Autism Screening

Overview

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication skill deficits and restricted and repetitive patterns of behavior, interests, and activities that typically appear within the first 2 years of life. ASD has a prevalence of 1:59 children. [Centers: 2019] Using screening tools for ASD in early childhood can help primary care providers detect symptoms more reliably than surveillance alone and lead to early intervention, which can improve developmental outcomes. This resource provides primary care clinicians with guidance about screening for autism in the medical home.

Other Names & Coding

Other Names
Surveillance and screening of autism spectrum disorder
ICD-10
Z13.41, Encounter for autism screening
CPT
96110, Developmental screening

Pearls & Alerts

Concerns despite a negative screen
Because screens may have false negative results that can delay diagnosis and intervention, when concerning behaviors are reported by the caregiver or observed during a well-child visit, despite a negative autism screen, consider referring for formal evaluation.
Refer for behavioral therapy while awaiting a formal evaluation
Due to prolonged wait times for diagnostic testing, some Medicaid and private insurers will cover evidence-based behavioral therapy, such as applied behavioral analysis (ABA), for a child strongly suspected of having autism. For children under age 3, also provide a referral to Early Intervention.
Validation issues
Many Level 1 screens used in a low-risk population were initially validated in at-risk populations or children already diagnosed with ASD, so their stated psychometric properties may be somewhat misleading. In addition, many ASD screens were validated using DSM-IV (or earlier) diagnostic criteria for autism or pervasive developmental disorders. When a screen has been translated into multiple languages, validation data are frequently not available for non-English versions.

Screening Recommendations

Though the U.S. Preventive Services Task Force in 2016 found insufficient evidence to recommend screening for ASD in young children who have had no concerns of ASD raised by their parents or a clinician, the American Academy of Pediatrics (AAP) and the Council on Children with Disabilities advise the following: [Zwaigenbaum: 2015] [Johnson: 2007]
  • Provide ongoing developmental surveillance at every well-child visit.
  • Implement autism screening at 18 and 24 months.
  • Develop a plan for referral and further evaluation of children who have a positive screen or a family member or clinician with concerns.

Surveillance Tips

Ongoing surveillance in early childhood for risk for ASD or other social/emotional or mental health problems should include the following behaviors:
Infants and toddlers
  • Displays very little emotion - rarely coos, babbles, or whimpers
  • Sad affect - rejects being held or touched
  • Unusually difficult to soothe or console
  • Extremely fearful or on guard
  • Does not turn to familiar adults for comfort or help
  • Rare eye contact with caregiver
  • Unable to comfort or console self
Preschool children [Graham: 2001]
  • Does not consistently turn to name being called (highest predictive value on observational and screening studies)
  • Rarely or never engages in pretend play with others or objects
  • Very sad or flat affect, withdrawn, expressionless
  • Absence or delayed use of language or communication
  • Extreme mood swings
  • Inappropriate responses to situations (laughs instead of cries when hurt)
  • Loss of earlier skills like toileting, language, social, or motor skills
  • Reckless behavior, accident prone, destructive to self or others, frequently fights

Autism Screens

Level 1 screens are “universal” and developed for use in general populations regardless of pre-existing risk factors.
Level 2 screens are designed for children with increased risk for ASD (e.g., siblings of children with ASD or children referred for developmental evaluation) and are not commonly performed in a primary care setting.
The following provides guidance on selecting a Level 1 screen appropriate for use in the primary care.

Selecting a Screen

Some screens are designed specifically to detect autism, while others contain cross-cutting elements that screen for autism, developmental delays, and early childhood social-emotional disorders. When selecting a screen to use in clinical practice, consider:
  • Availability, cost, and psychometric properties of the instrument (e.g., rate of false positives)
  • Patient characteristics (e.g., language, reading ability, web access)
  • How the screen will be integrated into the clinic workflow and medical records
  • How and when to discuss the results with the family
  • Where to refer children for additional testing and support
Selecting and implementing autism screens may be done as a quality improvement project to fulfill MOC requirements for the American Board of Pediatrics. Education in Quality Improvement in Pediatric Practice (EQIPP) and The American Board of Pediatrics — Quality Improvement provide enrollment opportunities.

