Rehab Buddy Child Development Center & Autism
Research Institute
Screening vs Diagnostic Evaluation (Autism & ADHD)
1) Screening vs Diagnostic Evaluation — what’s the difference?
• Screening = a short questionnaire or checklist given to all children (or at-risk children) to see if early signs
are present.
o Quick, early detection tool
o Not a diagnosis — just flags children who may need further evaluation.
o Example: M-CHAT-R/F for toddlers (16–30 months).
• Diagnostic Evaluation = detailed, multidisciplinary assessment to determine if a child meets criteria
(DSM-5).
o Includes: parent interview, developmental history, clinician observation, and standardized tests.
o Example tools: ADOS-2, ADI-R.
2) Autism — common screening tools
1. M-CHAT-R/F (Modified Checklist for Autism in Toddlers — Revised, Follow-up)
• Age: 16–30 months (commonly at 18 & 24 month well-visits).
• Format: 20 yes/no parent questions + follow-up interview.
• Use: Decides if referral is needed for evaluation.
• Research: Strong evidence; validated in Indian languages (high sensitivity/specificity)
3) Autism — commonly used diagnostic tools
1. ADOS-2 (Autism Diagnostic Observation Schedule, 2nd ed.)
• Structured play/interaction observed by clinician.
• Gold-standard observation tool.
• Valid but performance can vary by language, age, culture.
2. ADI-R (Autism Diagnostic Interview – Revised)
• Semi-structured parent interview on early development, communication, social skills, behaviours.
• Complements ADOS-2; aligned with DSM-5.
3. CARS / CARS-2 (Childhood Autism Rating Scale)
• Clinician rating scale from history + observation.
• Provides severity score.
• Validated against ADOS in multiple studies.
4. ISAA (Indian Scale for Assessment of Autism)
• Developed in India; measures autism severity with local context.
• Validated and used in Indian clinics/research.
Key point: No single test “proves” autism. Clinicians combine structured tools + history + observation +
teacher/therapist input.
4) ADHD — screening and diagnostic tools parents may meet
Screening & rating scales (parents + teachers complete):
1. Vanderbilt Scales – widely used; maps directly to DSM; validated in India.
2. Conners’ (Conners 3 / Conners 4) – parent, teacher, self-report; measures inattention,
hyperactivity, oppositional traits.
3. ADHD Rating Scale (ADHD-RS-IV/5) – symptom checklist for DSM criteria.
Diagnostic process (ADHD):
• Based on DSM-5 criteria:
o Symptoms in 2+ settings (e.g., home + school)
o Onset in childhood
o Causing impairment
• Rating scales support clinical interview, but do not replace it.
• Medical review to rule out vision, hearing or other conditions.
5) What a typical assessment visit looks like (parents’ checklist)
1. Screening step (young children): brief parent questionnaire (e.g., M-CHAT-R/F). If positive → referral.
2. Comprehensive evaluation:
o Developmental history (parent interview)
o Structured tools (ADOS-2, ADI-R, Vanderbilt, Conners)
o Clinician observation/play
o Teacher reports
3. Medical review: hearing/vision checks, rule out other conditions, consider comorbidities (e.g., anxiety,
language delay).
4. Multidisciplinary team (ideal): pediatrician/psychiatrist + psychologist + speech therapist + OT.
6) Accuracy, cultural issues & India-specific findings
• Screening/diagnostic tools must be validated for language/culture to avoid false positives/negatives.
• India-specific evidence:
o M-CHAT-R/F Hindi and regional language versions show >90% sensitivity/specificity in some
studies.
o ISAA developed for Indian context; validated and in use.
• Ongoing research aims to improve routine use in primary care and school screening.
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