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Identifying False Negatives When Screening for Autism: Can It Be Done Sooner than Later? :

May 28, 2018

The AAP recommends screening for autism spectrum disorders at the 18- and 24-month visits using a valid and reliable screening tool, such as the recently revised Modified Checklist for Autism in Toddlers (MCHAT-R).

The AAP recommends screening for autism spectrum disorders at the 18- and 24-month visits using a valid and reliable screening tool, such as the recently revised Modified Checklist for Autism in Toddlers (MCHAT-R). All screening tests are at risk for having false positives and false negatives. What factors are associated with false-negative autism screening?  Oien et al. (10.1542/peds.2017-3596) decided to look at false and true negatives screened at 18 months in over 68,000 toddlers from the Norwegian Mother and Child Cohort.  The authors looked at domains of the Ages and Stages Questionnaire (ASQ) and the Emotionality, Activity and Temperament Survey (EAS) in these children to determine differences in those children who were false negatives from true negative screens.  They identify some aspects of developmental delay in children who had false negative results compared to those who never developed autism spectrum disorder and provide us with clues to the diagnosis that may go undetected on the MCHAT screen.  So, should we consider ASQ and EAS results along with the MCHAT-R when we screen for autism spectrum disorders at 18 months?  While the authors weigh in with their thoughts in the discussion section of this paper, we asked developmental specialists Drs. Sarabeth Broder-Fingert, Emily Feinberg, and Michael Silverstein to share their perspectives in an accompanying commentary (10.1542/peds.2018-0965).  They discuss reasons for false negatives in this study. They suggest that with the new MCHAT-R, the findings may not be as worrisome as Oien et al suggest.  Check out this interesting study and commentary and then see if you want to develop any modification in how you screen for autism.

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