Level 1 Autism Screens

Level 1 screens are for use in low-risk populations, such as those often seen in primary care.
Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist
This focused, developmental screen quantifies an infant’s proficiency in 3 subdomains: social and emotional communication, receptive and expressive speech, and symbolic behavior. It can be used earlier than many autism-specific screens, although it has a low positive predictive value for ASD alone.
  • Format: 24-item, paper or computerized questionnaire, 5-10 minutes for parent/professional report (scored <2 minutes by medical staff)
  • Age range: Functional communication age between 6 months and 24 months
  • Languages: English
  • Sensitivity=89% and specificity=89% for ASD or other developmental delays; however, positive predictive value of 20% for ASD alone when used as a stand-alone broadband screener. [Wetherby: 2008] [Towle: 2016] Scoring based on 10th percentiles.
A free, downloadable PDF with scoring sheet is available at Infant/Toddler Checklist from the Communication and Symbolic Behavior Scales Developmental Profile (PDF Document 56 KB) and a CD-ROM (for purchase) at Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist (Brookes) (PDF Document 51 KB).
Modified Checklist for Autism in Toddlers – Revised, with Follow-Up (M-CHAT-R/F)
This well-studied, 2-step, autism screen uses Yes/No questions about joint attention, pretend play, repetitive behaviors, and sensory abnormalities. It is considered more accurate than the previously used M-CHAT and CHAT when both steps are used. The multiple validation studies of the M-CHAT and availability in many languages make this a reliable and appealing option for many practices. When compared to surveillance alone, use of the M-CHAT-R/F improves ASD identification time by about 2 years. [National: 2001] Of the 7% of children who were in the medium- or high-risk categories, about half ended up with a diagnosis of ASD, and the majority of the remaining children were found to have another developmental disorders or concerns.
  • Format: 20-item, 5-10 minutes to complete (~1 minute to score first part but may take an additional 5-10 minutes to perform a follow-up interview in the office or over the telephone for medium-risk respondents), paper and online forms, first step completed by parent/caregiver, second step (when indicated) completed by a clinician for the paper version (or by the parent in online versions in development)
  • Age range: 16–30 months of age
  • Languages: >50 languages in printable forms, and English and Spanish online versions
  • Scoring: The initial step is administration of the M-CHAT-R/F to stratify into low-, medium-, and high-risk categories. For the medium-risk group (scores of 3-7 on the first part), use the follow-up tool to ask specific questions to improve specificity and determine need for referral. Refer high-risk patients (scores of ≥8 on the first part) directly for further evaluation.
  • Sensitivity: Using an initial step with a cutoff of 3, sensitivity=73% and specificity=89%, but then adding the second step with a cutoff of 2 increased sensitivity to 94%. 47.5% of children referred for evaluation based on positive 2-step M-CHAT-R/F were diagnosed with an ASD. [Robins: 2014]
Free to download or access online at Modified Checklist for Autism in Toddlers – Revised, with Follow-Up (M-CHAT-R/F).
Parent’s Observations of Social Interactions (POSI)
POSI is a component of the Survey of Well-Being of Young Children (SWYC), which encompasses screening and surveillance topics at every well-child visit. The components may be bundled or used separately. Scoring algorithms for each component of the SWYC can be done in Excel, manually, or via the electronic medical record in an integrated eSWYC system. The brevity of the POSI makes it appealing; however, more validation studies in low-risk primary care settings would be useful to reduce false positives.
  • Format: 7-item screen that is part of a set of age-specific tools, usually completed in less than 5 minutes. Asks parents to rate the consistency of behaviors (e.g., sometimes, always, never).
  • Age range: 16-35 months and 31 days. The POSI is integrated into the 18-, 24-, and 30-month SWYC screens.
  • Languages: English, Spanish, Khmer, Burmese, Nepali, Portuguese, Haitian-Creole, and Arabic
  • Scoring: ≥3 indicates increased risk
  • Sensitivity=83% and specificity=74% in a primary care setting. According to the SWYC website, these are “comparable” to other similar instruments, e.g., ASQ-SE and M-CHAT.
Free access online at The Survey of Well-Being of Young Children (Tufts Medical Center). The other SWYC components include: Developmental Milestones Checklists, Baby Pediatric Symptom Checklists, Preschool Pediatric Symptom Checklists, the Edinburgh Maternal Depression Screen, and Family Risk Factors.
Quantified Checklist for Autism in Toddlers-10 (Q-CHAT-10)
The Q-CHAT-10, derived from the 25-item Q-CHAT, focuses on joint attention, pretend play, language development, and other aspects of social communication. More validation data are needed to determine sensitivity and specificity of the screener as a broadband instrument for autism; however, its simplicity shows promise. [Zwaigenbaum: 2015]
  • Format: A 10-item, <5 minutes, paper forms, completed by parent/caregiver
  • Age range: 18-24 months
  • Languages: The 10-item version is available in English, Spanish, Arabic, Chinese, German, Hungarian, Indonesian, Portuguese, Romanian, and Serbian. The Q-CHAT 25-item version is also available in French, Hebrew, Italian, Polish, Romanian, Slavic, and Swedish.
  • Scoring: Uses a 5-point Likert scale - ≥3 indicates increased risk
  • Sensitivity: A case-control study demonstrated sensitivity of 91% and specificity of 89%. [Raza: 2019]
Free download with scoring sheet at Autism Research Centre (ARC) Downloadable Tests.

