Toddler Screening for Autism Spectrum Disorder: A Meta-Analysis of Diagnostic Accuracy

Sánchez-García, Ana B.; Galindo-Villardón, Purificación; Librero, Ana Belén Nieto; Rodero, Helena Martín; Robins, Diana L.

doi:10.1007/s10803-018-03865-2

Cited by 46 publications

(35 citation statements)

References 51 publications

(116 reference statements)

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“…All the other measures did not report any positive or negative predictive values. Overall considered, the measures for which the Sensitivity, Specificity, PPVs and NPVs were reported, demonstrated from moderate to high predictive values (see also [27]), although for the M-CHAT results can be considered more stable compared to other measures that need further and deeper exploration of these properties.…”

Section: Discussionmentioning

confidence: 99%

“…Although we found these measures promising, none of them can be currently considered as the gold standard in the early detection of risk of ASD and further development in this field is desirable. For example, future studies should improve sensitivity, specificity, NPV, and PPV properties of those measures since they are not considered at all for the FYI and they are barely considered for M-CHAT and Q-CHAT, as also suggested by [27].…”

Section: Discussionmentioning

confidence: 99%

“…The meta-analysis by Sánchez-García and colleagues [27] evaluated the accuracy of screening measures according only to their sensitivity, specificity, positive, and negative predictive values (PPV and NPV respectively); furthermore, their electronic search was limited to 5 databases and included paper published up to 2015. Finally, the review by Thabtah and Peebles [28] provided a no systematic review on screening tools administrable from toddlerhood to adulthood, but the authors did not report the search strategy (i.e., databased searched; range of publication years considered) applied and described the tools only in terms of sensitivity and specificity.Summarizing, most of the above-mentioned reviews are not systematic [22,24,25,28], have limited search strategies to 1-5 databases [22][23][24]26,27], or focus on a specific geographic area as Europe or USA [21,22,24]. Furthermore, they did not analyze the psychometric and measurement properties of the measures with the exception of Sánchez-García and colleagues [27] meta-analysis which applied the Bayesian Hierarchical Model to evaluate some psychometric properties associated to accuracy.…”

mentioning

confidence: 99%

“…Summarizing, most of the above-mentioned reviews are not systematic [22,24,25,28], have limited search strategies to 1-5 databases [22][23][24]26,27], or focus on a specific geographic area as Europe or USA [21,22,24]. Furthermore, they did not analyze the psychometric and measurement properties of the measures with the exception of Sánchez-García and colleagues [27] meta-analysis which applied the Bayesian Hierarchical Model to evaluate some psychometric properties associated to accuracy.…”

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confidence: 99%

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Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers

2020

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The present study provides a systematic review of level 1 and level 2 screening tools for the early detection of autism under 24 months of age and an evaluation of the psychometric and measurement properties of their studies. Methods: Seven databases (e.g., Scopus, EBSCOhost Research Database) were screened and experts in the autism spectrum disorders (ASD) field were questioned; Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and Consensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist were applied. Results: the study included 52 papers and 16 measures; most of them were questionnaires, and the Modified-CHecklist for Autism in Toddler (M-CHAT) was the most extensively tested. The measures’ strengths (analytical evaluation of methodological quality according to COSMIN) and limitations (in term of Negative Predictive Value, Positive Predictive Value, sensitivity, and specificity) were described; the quality of the studies, assessed with the application of the COSMIN checklist, highlighted the necessity of further validation studies for all the measures. According to COSMIN results, the M-CHAT, First Years Inventory (FYI), and Quantitative-CHecklist for Autism in Toddler (Q-CHAT) seem to be promising measures that may be applied systematically by health professionals in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers

2020

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“…Given the aforementioned considerations, the FYI and Q-CHAT appear to be promising measures, as indicated in previous studies [ 37 , 38 , 39 ], though several gaps exist in the development of the two measures. Further longitudinal studies are especially needed to test their properties, as also suggested by other authors [ 62 ]. As underlined in a systematic review conducted by Petrocchi et al [ 37 ], the FYI and Q-CHAT cannot yet be considered as the gold standard, which includes instruments with the highest reliability, of the early identification of risk of ASD.…”

