Evaluating screening for autism spectrum disorder using cluster randomization

Abstract We evaluated the rate of autism spectrum disorder (ASD) in a group invited to a screening program compared to the rates in two groups who received usual care. The population eligible for screening was all children in Iceland registered for their 30-month well-child visits at primary healthc...

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Bibliographic Details
Published in:Scientific Reports
Main Authors: Sigridur Loa Jonsdottir, Evald Saemundsen, Elin Astros Thorarinsdottir, Vilhjalmur Rafnsson
Format: Article in Journal/Newspaper
Language:English
Published: Nature Portfolio 2024
Subjects:
Autism spectrum disorder
Screening
M-CHAT-R/F
Usual care
Cluster randomization
Medicine
R
Science
Q
Iceland
Online Access:https://doi.org/10.1038/s41598-024-57656-0
https://doaj.org/article/b84d3ad408d94cf28079a90401324af8
Description
Summary:Abstract We evaluated the rate of autism spectrum disorder (ASD) in a group invited to a screening program compared to the rates in two groups who received usual care. The population eligible for screening was all children in Iceland registered for their 30-month well-child visits at primary healthcare centers (PHCs) from March 1, 2016, to October 31, 2017 (N = 7173). The PHCs in the capital area of Reykjavik were the units of cluster randomization. Nine PHCs were selected for intervention (invited group), while eight PHCs received usual care (control group 1). PHCs outside the capital area were without randomization (control group 2). An interdisciplinary team, including a pediatrician contributing with physical and neurological examination, a psychologist evaluating autism symptoms using a diagnostic instrument, and a social worker interviewing the parents, reached a consensus on the clinical diagnosis of ASD according to the ICD-10 diagnostic system. Children in the population were followed up for at least two years and 119 cases were identified. The overall cumulative incidence of ASD was 1.66 (95% confidence interval (CI): 1.37, 1.99). In the invited group the incidence rate was 2.13 (95% CI: 1.60, 2.78); in control group 1, the rate was 1.83 (95% CI: 1.31, 2.50); and in control group 2, the rate was 1.02 (95% CI: 0.66, 1.50). Although the rate of ASD was higher in the invited group than in the control groups, the wide confidence intervals prevented us from concluding definitively that the screening detected ASD more readily than usual care.

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