Response to a Positive Screen

Talking with Parents

One of the most difficult tasks in identifying a potential delay is sharing the concern with the parent. However, not sharing a concern, dismissing it, or relating symptoms to other reasons (e.g., “your child will grow out of this”) delays early identification, early intervention, and impedes overall prognosis. Reassure families that you will be available as a resource for them and their child during and after the evaluation process. [Council: 2016]
Explain the value of addressing the impairing behaviors and delays instead of focusing on the labels. A parent explains, "Whenever I hear something "new" about Becca's condition or abilities, I have to remind myself that it didn't change her right then, and that it can be helpful to name the problem so that we can work on it, but it doesn't change her or our love for her." Diana S.

Testing

Diagnostic Testing
When a positive screen indicates that a child is at risk for ASD, timely referral for formal diagnosis is key. A neuropsychological evaluation using evidence-based tools, such as the Autism Diagnostic Observation Schedule (ADOS), is generally required for the diagnosis. If testing for an educational diagnosis of autism is performed through the school district, review the report to see if additional testing, such as an ADOS, is merited to formalize a medical diagnosis. If unsure, contact a specialist.
Other Testing
Consider referral for additional evaluations, such as occupational therapy, physical therapy, genetic counseling, genetic testing, speech-language evaluation, pediatric neurology, brain MRI, ophthalmology, or audiology. Some developmental assessment centers provide multi-disciplinary evaluations as part of their assessment of the child.

Referrals

Refer the child promptly for services. In many places, children suspected of having ASD can also access behavioral therapy, such as ABA, prior to completing the diagnostic evaluation.
Also, consider:
  • Early Intervention
  • School district-based services
  • Speech-language therapy
  • Occupational therapy
  • Physical therapy
  • Behavioral health
See the Autism Spectrum Disorder module for more detailed information.

