OBJECTIVES: Modified Checklist for Autism in Toddlers (M-CHAT) is widely used internationally to screen autism spectrum disorder (ASD). Three-item Direct Observation Screen (TIDOS) is a novel observational tool which may be used by physicians in a short time as a part of routine well-child visit. It includes the following: (a) Joint Attention, (b) Eye Contact, and (c) Response to Name. We aimed to compare the screening performance of TIDOS and M-CHAT for ASD.
MATERIAL AND METHODS: A total of 1345 children aged 16–38 months were examined during well-child care visits at Social Pediatrics Department of Ankara University between May 2015 and May 2016. Five hundred and eleven of 1345 children aged 16—38 months whose parents approved informed consent were enrolled in this study to evaluate the performance of two screening tests: TIDOS and M-CHAT for ASD. The children whose screening tests were positive and controls whose tests were negative had undergone clinical evaluation for the diagnosis of ASD. Clinical evaluation was performed within 2 weeks of the initial M-CHAT, M-CHAT/F, or TIDOS screenings for screening positive children and within 3–9 months for screening randomly selected negative children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those tests were determined.
RESULTS: ASD was diagnosed in 5 of the 511 children in a healthy child clinic of a university hospital with the prevalence of approximately 1%. All the children with ASD were boys. The growth parameters (including body weight, height, head circumference) did not have any properties. There were no consanguineous marriages among the parents of children with ASD. The ages of mothers and fathers of the children with ASD were in a range between 31–39 years and 31–46 years, respectively. The sensitivity for diagnosis of ASD was found to be 0.60 for both M-CHAT and M-CHAT/F tests. The specificity of M-CHAT and M-CHAT/F tests for diagnosis of ASD was found to be 0.96 and 0.97, respectively. PPV were found to be 0.14 and 0.18, respectively. The sensitivity for diagnosis of ASD was found to be 0.80 for TIDOS. Specificity and PPV in the diagnosis of ASD were found to be 0.99 and 0.80, respectively. NPV for all tests were above 0.99.
CONCLUSION: The current study has demonstrated that TIDOS was more sensitive and had higher PPV than M-CHAT. TIDOS has required little time and might be easily combined to routine physical examination of toddlers attending 18- to 36-month well-child clinic visits.