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Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism
- Source :
- BMJ Paediatrics Open, BMJ Paediatrics Open, Vol 5, Iss 1 (2021)
- Publication Year :
- 2021
- Publisher :
- BMJ Publishing Group, 2021.
-
Abstract
- ObjectiveThis is a prospective population screening study for autism in toddlers aged 18–30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4.DesignObservational study.SettingLuton, Bedfordshire and Cambridgeshire in the UK.Participants13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18–30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4.InterventionsA stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT.Main outcome measuresConsensus diagnostic outcome at phase 1 and phase 2.ResultsAt phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2.ConclusionsThe Q-CHAT can be used at 18–30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4–5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.
- Subjects :
- Childhood Autism Spectrum Test
Pediatrics
medicine.medical_specialty
Referral
Checklist for Autism in Toddlers
Psychological intervention
autism
RJ1-570
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
mental disorders
medicine
Humans
Mass Screening
0501 psychology and cognitive sciences
Prospective Studies
Toddler
Autistic Disorder
Child
medicine.diagnostic_test
business.industry
screening
05 social sciences
Infant
medicine.disease
Checklist
3. Good health
Research Design
Child, Preschool
Pediatrics, Perinatology and Child Health
Autism
Observational study
business
050104 developmental & child psychology
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- BMJ Paediatrics Open, BMJ Paediatrics Open, Vol 5, Iss 1 (2021)
- Accession number :
- edsair.doi.dedup.....0bb940d2a9a82069df393c4b2e9acee9