Autism Screening in Toddlers: 82% of Positive Tests are False

Autism screening in toddlers likely results in a huge number of false positives.

Peter Simons
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The American Academy of Pediatrics has recommended autism screening in toddlers since 2007, despite a lack of evidence for better outcomes in screened children. Now, a new study has revealed that autism screening in toddlers has an incredibly low predictive value and likely results in a large number of false positives.

The study, led by Paul S. Carbone and published in Pediatrics, found that the Modified Checklist for Autism in Toddlers (M-CHAT) screening measure has a 17.8% positive predictive value.

That means that for every 100 toddlers who screen positive for autism spectrum disorder (ASD), only about 18 of them will go on to receive a diagnosis. The other 82 toddlers will be referred out for further assessment, told that they “may” have ASD, and potentially be exposed to drugs such as antipsychotics (often used for behavioral control in children with autism), all without even meeting the criteria for an ASD diagnosis.

Additionally, the study found that the M-CHAT’s sensitivity was 33.1%. That means that in the subgroup of toddlers who will go on to receive a diagnosis of ASD, the test was able to identify 33 out of every 100 correctly. The other 67% are false negatives—children who screen negative but do meet the criteria for a diagnosis of ASD.

So if your toddler screens positive for ASD on the M-CHAT, the overwhelming likelihood is that they do not actually meet the criteria for ASD (82%). Additionally, if your child actually did have a diagnosis of ASD, the overwhelming likelihood is that they would screen negative for ASD on the M-CHAT (67%).

Despite this, the authors insist that autism screening is helpful. “Children who screened positive were more likely to be diagnosed with autism and were diagnosed earlier,” writes Carbone and his co-authors.

Of course, this is tautological: children who were identified by a test as having autism were more likely to be diagnosed with ASD. But that could be harmful if those diagnoses were also false positives—children who should not have received the diagnosis but were given it anyway because the test wrongly suggested it.

In the current study, Carbone and his co-authors looked at the screening data from 20 clinics. A total of 36,233 toddlers were part of the study. Doctors screened 73% of the children, and 1.4% later received a diagnosis of ASD.

Screening children for psychiatric disorders can have harmful effects. For instance, many of the criteria for psychiatric disorders are quite subjective, and if a child screens positive (even if the test is wrong), a clinician may decide to err on the side of providing a diagnosis for the child when looking at ambiguous results.

The perils of overdiagnosis due to depression screening in children have been reported by researchers in several other instances. For instance, it can lead to children being unnecessarily exposed to the harms of psychiatric medications.

According to researchers writing in JAMA earlier this year, falsely being told you have a psychiatric disorder can lead to emotional distress and anxiety, the adverse effects of unnecessary treatments, and the excessive costs of further testing and visits to the doctor.

Indeed, those researchers argued that “The diversion of health care resources and attention to treat those with mild disease is threatening the viability of health care systems worldwide.”

 

 

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Carbone PS, Campbell K, Wilkes J, et al. (2020). Primary care autism screening and later autism diagnosis. Pediatrics, 146(2), e20192314 (Link)

6 COMMENTS

  1. Thank you Peter.

    I’m not sure which psychiatrists can possibly suggest and prescribe drugs to children, unless
    something is indeed gravely wrong with these psychiatrists. And yes, there is definitely something wrong
    with adults who drug children with chemicals.

    And we have all these young teachers who were raised with the BS of psychiatry, either at home, from their peers or school..all these young parents and the information is simply not getting out fast enough.

    Perhaps it is time for another book, by someone. Perhaps one that is free online, to be able to be accessed by poor parents.

    We are living at a time where it is time to get power back, yet we stand by idle as the kids get poisoned by pretend doctors who hate people.

    Does anyone at the drug labs have a consciousness? As they are packing the pills? Nope, it’s a living. Just like packing smokes into little boxes.

    Well done psychiatry. You should be proud, real men and women, to be admired as you walk around with that guilty sheepish look about you, pretending you are “ok”.

