Systematic, standardized screening for autism in toddlers through pediatric clinic visits

Lack of systematic screening may delay identification of autism spectrum disorders (ASDs), which may limit developmental outcomes of affected children. Pediatric clinics are logical screening points due to frequency of visits for immunizations, well- and sick-child visits. The American Academy of Pediatrics established guidelines recommending use of formal autism-specific screening instruments for all children during well-child visits at ages 18 and 24 months. Most physicians, however, do not use formal, standardized screening instruments for ASDs in this age group. The current study controlled for the most frequently cited barrier to screening (e.g., time) in a community pediatric clinic by providing scoring and follow-up for parent-report screening questionnaires distributed by clinic staff. Parents of all patients born in 2006 who visited during the six-month study period were offered questionnaires. The pediatric clinic staff was successful in screening 813 or 81% of eligible children with minimal intrusion into existing practice. Of 13 children identified by a follow-up, in-person screening as showing significant early signs of autism, only 23% had previously been referred for autism early intervention. Another 31% had previously been referred to early intervention for other reasons. No previous referral had been given 46%. An additional benefit from screening was identification of 16 children with symptoms of non-ASD developmental delays, of which 67% had not previously been referred to early intervention. The at-risk incidence rate from the sample population was 1.6% or 1 in 63. This is higher than the prevalence rate from a study of 8-year-olds statewide with clinical diagnoses or ASD educational classification, which is 1 in 133. This study is the first to compare sensitivity and specificity of the Modified Checklist for Autism in Toddlers (MCHAT) and the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (ITC) within the same sample. The study concludes that screening all toddlers for autism in a pediatric clinic setting is capable of identifying children with significant early signs of autism and other delays, prompting earlier referral than present practice. The high incidence rate and lower sensitivity and specificity of screening questionnaires need to be verified by longitudinal follow-up to determine accuracy.