Care Coordination

Connect the child and their family to services and resources in a coordinated effort to enhance development in the home. Try to determine if other outpatient services can be accessed more readily (e.g., speech and language therapy). [Council: 2016] Fill out any referral/release forms needed for communication (e.g., with the child’s school or therapists). Because the wait for diagnosis can be lengthy, some states’ Medicaid and private insurers may allow children strongly suspected of autism to access evidence-based interventions such as ABA during the process of obtaining a formal diagnosis.

Monitoring

Continue to monitor the child's development closely and address family concerns. If a diagnosis of ASD is made, refer for evidence-based treatments promptly. See the Autism Spectrum Disorder module for more detailed management information.

Other Autism Screening

Level 2 Autism Screens

Developed for use in high-risk populations, Level 2 screens are sometimes used to help differentiate autistic behaviors from other developmental disorders. Due to long wait times for formal ASD evaluations, Level 2 screens are gaining popularity at referral centers to help differentiate those children at highest risk for an ASD who should access formal evaluation more rapidly.
Examples of Level 2 autism screens:
Autism Mental Status Exam (AMSE)
An 8-item, primarily observational assessment for ages ≥18 months performed by a clinician during a routine visit. It is designed to structure the way clinicians observe and document social, communicative, and behavioral functioning so not to add extra work.
Autism Spectrum Rating Scales (ASRS)
The ASRS has a version for preschool and older children, as well as a 15-item short version. It can be used for screening, diagnostic purposes, and monitoring treatment. [Goldstein: 2009]
Screening Tool for Autism in Toddlers & Young Children (STAT)
The STAT is an interactive, observational screen administered by trained providers to assess key social and communicative behaviors, including imitation, play, requesting, and directing attention.
Social Responsiveness Scale, 2nd Edition (SRS-2)
The SRS-2 includes a preschool and school-aged version and is used to distinguish the presence and severity of social impairment to differentiate among autism and other disorders. It also can be used for symptom monitoring.

Emerging Autism Screens

There is a need to streamline the lengthy diagnostic process for children with ASD. Early diagnosis enables children with ASD to access evidence-based interventions as early as possible to improve developmental outcomes. Emerging science provides expanded opportunities for earlier identification and a more straightforward diagnosis of ASD by using novel delivery systems, expanded screening settings, and screens for use prior to 18 months of age. The following provides a sample of some of these tools. Contact the study authors for more information.
Baby and Infant Screen for Children with Autism Traits (BISCUIT)
A short screen derived from the longer BISCUIT-Part I (62-item diagnostic instrument) based on DSM-5 criteria.
Cognoa for Child Development and Behavior Screening
A mobile application (app) that integrates a series of parent‐report questions with remote clinical ratings of brief video segments uploaded via smartphone to calculate level of ASD risk in general and high-risk populations. Cognoa [Kanne: 2018]
EDUTEA
A brief teacher questionnaire based on DSM-5 ASD criteria to help clinicians and researchers screen for autism spectrum and social communication disorders in school settings. [Morales-Hidalgo: 2017]
First-Year Inventory
A screening tool for social communication and sensory regulatory functions to help with early recognition of autism, performed at age 12 months. First-Year Inventory (FYI) [Reznick: 2007]
Psychological Development Questionnaire-1 (PDQ-1)
A concise, 1-step screen for autism in toddlers and young children. It shows promising psychometric properties. [Zahorodny: 2018]