  2. I work with teens and young adults with autism diagnosises. I estimate at least 1/3 of them to be complete bullshit. As in no or barely any autistic traits whatsoever. Often times it is parents who have severe problems themselves, mistreat their kids and then seek a diagnosis, when the kids behavioural problems are actually caused by their own abuse. (Psyhiatrist assesment) ADOS right on the cutoff with a way higher (parental assesment) ADI-R is more common than not. Some of them have done a (self assesment) AQ, none of them qualified for autism on that.

    • beokay, It is very disturbing what is happening. Adults were showing the results of lobotomies and now the drugs in most negative results, leading to physical suffering for families. So there is too much proof because adults can talk about it, so psychiatry grabs children, because if you drug a child, no one knows that the damages are from chemicals do they.

      People like to talk about psychiatry as having that stained history, as if it is something from the past, yet I might say they are worse than ever.
      When a man has absolutely no conscience and drugs kids brains and bodies, in fact sodomozing their brains, and the public stands by and does absolutely NOTHING.
      Psychiatry IS the ones who are sick. I don’t know what is wrong with them, but it is a chronic sickness that has penetrated every nook.

      Children are the product of society and families, they are not disordered. Parents are not perfect, neither are schools. And the blasted shrinks come to damage more, to try and make the child’s brain fit into something that others want, but it is all experimental, so horrific for our society to have engaged in.

      I do hope that eventually psychiatry becomes part of an ugly history, never to be repeated again. It was built on eradicating human expression, nothing else. It was NEVER built on “illness”.

  3. “The diversion of health care resources and attention to treat those with mild disease is threatening the viability of health care systems worldwide.”

    We here at MiA all already know none of the psychiatric DSM disorders are valid diseases, including “autism,” so none of them should even be “diagnosed” any longer. Yet they still are, because they’re “too profitable” for the pediatricians et al to stop utilizing, according to a Lutheran pediatrician. Who was confronted with the medical truth, and so embarrassed she stated such.

    And we know “falsely being told you have a psychiatric disorder can lead to emotional distress and anxiety, the adverse effects of unnecessary treatments, and the excessive costs of further testing and visits to the doctor,” are very detrimental to those so misdiagnosed.

    But this will result in us, doing our homework, researching, and losing pretty much all respect for the medical community in general. But also resulting in the head of family medicine at the Cleveland Clinic claiming us to be a “one in a million” medical researcher, who he had teach their students that now that we all live in the ‘information age,’ sometimes the “patients know more than the doctors.’

    But now we have medical Marshall law, thanks to COVID-19, a cold virus. Since those of us at MiA have destroyed the scientific validity of the “sacred symbol of psychiatry,” a disorder which has historically always been used to defame political dissidents. So a new “mysterious disease” is needed.

    Anything to cover up that paternalistic, multibillion dollar child abuse covering up system run by the “mental health” workers, and their now claimed to be ‘non-essential’ pastors, mainstream medical “professionals,” and the governmental’s “social workers, huh?

  4. If the physician is trying to detect the causal and the life in some part of the whole is for a brief period in time showing difference of expression, then how does whole “self-correct”? To think their might be occurring multiple ways the nerves are expressing connectivity, to work around and through the problem(s) is fascinating.

    • Sorry, the word “their” was misspelled. The correct word should have been “there” ? I ask this and question for there is a way I have come to realize in the richness of thinking, even about thinking, that multiple tracks wish to emerge, or the words invoked (perhaps from a certain struggle with phonetics) communicates a more nuanced reality(s) with hints of an underlying imagination trying to realize voice. So, having typed this, (how many speak as they type, to hear and make oral the message), there is a questioning occurring in the moment. Their is when used “To think their” is different from “To think there”.

      To try and read carefully what is being typed, may vary if we were speaking the words in person, having a conversation, which is different from a zoom, where many can watch and “feel connected” or have learned to accept the position of the technology, the costs, and the expenditure of time into their lives.

      In comment editor stance, now I realized (LOL) of either my inability to focus on “my life”, as I ended with “their lives”. How do others cast from the awareness of the self in the singular to the organizational self, of the We, the their in order to create understanding for what is called in legal terms, “standing”? Each letter seems to have a particular weight in trying to share a story; to have witnessed and experienced what was encountered in the course of medical practice needs to be placed on the agenda’s of organizations no less than what Justin Dart visualized and spoke before the Alternative Conference in Philly in the early 90’s.

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