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To detect signs of autism in toddlers, pediatricians routinely rely on parent-completed questionnaires about the child’s behavior. But parents’ answers may be influenced as much by their own bias about their child’s possible diagnosis as by their child’s actions.
A set of six questions about child development can identify parents who tend to overreport or underreport their child’s symptoms, according to a study published 30 March in the Journal of Autism and Developmental Disorders. Administered alongside a commonly used autism screen for toddlers, the questions help weed out these biases, improving the accuracy of the screen.
They could also help avoid unnecessary referrals to specialists for children who don’t have autism and ensure that children who have the disorder get the help they need.
The researchers analyzed responses to a general questionnaire from parents of 235 children under 3 years of age, most of whom had been diagnosed with autism. They identified six questions that the majority of parents tend to answer in the same way, whether or not their child has been diagnosed with autism. The researchers designated any answer to one of these six questions that disagrees with the majority as a sign of misreporting.
For instance, more than 90 percent of parents reported that their child was capable of rolling or throwing a ball; the parents who did not do so were flagged as overreporters of autism symptoms. In contrast, fewer than 10 percent of parents agreed with the statement “My child frequently makes up complex stories when pretending,” and those who did were considered to be underreporters.
The researchers then shortened their general development questionnaire to include these six questions and 14 others. They gave it along with the Modified Checklist for Autism in Toddlers (M-CHAT), a standard screen for the disorder, to 145 parents with a child who had been referred for psychological evaluation at an autism center at Vanderbilt University in Nashville, Tennessee.
In the study, the M-CHAT alone accurately classified 107 of the 145 children, and missed 12 children with the disorder. The general development questions flagged six of those 12 children’s parents as underreporters. In addition, the M-CHAT wrongly classified 26 children as having autism, and the questions identified nine of their parents as overreporters.
Identifying these misreporting parents may help clinicians determine the most appropriate referral for a child at risk for autism, says lead investigator Cora Taylor, pediatric psychologist at Geisinger Health System in Lewisburg, Pennsylvania.
Still, clinicians should not discount the results of M-CHAT tests from these parents’ children, she says. “Even if one of those red flags come up, it doesn’t mean that they don’t need a referral.”