Related Specialists

Services to help evaluate children for ASD and provide developmental services during the diagnostic process may include:
Early Intervention for Children with Disabilities/Delays (see UT providers [54])
Federally supported and provide developmental assessments and therapies for children ages 0-36 months at risk of developmental delays. A quality Early Intervention Program should provide:
  • Full assessment of a child's current health and developmental status
  • Service coordination among providers, programs, and agencies
  • Strategies to build on family concerns, priorities, and resources
  • Services including occupational therapy, physical therapy, and speech-language therapy
Be aware that Early Intervention does not diagnose ASD and may not provide ASD-specific interventions or communication with the medical home.
Head Start/Early Head Start (see UT providers [61])
Infant/preschool services, such as Early Head Start for children ages 0-3 years and Head Start for children ages 3-5 years provide learning opportunities and parent training to help children maintain or develop skills that will help them be ready to learn when they enter school.
School Districts (see UT providers [55])
Children ages 3 and older can be evaluated by their school district for special education. After neuropsychological testing for special education services, a child may obtain an educational diagnosis of autism, meaning that the child qualifies for autism-oriented educational interventions to increase his or her likelihood of success in the school setting.
The educational neuropsychological evaluation may include an Autism Diagnostic Observation Standard, 2nd Edition (ADOS-2), or the Autism Diagnostic Interview-Revised (ADI-R), both considered the “gold standard” for testing for ASD, or it may rely on less extensive evaluation tools. Because of this variability, an educational diagnosis may or may not also result in a medical diagnosis of ASD. Review the child’s neuropsychological testing thoroughly, and share this information with the autism specialist who is evaluating the child to see if additional testing is still warranted.
Behavioral Therapies (see UT providers [30])
These programs focus on improving behavioral skills for children with identified developmental delays or behavioral conditions.
General Counseling Services (see UT providers [450])
This category includes all types of counselors/counseling for children.  Once on the page, the search can be narrowed by city or using the Search within this Category field.
Psychiatry/Medication Management (see UT providers [62])
Often working with child psychologists, psychiatrists can prescribe medications that treat underlying medical or mental health conditions. They do not usually diagnose ASD.
Autism Programs (see UT providers [28])
Condition-specific clinics, such as a clinic for autism, may be available where children can have formal testing for autism and/or have access to specialized and multi-disciplinary care.
CSHCN Clinics (see UT providers [8])
Some states may have state-funded or federally funded clinics that have expertise in diagnosing or coordinating care for children with complex conditions, including those with developmental delays.
Developmental - Behavioral Pediatrics (see UT providers [9])
Specialty trained pediatricians may diagnose autism. Developmental pediatricians provide evaluations of developmental delays and advice on treatments.

Resources

Information & Support

If interested in a further list of autism screens, contact your state's Medicaid agency for other recommended tools or check the Compendium of Screening Measures for Young Children (HHS).

For Professionals

Autism Initiatives (AAP)
Autism tools, practice guidelines, CME for pediatricians, and resources to share with families; American Academy of Pediatrics.

Classification of Mental and Developmental Disorders (Zero to Three)
Introduces DC:0–5 (developmentally specific diagnostic criteria and information about mental health disorders in infants and young children), discusses why DC:0–5 is important, and provides policy recommendations.

Birth to 5: Watch Me Thrive (HHS & DOE) (PDF Document 1007 KB)
An early care and education provider’s guide for developmental and behavioral screening. Contains developmental screening measures for young children and information about the reliability and validity of commonly-used developmental screening tools; U.S. Department of Health and Human Services and U.S. Department of Education, 2014.

Autism Spectrum Disorder in Under 19s (NICE)
Clinical guideline for recognition, referral, and diagnosis of autism from birth up to 19 years; United Kingdom's National Institute for Health and Care Excellence.

For Parents and Patients

Autism Spectrum Disorder: What Every Parent Needs to Know, 2nd Edition (AAP)
Reliable information about how ASD is defined and diagnosed and the most current behavioral, developmental, educational, and medical therapies. Topics covered align with the DSM-5 updates. Paperback and eBook versions available for purchase; American Academy of Pediatrics.

Parenting (Zero to Three)
Information about parenting, development, learning, behavior, and well-being of infants and toddlers. Includes video real-life examples, articles, and FAQs.

Screening and Diagnosis of Autism Spectrum Disorder (CDC)
A brief explanation of screening and diagnosis of ASD, written for families. Spanish language version available; Centers for Disease Control and Prevention

Autism (healthychildren.org)
Answers to questions such as: How is autism diagnosed? If autism is suspected, what next? What are early signs? How do I keep a child with autism from wandering?

