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For flagging autism risk, using two tests is best option

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Laura Geggel
20 June 2014

The average child with autism is 18 months old before his parents first begin to be concerned. Given the importance of early intervention, it’s crucial that parents and doctors both catch on to the symptoms as soon as possible.

A study published 28 May in European Child and Adolescent Psychiatry finds that two autism screens are better than one at identifying toddlers who need specialized clinical services.

Screens are used not to diagnose autism, but rather to identify children who need more specialized attention — for example, from a child psychiatrist or a behavioral therapist.

Two such screens, the Modified Checklist for Autism in Toddlers (M-CHAT) and the Early Screening of Autistic Traits (ESAT), are widely used to assess children between 18 months and 3 years of age during routine doctor visits.

Each screen asks parents yes-or-no questions about their child’s behavior, such as whether the child makes eye contact or engages in imaginative play. More than three ‘No’ answers flags the child as being at risk for autism, and merits a referral to a specialist.

The researchers looked at surveys from nearly 13,000 mothers in the Norwegian Mother and Child Cohort Study, which follows children from birth through early childhood. The surveys asked the mothers about their children’s symptoms, and also whether a doctor had referred their child to a specialist by 18 months of age.

The survey revealed that the ESAT highlighted 0.5 percent of the children, or 71, as being at risk of autism, and the M-CHAT flagged 6.4 percent, or 826 children.

Used together, the two tests identified 52 children as being at risk for autism. Parents of these children reported more clinical and developmental concerns than parents of children who screened positive on the M-CHAT alone.

Though the M-CHAT flagged more children than the ESAT, doctors — who did not see the results of the screens — had referred just 10 percent of the 826 children to specialists compared with 30 percent of the ESAT group. Those in the ESAT group also have more behavioral, health and developmental problems than those in the M-CHAT group.

It’s possible that the M-CHAT misidentifies some children in the general population as being at risk of autism, the researchers say. This may help children with autism get the services they need, but may also cause unnecessary anxiety when the child does not have autism. By contrast, the ESAT may be too conservative, potentially missing children with the disorder.

Neither screen picked up another 103 children in the study who received a referral for specialized services. This suggests that even used together, the tests may miss some children at risk of autism. (The researchers did not report how many children in the study have autism.) 

Still, the two tests together flag more children who need these services than either test alone, the researchers note. They recommend combining the screens for routine use by pediatricians.

News and Opinion articles on SFARI.org are editorially independent of the Simons Foundation.


Name: Florencia Ardon
20 June 2014 - 3:29PM

Thank you for the information. I agree that early intervention is good and that early detection is key. But I do wish the "at risk" were not used anymore. Kids are not "at risk" of developing autism, they already ARE autistic (if they end up being diagnosed). SFARI news itself has published about how differences in brain anatomy and physiology start in the womb. This "at risk" wording keeps fueling fears of kids "acquiring" autism through whatever fad cause, be it gluten or dairy or vaccines. Please be careful with the words you use!

Name: lmn
29 June 2014 - 4:00AM

They are detecting autism as young as 9 months in Canada!

Name: lmn
29 June 2014 - 4:06AM

Furthermore, we know that autism stems from the mother. Early intervention is best! Don't wait until the child is 18 MO. Testing starts early as stated above.

Name: md
7 March 2015 - 8:17AM

I disagree with you Imn that the mother is the only donor. This condition is also affected by father's genes, furthermore old fathers are known of having autistic kids

Name: md
7 March 2015 - 8:06AM

In severe cases it will be easy to detect early, however in mild ones you might have to wait until 18 or 24 months. I do suggest using " developing" autism instead of are "at risk" since the condition is affected by different factors (genetic, toxic, social, food, age, etc ) and some of these factors are variable!!!

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