Section: Introductionmentioning

confidence: 96%

The Criterion Validity of the First Year Inventory and the Quantitative-CHecklist for Autism in Toddlers: A Longitudinal Study

2020

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Pediatric surveillance through screening procedures is needed to detect warning signs of risk for Autism Spectrum Disorder under 24 months of age and to promote early diagnosis and treatment. The main purpose of this study is to extend the literature regarding the psychometric properties of two screening tools, the First Year Inventory (FYI) and the Quantitative-CHecklist for Autism in Toddler (Q-CHAT), testing their criterion validity. They were administered during a three-wave approach involving the general population. At T1, 657 children were tested with the FYI and 36 of them were found to be at risk. At T2, 545 were tested with the Q-CHAT and 29 of them were found to be at risk. At T3, 12 out of the 36 children with a high score on the FYI and 11 out of the 29 children with a high score on the Q-CHAT were compared to 15 typically developing children. The criterion validity was tested considering the severity of the autistic symptoms, emotional/behavioral problems, and limited global functioning as criteria. Accuracy parameters were also calculated. Furthermore, we investigated which dimension of each questionnaire better predicted the aforementioned criterion. The results corroborated the hypotheses and confirmed the criterion validity of FYI and Q-CHAT.

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Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

et al. 2023

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ImportanceThe Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F)—henceforth referred to as M-CHAT(-R/F)—are the most commonly used toddler screeners for autism spectrum disorder (ASD). Their use often differs from that in the original validation studies, resulting in a range of estimates of sensitivity and specificity. Also, given the variability in reports of the clinical utility of the M-CHAT(-R/F), researchers and practitioners lack guidance to inform autism screening protocols.ObjectiveTo synthesize variability in sensitivity and specificity of M-CHAT(-R/F) across multiple factors, including procedures for identifying missed cases, likelihood level, screening age, and single compared with repeated screenings.Data SourcesA literature search was conducted with PubMed, Web of Science, and Scopus to identify studies published between January 1, 2001, and August 31, 2022.Study SelectionArticles were included if the studies used the M-CHAT(-R/F) (ie, original or revised version) to identify new ASD cases, were published in English-language peer-reviewed journals, included at least 10 ASD cases, reported procedures for false-negative case identification, screened children by 48 months, and included information (or had information provided by authors when contacted) needed to conduct the meta-analysis.Data Extraction and SynthesisThe systematic review and meta-analysis was conducted within the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality Assessment of Diagnostic Accuracy Studies–2 tool evaluated bias in sample selection. Data extraction and quality assessment were performed by 2 authors independently. The overall diagnostic accuracy of the M-CHAT(-R/F) was assessed with the hierarchic summary receiver operating characteristic (HSROC) model.Main Outcomes and MeasuresSensitivity, specificity, diagnostic odds ratios, and HSROC curves of M-CHAT(-R/F).ResultsThe review included 50 studies with 51 samples. The pooled sensitivity of M-CHAT(-R/F) was 0.83 (95% CI, 0.77-0.88), and the pooled specificity was 0.94 (95% CI, 0.89-0.97). Heterogeneity analyses revealed greater diagnostic accuracy for low- vs high-likelihood samples, a concurrent vs prospective case confirmation strategy, a large vs small sample size, use of M-CHAT(-R/F) Follow-up, and non-English vs English only.Conclusions and RelevanceOverall, results of this study suggest the utility of the M-CHAT(-R/F) as an ASD screener. The wide variability in psychometric properties of M-CHAT(-R/F) highlights differences in screener use that should be considered in research and practice.

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Toddler Screening for Autism Spectrum Disorder: A Meta-Analysis of Diagnostic Accuracy

Cited by 46 publications

References 51 publications

Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers

Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers

The Criterion Validity of the First Year Inventory and the Quantitative-CHecklist for Autism in Toddlers: A Longitudinal Study

Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

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