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Sensitivity and specificity of early screening for autism

  • Pål Surén (a1), Alexandra Saasen-Havdahl (a2), Michaeline Bresnahan (a3), Deborah Hirtz (a4), Mady Hornig (a5), Catherine Lord (a6), Ted Reichborn-Kjennerud (a7), Synnve Schjølberg (a8), Anne-Siri Øyen (a9), Per Magnus (a10), Ezra Susser (a11), W. Ian Lipkin (a12) and Camilla Stoltenberg (a13)...

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Pål Surén, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway. Email: pal.suren@fhi.no

References

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Sensitivity and specificity of early screening for autism

  • Pål Surén (a1), Alexandra Saasen-Havdahl (a2), Michaeline Bresnahan (a3), Deborah Hirtz (a4), Mady Hornig (a5), Catherine Lord (a6), Ted Reichborn-Kjennerud (a7), Synnve Schjølberg (a8), Anne-Siri Øyen (a9), Per Magnus (a10), Ezra Susser (a11), W. Ian Lipkin (a12) and Camilla Stoltenberg (a13)...
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