Effectiveness of a screening test for early identification of autistic spectrum disorders in children

Early diagnosis of autism spectrum disorders (ASD) is a key factor in ensuring timely intervention and improving long-term outcomes for children with this pathology. The development and validation of effective screening tools for use in primary health care are of significant clinical interest.
Objective. To evaluate the effectiveness of a test for the early diagnosis of ASD, developed for use in outpatient health care organizations.
Materials and methods. In the 2023—2024 study, 1984 children were screened using an original screening test developed by specialists in the healthcare system of the Republic of Belarus. The test included 24 questions grouped into six scales: sensory sphere, emotional sphere, visual contact, social interaction, speech development and cognitive sphere. The test results were assessed on a scale from 24 to 96 points with the following interpretation: 24—36 points — high risk of ASD; 37—63 points — average risk; 64—96 points — low risk. The diagnostic value of the test was assessed using ROC analysis with determination of sensitivity, specificity, positive and negative predictive value.
Results. Of the 1984 examined children, 64 (3.23 %) had a clinically confirmed diagnosis of ASD. The average test score was 76.16 (±13.14) in the overall group; 30.31 (±4.05) in the group with ASD; 77.69 (±13.14) in the group without ASD. The area under the ROC curve (AUC) was 0.9931, indicating excellent discriminatory ability of the test. The optimal threshold for detecting ASD is 38 points with a sensitivity of 100 % (95 % CI (100—100)) and a specificity of 97.60 % (95 % CI (96.92—98.29)). With a standard high risk threshold of 36 points, the test showed a sensitivity of 96.88 % and a specificity of 98.07 %, a positive predictive value of 62.63 % and a negative predictive value of 99.89 %.
Conclusion. The developed screening test demonstrates high efficiency for the early detection of ASD in young children. The optimal threshold for clinical practice is 38 points, but the standard threshold of 36 points also provides a good balance between sensitivity and specificity. The test can be recommended for widespread use in outpatient practice as a screening tool for the primary diagnosis of ASD.

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