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Screening tools for autism spectrum disorder

Tool	Age	Description	Sensitivity/specificity	Validation	Comment
M-CHAT-R/F	16 to 30 months	20 caregiver-report items Takes approximately 5 minutes to administer and 2 minutes to score Available in English, Spanish, and other languages from the Official M-CHAT Website	Sensitivity: 85% Specificity: 99%	>15,000 children in primary care practices	Validated as first-tier screen*. Assesses risk of ASD as low, medium, or high. Children at medium risk require structured follow-up questions for additional information before referral for diagnostic evaluation. Follow-up interview takes approximately 5 to 10 minutes.
STAT	24 to 36 months	12 observed activities during 20-minute play session Requires training for administration and scoring	Sensitivity: 92 to 95% Specificity: 73 to 85%	52 children with ASD and other developmental disorders and 71 high-risk children	Not validated as a first-tier screen*. Language comprehension is not required.
ITC	6 to 24 months	24-item questionnaire, a component of the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP)	Positive predictive value: 75%	10,479 infants screened at one-year health supervision visit	The CSBS-DP is a broadband screen for communication delays but has not been validated as a screen for ASD.
POSI	18 to 35 months	7-item caregiver-report items, a component of the Survey of Wellbeing of Young Children (SWYC) Takes ≤5 minutes to complete	Sensitivity: 83% Specificity: 74%	232 children (16 to 36 months) from primary care and specialty clinics	Additional studies in community samples are necessary before the POSI can be recommended as a first-tier screen*.
POSI	18 to 35 months		Sensitivity: 89% Specificity: 54%	217 children (18 to 48 months) from specialty clinic
SCQ	4 to 40 years	40 caregiver-report items (yes/no) Takes <10 minutes to administer and <5 minutes to score	Sensitivity: 85% Specificity: 75%	200 high-risk patients	Additional studies are necessary before the SCQ can be used as a first-tier screen*. Nonverbal children may require different cut-off scores.
SCQ	4 to 40 years		Sensitivity: not reported Specificity: not reported 90% of children who failed (SCQ score ≥15) had a neurodevelopmental disorder	247 low-risk children from school or general population
ASSQ	7 to 16 years	27-item checklist to be completed by caregivers or teachers Takes approximately 10 minutes to complete	Varies depending upon the cut-off score: Sensitivity: 91% Specificity: 86% (with cut-off score ≥17)	9430 children (7 to 9 years)	Validated as first-tier screen*. Designed as a first-tier screen for children with high-functioning ASD. Clinicians can individualize cut-off scores to meet their diagnostic needs.
AQ-Child	4 to 11 years	Caregiver-report measure	Sensitivity: 95% Specificity: 95%	540 children with ASD, 1225 children from the general population	Additional studies are necessary before the AQ-Child can be recommended as a first-tier screening* tool.
DBC-ASA	4 to 18 years	29 caregiver-report items from the DBC-P	Sensitivity: 86% Specificity: 79% (with cut-off score of 17)	180 children with ASD and 180 controls (matched for age, sex, and IQ-range)	For use in children with intellectual disability.
DBC-ES	18 to 48 months	17 caregiver-report items from the DBC-P	Sensitivity: 88% Specificity: 69% (with cut-off score of ≥10.5)	60 children with developmental delay and ASD and 60 controls (developmental delay without ASD)	For use in children with developmental delay.
DBC-ES	18 to 48 months	17 caregiver-report items from the DBC-P	Sensitivity: 83% Specificity: 48% (with cut-off score of 11)	207 children from the community	For use in children with developmental delay.

M-CHAT-R/F: Modified CHAT, Revised with Follow-Up; ASD: autism spectrum disorder; ADHD: attention deficit hyperactivity disorder; STAT: Screening Tool for Autism in Toddlers and Young Children; ITC: Infant Toddler Checklist; POSI: Parent's Observations of Social Interactions; SCQ: Social Communication Questionnaire; ASSQ: Autism Spectrum Screening Questionnaire; AQ-Child: Autism Spectrum Quotient-Children's Version; DBC-ASA: Developmental Behaviour Checklist-Autism Screening Algorithm; IQ: intelligence quotient; DBC-P: Developmental Behaviour Checklist for Pediatrics; DBC-ES: Developmental Behaviour Checklist-Early Screen.

* First-tier screening tools are used to identify children at risk for ASD from a general population; second-tier screening tools are used to discriminate ASD from other developmental disorders in children with developmental concerns.

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