TABLE 6

Commonly Used ASD Screening Tests

Autism Screening TestsDescriptionAge RangeAverage No. ItemsAdministration TimeForms Available EHR compatiblePsychometric PropertiesScoring MethodCultural ConsiderationsSourceKey References
M-CHAT-R/FParent-completed questionnaire designed to identify children at risk for autism from the general population; follow-up clinician-administered questions and repeat questionnaire required for specificity16–30 mo205–10 minYesStandardization sample included 16 071 children screened; 115 had positive screen results, 348 needed evaluation, 221 were evaluated, and 105 diagnosed with an ASD; validated by using the ADI-R, ADOS-G, CARS, and DSM-IV-TR; sensitivity: 0.91; specificity: 0.95 for low-risk 18- and 24-mo-old children with follow-up questionnaire and interview; 45% of children with a score ≥3 on the initial screen and ≥2 on follow-up had ASD; 95% had clinically significant developmental delayRisk categorization for questionnaire (pass/need interview/ fail); after interview (pass/fail)Available in multiple languages; see test information for detailshttp://mchatscreen.com/Ref 51
SCQParent-completed questionnaire; designed to identify children at risk for ASD from the general population; based on items in the ADI-R4+ y405–10 minNoValidated by using the ADI-R and DSM-IV on 200 subjects (160 with pervasive developmental disorder, 40 without pervasive developmental disorder); for use in children with mental age of at least 2 y and chronologic age 4+ y; available in 2 forms: lifetime and current. overall test: sensitivity: 0.85 (moderate), specificity: 0.75 (moderate); sensitivity can be improved with lowering cutoff for children younger than 5 y and 5–7 y, specificity poor for younger childrenRisk categorization (pass/fail)Available in multiple languages; see test information for details.Western Psychological Corporation: www.wpspublish.comRefs 77 and 572
STATClinician-directed, interactive, and observation measure; requires training of clinician for standardized administration; not for population screening24–35 mo; <24 mo (exploratory)1220–30 minNoValidated by comparison with ADOS-G results in 52 children 24–35 mo (26 with autism, 26 with developmental delay); sensitivity: 0.83, specificity: 0.86, PPV: 0.77, NPV: 0.90, for <24 mo: sensitivity: 0.95, specificity: 0.73, PPV: 0.56, NPV: 0.97; screening properties improved for children >14 mo12 activities to observe early social-communicative behavior; risk categorization (high risk/low risk)Englishhttp://stat.vueinnovations.com/Refs 573 and 574
Promising autism screening tests
 The Infant/Toddler Checklist (Communication and Symbolic Behavior Scales Developmental Profile)Parent questionnaire: screens for language delay6–24 mo2415 minNoPPV DD: 0.43 (6–8 mo); PPV DD: 0.79 (21–24 mo)Identifies language delays (alone/with ASD); risk for ASD; risk status for social, speech, symbolic composites, and total scoreAvailable in multiple languages; see test information for detailsPaul H. Brookes Publishing Co Inc: 800-638-3775 or www.brookespublishing.comRef 59
 Early Screening for Autism and Communication DisordersParent questionnaire: research edition, 47 items12–36 mo4710–15 minNoSensitivity: 0.85–0.91; specificity: 0.82–0.84; PPV: 0.55–0.81; NPV: 0.88–0.98Investigation ongoing of subset (24 items)Englishhttps://firstwordsproject.com/screen-my-child/Not in peer-reviewed literature
 First-Year InventoryParent questionnaire; promising in high-risk population to identify risk in 12-mo-old infants12 mo6310 minNoSensitivity, specificity, PPV not reportedScores at risk; promising in high-risk (infant sibling) cohort (Rowberry et al575)Englishhttps://www.med.unc.edu/ahs/pearls/research/first-year-inventory-fyi-development/Ref 575
 Parent’s Observations of Social InteractionsParent questionnaire used to assess autism risk; ASD screening included on 18-, 24-, and 30-mo The Survey of Well-Being of Young Children: forms16–35 mo7∼5 minAvailable through patient tools, epic, and CHADIS; available for free download as pdfs from www.theswyc.orgSensitivity: 83%–93%, average 88.5%; specificity: 42%–75%, average 56.9%3 of 7 symptoms in at-risk rangeAvailable in multiple languages; see test information for detailsFree download from www.theswyc.orgPublications and User’s Manual available at www.theswyc.org; Refs 576 and 577
 Rapid Interactive Screening Test for Autism in Toddlers 13Clinician observation: administered by trained examiner12–36 mo9 interactive items20–30 minNoCutoff >15; sensitivity: 1; specificity: 0.84; PPV: 0.88; NPV: 0.94; needs further study in larger samples9 interactive activities; total score summed, cutoff score of 15 (for that sample)Englishhttps://umassmed.edu/AutismRITA-T/about-the-test/Ref 578
  • The AAP does not approve/endorse any specific tool for screening purposes. This table is not exhaustive, and other tests may be available. ADOS-G, Autism Diagnostic Observation Schedule – Generic; CARS, Childhood Autism Rating Scale; CHADIS, Comprehensive Health and Decision Information System; EHR, electronic health record; ICD-10, International Classification of Diseases, 10th revision; IMFAR, International Meeting for Autism Research; NPV, negative predictive value; PPV, positive predictive value.