Improving autism screening in French-speaking countries: Validation of the Autism Discriminative Tool, a teacher-rated questionnaire for clinicians’ use

Abstract

Abstract Background Autism screening remains a major challenge in most French-speaking countries. Two main issues contribute to this problematic situation: unavailability of tests in French and psychometric/ methodological weaknesses of existing instruments. These shortfalls result in late and inadequate referrals to autism specialist clinics, jeopardising both children’s diagnosis and prognosis. This article describes the validation of the Autism Discriminative Tool (ADT), a teacher-rated level-two screener for children aged two to six years. It demonstrates how the ADT specific properties may help reduce actual screening challenges and improve referrals’ adequacy to tertiary autism diagnostic services. Method ADT items were prospectively tested in a community-based group (n\u2009=\u2009118), children with autism spectrum disorders (ASD; n\u2009=\u200990) and non-ASD children presenting mimicking conditions such as intellectual disabilities, language impairments and various psychological disorders (n\u2009=\u200936). Children in the clinical samples were rated by their teacher at the beginning of a diagnostic assessment process within three specialised autism clinics. Results results suggest that a 26-item version performs well as a stage-two screening device, with theoretical sensitivity rate of 0.83, specificity of 0.94 and an overall correct detection rate of 86.5%. Using different cut-off scores categories, results illustrate how inadequate referrals may be avoided as 44% of non-ASD children scored negatively on the questionnaire prior to their evaluation. Conclusions based on blind teachers’ ratings, the ADT appears to be a good complementary device to help French-speaking clinicians identify preschoolers needing multidisciplinary ASD diagnostic assessment.