Autism Spectrum Disorder FAQ (NINDS)
Answers to common questions about ASD and a long list of other places to go for more information; National Institute of Neurologic Disorders and Stroke.

Practice Guidelines

American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
Pediatrics (original publication 2006; reaffirmed 2014). 2014;118(1):405-20. PubMed abstract / Full Text
Includes the 5 components of developmental surveillance, screening, follow-up on a positive screen, CPT coding, and an algorithm for assessing development at each pediatric preventive care visit throughout the first 5 years of life.

Johnson CP, Myers SM.
Identification and evaluation of children with autism spectrum disorders.
Pediatrics. 2007;120(5):1183-215. PubMed abstract / Full Text
Addresses the definition, history, epidemiology, diagnostic criteria, early signs, neuropathologic aspects, and etiologic possibilities in autism spectrum disorder. This report also provides the primary care provider with an algorithm for assistance in the early identification.

Patient Education

How Pediatricians Screen for Autism (AAP)
A printable resource explaining autism screening in the primary care setting. Written and audio versions in English and Spanish; American Academy of Pediatrics.

Tools

Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians (AAP)
Supports for health care professionals in the identification and ongoing management of children with autism; American Academy of Pediatrics.

Screening Guidelines and Algorithm (AAP) (PDF Document 5.3 MB)
Two-page algorithm for primary care clinicians performing autism surveillance, screening, and follow-up; reproduced by the Centers for Disease Control and Prevention with permission from the American Academy of Pediatrics (2007).

Services for Patients & Families in Utah (UT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Helpful Articles

Janvier YM, Harris JF, Coffield CN, Louis B, Xie M, Cidav Z, Mandell DS.
Screening for autism spectrum disorder in underserved communities: Early childcare providers as reporters.
Autism. 2016;20(3):364-73. PubMed abstract
Findings suggest that early childcare providers can effectively screen young children for autism spectrum disorder in preschool/daycare settings, thus improving access to early diagnosis and reducing potential healthcare disparities among underserved populations.

Zwaigenbaum L, Penner M.
Autism spectrum disorder: advances in diagnosis and evaluation.
BMJ. 2018;361:k1674. PubMed abstract
This review describes advances in detecting early behavioral and biological markers, current options and controversies in screening for the disorder, and best practice in its diagnostic evaluation including emerging data on innovative service models.

Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP.
Screening for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement.
JAMA. 2016;315(7):691-6. PubMed abstract
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician.

Pierce K, Courchesne E, Bacon E.
To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong.
J Pediatr. 2016;176:182-94. PubMed abstract / Full Text
Article refuting the USPSTF recommendation statement regarding the lack of evidence to support universal screening for autism spectrum disorders in early childhood.

Authors & Reviewers

Initial publication: August 2019; last update/revision: August 2019
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewers: Sean Cunningham, Ph.D.
Kathleen Campbell, MD, MHSc
Paul Carbone, MD

Page Bibliography

Centers for Disease Control and Prevention.
Autism spectrum disorder.
(CDC); (2019) https://www.cdc.gov/ncbddd/autism/index.html. Accessed on August 2019.

Council on early childhood; committee on psychosocial aspects of childhood and family health.
Addressing Early Childhood Emotional and Behavioral Problems.
Pediatrics. 2016;138(6). PubMed abstract
Policy statement on how pediatricians can improve the care of young children with emotional, behavioral, and relationship problems; American Academy of Pediatrics.

Goldstein, S., & Naglieri, J.A.
ASRS: Autism Spectrum Rating Scales.
Toronto, Ontario, Canada: Multi-Health Systems; 2009.

Graham, MA; White, BA; Clarke, CC; Adams, S.
Infusing infant mental health practices into front-line caregiving.
Infants and Young Children. 2001;14(1):14-23.

