Improving Autism Detection Through Telemedicine in China: A Comparative Analysis of Multitool-Combined Screening Protocols.

Researchers tested autism screening tools delivered through video calls for toddlers aged 18-36 months in Shanghai. They found that combining certain screening questions worked better than using just one tool. The video-based screening was completed successfully by most families (83%). While some combinations were better at catching autism cases, others were better at correctly identifying children without autism.

This approach could make early autism screening more accessible, especially when in-person visits are difficult.

This multicenter cross-sectional study in Shanghai evaluated telemedicine-based autism screening protocols combining three tools: Warning Signs Checklist (WSC), Five No's behavior markers, and Modified Checklist for Autism in Toddlers section A (CHAT-23-A). Among 1,102 children aged 18-36 months screened via telemedicine with 83.3% completion rate, individual tools showed varying performance: WSC and Five No's achieved 90.9% sensitivity while CHAT-23-A demonstrated 88.6% specificity but only 63.6% sensitivity. Serial testing combining all three tools improved specificity to 97.6% but reduced sensitivity. The WSC and Five No's combination in serial testing showed optimal performance based on area under the ROC curve and Youden index, suggesting telemedicine can effectively support early autism screening.

Telemedicine-based autism screening using combined tools shows promise for improving access to early detection, particularly in regions with limited specialist availability. The choice between sensitivity and specificity depends on screening program goals and available follow-up resources.

Single geographic location (Shanghai) limits generalizability. Cross-sectional design prevents assessment of long-term outcomes. No comparison with in-person screening accuracy. Sample demographics and specific diagnostic confirmation methods not detailed in abstract.

Autism spectrum disorder (ASD) prevalence is rising globally, yet traditional face-to-face screening faces challenges, especially during COVID-19. Telemedicine offers a viable alternative for remote ASD detection. Telemedicine offers a promising alternative for remote ASD screening. This study aimed to enhance ASD screening efficiency through telemedicine by integrating multiple early screening tools and comparing their combined efficacy in China.A cross-sectional, observational, multicenter study was conducted in three districts of Shanghai, utilizing a telemedicine system, the Early Childhood Development Screening, which includes the Warning Signs Checklist for Screening Psychological, Behavioral, and Developmental Problems of Children (WSC), the Early Behavioral Markers of Autism-Five No's behavior, and section A of the Modified Checklist for Autism in Toddlers-23 (CHAT-23-A).

Children aged 18 to 36 months were screened, and the Childhood Autism Rating Scale was used as a diagnostic tool. The study evaluated the sensitivity, specificity, and screening performance of these tools individually and in combination.A total of 1,102 valid cases were screened with an effective rate of 83.30%. The WSC and the Five No's demonstrated high sensitivity (90.9%), while the CHAT-23-A showed higher specificity (88.6%) but lower sensitivity (63.6%). In parallel testing, the combination of WSC and Five No's maintained high sensitivity but reduced specificity.

Serial testing improved specificity to 97.6% with the triple test but at the cost of lower sensitivity. The area under the receiver operating characteristic curve and the Youden index were highest for the WSC and Five No's combination in serial testing.The study presents a novel ASD screening combination protocol with good sensitivity and specificity, validated through a telemedicine system. This protocol is expected to enhance the accuracy and efficiency of early ASD screening, improving long-term prognoses for children and contributing to their healthy development.