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Sensitivity and Specificity of 2 Autism Screeners Among Referred Children Between 16 and 48 Months of Age

Salisbury, Louisa, A., MD*; Nyce, Jonathan, D., MD; Hannum, Charles, D., MD; Sheldrick, R., Christopher, PhD§; Perrin, Ellen, C., MD

Journal of Developmental & Behavioral Pediatrics: April 2018 - Volume 39 - Issue 3 - p 254–258
doi: 10.1097/DBP.0000000000000537
Brief Report

Objective: Autism screening is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention at ages 18 and 24 months. Popular screening tests have been validated for the age range of 16 to 30 months. However, only a minority of children with autism spectrum disorder (ASD) are identified by age 3 years, and many are not identified until after they enter school. Thus, we aimed to measure the sensitivity and specificity of 2 available screening tests for ASDs in children older than 30 months.

Methods: We assessed the sensitivity and specificity of 2 ASD screening tools administered to parents of children who were referred to a developmental clinic between the ages of 16 and 48 months: the Modified Checklist for Autism in Toddlers (M-CHAT) and the Parent's Observations of Social Interactions (POSI), which is a component of a comprehensive screening instrument called, the Survey of Well-being of Young Children.

Results: Both the M-CHAT and the POSI had acceptable sensitivity (≥75%) among children across the age range studied. Their specificity was limited by the fact that the study was conducted in a developmental referral clinic.

Conclusion: Two readily available screening tools, the POSI and the M-CHAT, have acceptable sensitivity in evaluating risk for autism in children at least to age 48 months. Further research should investigate their sensitivity and specificity when used in primary care settings.

*Department of Pediatrics, Mammoth Hospital, Mammoth Lakes, CA;

Kravis Children's Hospital at Mount Sinai, New York, NY;

Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA;

§Boston University School of Public Health, Boston, MA.

Address for reprints: Ellen C. Perrin, MD, 800 Washington Street, #854, Tufts Medical Center, Boston, MA 02111; e-mail:

Disclosure: E. C. Perrin and R. C. Sheldrick are among the coauthors of the Parent's Observations of Social Interactions (POSI), which is a component of the Survey of Well-being of Young Children (SWYC). The remaining authors declare no conflict of interest.

See the Video Abstract at

Received June , 2017

Accepted November , 2017

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