BACKGROUND: Early detection of autism spectrum disorders (ASD) is crucial for best outcomes; therefore it is essential to identify the specific characteristics on developmental-behavioral (DB) screening that call for further ASD screening.

OBJECTIVE: This study determines what DB concerns on the Parents’ Evaluation of Developmental Status (PEDS®), a parent competed DB screening tool, were associated with critical (2/6 items most sensitive to ASD diagnosis) failures on an ASD specific screening tool, the Modified Checklist for Autism in Toddlers (M-CHAT), and if specific concerns are predictive for certain failed M-CHAT critical items.

DESIGN/METHODS: By retrospective chart review, demographic data and scores for M-CHAT and PEDS® were abstracted from the website Subjects who failed the M-CHAT were divided into two groups: Critical vs. Non-Critical Failure. One or more predictive concerns on PEDS® constituted a failed screen. Concerns in each PEDS® developmental domain were analyzed for prediction of critical M-CHAT failures, and if particular concerns were associated with certain failed items.

RESULTS: Of the 361 subjects, 59% failed on the basis of critical items. With respect to demographic factors, the 2 groups differed only on residential location. The Critical Fail group was more likely to have a PEDS® score that would lead to referral for further testing (OR 4.3 CI 1.34-13.77). The predictive items on PEDS® for M-CHAT critical failure included expressive language (OR 2.1 CI 1.01-4.55), receptive language (OR 2.3 CI 1.33-3.91), and self-help (OR 2.2 CI 1.30-3.69), while behavior concerns were less predictive (OR .46 CI .21-.99). Each of these domains was associated with failed responses for 3 M-CHAT items-imitation, sharing, and joint attention; receptive language was also associated with response to name (p<0.05).

CONCLUSIONS: Concerns within language domains are expected, as these are prominent ASD features. The association between the self-help domain and M-CHAT critical items reinforces the importance of joint attention in detecting a possible ASD. Particular attention to the language and self-help domains in DB screening tools such as PEDS® may elicit concerns for behaviors most sensitive to ASD which require further screening.