2 years later ( Roberts et al, 2019 ), so preschool age may be the appropriate age to study ASD.…”