Johnson CP, Myers SM.
Identification and evaluation of children with autism spectrum disorders.
Pediatrics. 2007;120(5):1183-215. PubMed abstract
Comprehensive clinical report addressing the definition, history, epidemiology, diagnostic criteria, early signs, neuropathologic aspects, and etiologic possibilities in autism spectrum disorders. This report also provides the primary care provider with an algorithm for assistance in the early identification of children with autism spectrum disorder.

Kanne SM, Carpenter LA, Warren Z.
Screening in toddlers and preschoolers at risk for autism spectrum disorder: Evaluating a novel mobile-health screening tool.
Autism Res. 2018;11(7):1038-1049. PubMed abstract
This study compares four screening measures that have been in use for some time to a novel mobile-health screening tool, called Cognoa. The Cognoa tool is novel because it integrates parent-report questions with clinical ratings of brief video segments uploaded via parent's smartphones to calculate ASD risk.

Morales-Hidalgo P, Hernández-Martínez C, Voltas N, Canals J.
EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder.
Int J Clin Health Psychol. 2017;17(3):269-281. PubMed abstract / Full Text
This study examines the validation of the EDUTEA questionnaire which aims to provide clinicians and researchers with a brief tool that can be used to screen autism spectrum disorders and social communication disorders in school settings.

National Research Council.
Educating Children with Autism.
1st ed. National Academies Press; 2001. 0309072697

Raza S, Zwaigenbaum L, Sacrey LR, Bryson S, Brian J, Smith IM, Reid K, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N.
Brief Report: Evaluation of the Short Quantitative Checklist for Autism in Toddlers (Q-CHAT-10) as a Brief Screen for Autism Spectrum Disorder in a High-Risk Sibling Cohort.
J Autism Dev Disord. 2019;49(5):2210-2218. PubMed abstract

Reznick JS, Baranek GT, Reavis S, Watson LR, Crais ER.
A parent-report instrument for identifying one-year-olds at risk for an eventual diagnosis of autism: the first year inventory.
J Autism Dev Disord. 2007;37(9):1691-710. PubMed abstract
This article reviews a parent-report instrument, the First Year Inventory (FYI), which was developed to assess behaviors in 12-month-old infants that suggest risk for an eventual diagnosis of autism.

Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D.
Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F).
Pediatrics. 2014;133(1):37-45. PubMed abstract / Full Text
This study validated the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrated improved utility compared with the original M-CHAT.

Towle PO, Patrick PA.
Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review.
Autism Res Treat. 2016;2016:4624829. PubMed abstract / Full Text
This study investigates the potential and risks of using autism screening instruments for young children up to 18 months.

Wetherby AM, Brosnan-Maddox S, Peace V, Newton L.
Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age.
Autism. 2008;12(5):487-511. PubMed abstract / Full Text
This article provides a brief review of research on the accuracy of screeners for children with ASD that have been administered to general pediatric samples and the results of a population-based study with a broadband screener to detect children with communication delays including children with ASD.

Zahorodny W, Shenouda J, Mehta U, Yee E, Garcia P, Rajan M, Goldfarb M.
Preliminary Evaluation of a Brief Autism Screener for Young Children.
J Dev Behav Pediatr. 2018;39(3):183-191. PubMed abstract / Full Text
This study examines the validity of a parent report-based Level 1 (low risk, general population) screen of toddler psychological development. Findings suggest that the PDQ-1 may be a useful supplement to developmental surveillance of autism.

Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins DL, Wetherby A, Choueiri R, Kasari C, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S.
Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research.
Pediatrics. 2015;136 Suppl 1:S41-59. PubMed abstract
This article reviews evidence for autism spectrum disorder (ASD) screening to promote earlier detection and diagnosis, consistent with current American Academy of Pediatrics’ recommendations. The article identifies ASD-specific and broadband screening tools that have been evaluated in large community samples and suggests strategies to help overcome challenges to implementing ASD screening.