| "Screening Tool Can Identify Autism at 18 Months of Age" WESTPORT, May 31 (Reuters Health |
| The Checklist for Autism in Toddlers has a high positive predictive value for autism and related disorders in children at 18 months of age. However, screening this age group identifies only about one third of children who will be diagnosed with autism by age 7 years, according to Dr. Tony Charman, of the Institute of Child Health, in London, UK, and colleagues. The investigators examined the sensitivity, specificity and positive predictive value of the Checklist in 16,235 children who were first screened by primary care providers at age 18 months. The instrument "assesses pretend play, proto-declarative pointing, and gaze monitoring." The children were screened again at 3 years and 5 years, and followed up at age 7 years. Nineteen cases of childhood autism were identified in the cohort at the 18-month screening, and 50 cases by 7 years. The specificity of the checklist at 18 months was 98%, but the sensitivity was only 38%. A two-stage screening procedure, performed at an interval of 1 month, increased the positive predictive value of the Checklist to 75% in high-risk children, increased the specificity to nearly 100%, but decreased the sensitivity to only 20%. The Checklist also identified autism-related disorders, such as pervasive developmental disorder, the team reports in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The new findings demonstrate "that autism can be prospectively identified at 18 months of age," Dr. Charman and colleagues say. "In light of the need for genetic advice so that parents can make informed decisions about increasing their family size...and with encouraging evidence of the benefits of early intervention programs...early detection of autism may result in considerable benefit to children and their families," they conclude. (J Am Acad Child Adolesc Psychiatry 2000;39:694-702) |