Combination of Two Primary Screening Instruments (K-SCQ and K-SRS-2) and Setting of New Cutoff Values to Improve Diagnostic Accuracy of Autism Spectrum Disorder in Young Children
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Objective This study aimed to explore the diagnostic validity of primary screening instruments (Korean version of the Social Communication Questionnaire [K-SCQ] and Korean version of Social Responsiveness Scale second edition [K-SRS-2]) in Korean children aged 10–60 months and to examine patterns of validity across age. Additionally, we aimed to propose new cutoff values specific to age subgroups.Methods The study included 1,326 children (autism spectrum disorder [ASD], n=822, M=41.79, SD=10.28; non-ASD, n=504, M=32.48, SD=10.88) divided by age (10–17, 18–29, 30–41, 42–53, and 54–60 months) who completed the instruments and underwent clinical best-estimate diagnostic evaluation. An optimal screening strategy was sought by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) based on instrument combinations. Receiver operating characteristic (ROC) analysis was conducted to determine the optimal novel cutoff values for the instruments in each age subgroup.Results The validity of individual instruments varied significantly across age subgroups. However, there was some improvement in validity when applying “either K-SCQ or K-SRS-2,” especially in children aged 30 months and older (sensitivity, 83.3%–94.9%; specificity, 58.1%–90.9%; PPV, 21.7%–98.5%; NPV, 65.3%–96.2%). Estimated cutoff for K-SCQ were 13.5, 9.5, 10.5, 7.5, and 9.5 for ages 10–17, 18–29, 30–41, 42–53, and 54-60 months respectively (sensitivity, 82.4%–92.2%; specificity, 74.8%–90.9%). Estimated cutoffs for K-SRS-2 were 58.5, 54.5, 55.5, 55.5, and 52.5 for ages 10–17, 18–29, 30–41, 42–53, and 54–60 months, respectively (sensitivity, 50.0%–94.1%; specificity, 80.3%–97.7%).Conclusion In children aged 30 to 60 months, the combination of either K-SCQ or K-SRS-2 allowed for accurate screening of ASD. To further improve accuracy, adjusted cutoff values can be applied based on age subgroups.
Abstract
Objective This study aimed to explore the diagnostic validity of primary screening instruments (Korean version of the Social Communication Questionnaire [K-SCQ] and Korean version of Social Responsiveness Scale second edition [K-SRS-2]) in Korean children aged 10–60 months and to examine patterns of validity across age. Additionally, we aimed to propose new cutoff values specific to age subgroups.Methods The study included 1,326 children (autism spectrum disorder [ASD], n=822, M=41.79, SD=10.28; non-ASD, n=504, M=32.48, SD=10.88) divided by age (10–17, 18–29, 30–41, 42–53, and 54–60 months) who completed the instruments and underwent clinical best-estimate diagnostic evaluation. An optimal screening strategy was sought by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) based on instrument combinations. Receiver operating characteristic (ROC) analysis was conducted to determine the optimal novel cutoff values for the instruments in each age subgroup.Results The validity of individual instruments varied significantly across age subgroups. However, there was some improvement in validity when applying “either K-SCQ or K-SRS-2,” especially in children aged 30 months and older (sensitivity, 83.3%–94.9%; specificity, 58.1%–90.9%; PPV, 21.7%–98.5%; NPV, 65.3%–96.2%). Estimated cutoff for K-SCQ were 13.5, 9.5, 10.5, 7.5, and 9.5 for ages 10–17, 18–29, 30–41, 42–53, and 54-60 months respectively (sensitivity, 82.4%–92.2%; specificity, 74.8%–90.9%). Estimated cutoffs for K-SRS-2 were 58.5, 54.5, 55.5, 55.5, and 52.5 for ages 10–17, 18–29, 30–41, 42–53, and 54–60 months, respectively (sensitivity, 50.0%–94.1%; specificity, 80.3%–97.7%).Conclusion In children aged 30 to 60 months, the combination of either K-SCQ or K-SRS-2 allowed for accurate screening of ASD. To further improve accuracy, adjusted cutoff values can be applied based on age subgroups.