Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F
Autor: | Rebecca Landa, Barbara J. Howard, Paul Bergmann, Danielle Marks, Lindsay Andon, Raymond A. Sturner, Tanya M. Morrel, Patricia A. Rao |
---|---|
Rok vydání: | 2016 |
Předmět: |
Male
medicine.medical_specialty Pediatrics Autism Spectrum Disorder Clinical Decision-Making MEDLINE Modified Checklist for Autism in Toddlers Aftercare Primary care Sensitivity and Specificity Autism Diagnostic Observation Schedule Interviews as Topic 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Medicine Humans Mass Screening 0501 psychology and cognitive sciences Autistic Disorder Practice Patterns Physicians' Observer Variation Internet Maryland Primary Health Care business.industry 05 social sciences Infant Reproducibility of Results medicine.disease Decision Support Systems Clinical Predictive value Checklist Family medicine Child Preschool Pediatrics Perinatology and Child Health Autism Feasibility Studies Test performance Female business 050104 developmental & child psychology |
Zdroj: | Pediatrics. 138(3) |
ISSN: | 1098-4275 |
Popis: | BACKGROUND AND OBJECTIVE: Autism spectrum disorders (ASDs) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up Interview (M-CHAT/F) has been shown to improve detection and reduce over-referral. However, there is little evidence supporting the administration of the interview by a primary care pediatrician (PCP) during typical checkups. The goal of this study was to evaluate the feasibility, validity, and reliability of the M-CHAT/F by PCPs with online prompts at the time of a positive M-CHAT screen. DESIGN Forty-seven PCPs from 22 clinics completed 197 M-CHAT/Fs triggered by positive M-CHAT screens via the same secure Web-based platform that parents used to complete M-CHATs before an 18- or 24-month well-child visit. A second M-CHAT/F was administered live or by telephone by trained research assistants (RAs) at the Kennedy Krieger Institute Center for Autism and Related Disorders. The Autism Diagnostic Observation Schedule, Second Edition, and the Mullen Scales of Early Learning were administered as criterion measures. Measures of agreement between PCPs and RAs were calculated, and measures of test performance compared. RESULTS: There was 86.6% agreement between PCPs and RAs, with a Cohen’s κ of 0.72. Comparison of sensitivity, specificity, positive predictive value (PPV), and overall accuracy for M-CHAT/F between PCPs and RAs showed significant equivalence for all measures. Use of the M-CHAT/F by PCPs resulted in significant improvement in PPV compared with the M-CHAT alone. CONCLUSIONS: Minimally trained PCPs can administer the M-CHAT/F reliably and efficiently during regular well-child visits, increasing PPV without compromising detection. |
Databáze: | OpenAIRE |
Externí odkaz: |
načítá se...