Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Early Detection of Autism: Comparison of Three Screening Instruments

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Project Number: R40 MC 00270-04
Grantee: University of Connecticut
Department/Center: Department of Psychology
Project Date: 09/01/2001

Final Report


Principal Investigator

Deborah A. Fein, Ph.D.
Executive Dir. & Asst. Vice Provost for Research
406 Babbidge Road, Unit 1020
Storrs, CT  06269-1020
Phone: (860) 486-3518
Email: Fein@Uconnvm.UConn.Edu


  • Perinatal/Infancy (0-12 months)
  • Early Childhood (3-5 years)


Autism and other pervasive developmental disorders (PDD) are severe disorders of development, often leading to life-long disability. Early detection and intervention can substantially improve prognosis; however, with available screening instruments early detection is difficult. Diagnosis and intervention often follow initial suspicion by as much as three years or more. The proposed study involves the comparison of three parent checklist screening instruments for 24-month-olds: (1) The Checklist for Autism in Toddlers (CHAT)-Parent Report section (Baron-Cohen, Allen, & Gillberg, 1992; Baron-Cohen et al, 1996), (2) The Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, & Barton, in press), and (3) the Yale Autism/PDD Screener. The CHAT parent report has 9 items. To form the M-CHAT, items were added to the CHAT and after pilot testing, refined to a 23-item scale. Pilot data on 1293 two-year-olds from pediatric practices and early intervention sites, 58 of whom were evaluated and 39 of whom were diagnosed with autism or PDD, demonstrates excellent promise of effectiveness for both the CHAT and M-CHAT, with the M-CHAT showing slightly better screening properties. A follow-up study of the first 600 participants at the age of 42-48 months, to ascertain true sensitivity, has been started. The Yale Autism/PDD Screener, a 14-item parent checklist, has been used to study young children referred for possible autism. All but 4 items have been found to discriminate children with autism/PDD from children with other developmental disorders or normal development. The proposed study will investigate the effectiveness of this 14-item screener in an unselected population of 2-year olds. In the proposed project, 33,000 children will be screened, 30,000 from an unselected sample of children at pediatric visits, and 3,000 from a high risk sample of children referred for early intervention. A projected 120 with PDD (and approximately 30 false positives) will be evaluated at 24 months and again at 42 months. All pediatricians and early intervention sites in the State of Connecticut will be contacted; pilot data have successfully included a representative demographic sample of SES and ethnicity and include urban, suburban and rural communities. Evaluations will include psychiatric diagnoses and assessment of cognitive, language, and adaptive functioning. Analyses at both time points will use signal detection and discriminant function analyses to assess and compare the sensitivity and specificity of each instrument, and to determine the optimal set of items to detect PDD. The proposed study should greatly advance the development of an effective early screening tool for autism and related disorders. Planned future studies include replication in other states, and cross-cultural comparisons in such countries as Japan.


Listed is descending order by year published.

Kleinman J, Robins D, Ventola P, Pandey J, Boorstein H, Esser E, et al. The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord. 2008 May;38(5):827-39.

Kleinman JM, Ventola PE, Pandey J, Verbalis AD, Barton M, Hodgson S, Green J, Dumont-Mathieu T, Robins DL, Fein D. Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord. 2008 Apr;38(4):606-15. Epub 2007 Oct 9.

Pandey J, Verbalis A, Robins DL, Boorstein H, Klin AM, Babitz T, Chawarska K, Volkmar F, Green J, Barton M, Fein D. Screening for autism in older and younger toddlers with the Modified Checklist for Autism in Toddlers. Autism. 2008 Sep;12(5):513-35.

Mraz KD, Green J, Dumont-Mathieu T, Makin S, Fein D. Correlates of head circumference growth in infants later diagnosed with autism spectrum disorders. J Child Neurol. 2007 Jun;22(6):700-13.

Sutera S, Pandey J, Esser EL, Rosenthal MA, Wilson LB, Barton M, et al. Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. J Autism Dev Disord. 2007 Jan;37(1):98-107. Epub 2007 Jan 6.

Ventola P, Kleinman J, Pandey J, Wilson L, Esser E, Boorstein H. Differentiating between autism spectrum disorders and other developmental disabilities in children who failed a screening instrument for ASD. Journal of Autism and Developmental Disorders. J Autism Dev Disord. 2007 Mar;37(3):425-36.

Ventola P, Kleinman J, Pandey J, Barton M, Allen S, Green J, et al. Agreement among four diagnostic instruments for autism spectrum disorders in toddlers. J Autism Dev Disord. 2006 Oct;36(7):839-47.


Autism, Screening, Developmental Disabilities, Special Health Care Needs

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