Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, The Netherlands.
J Child Psychol Psychiatry. 2010 Nov;51(11):1260-8. doi: 10.1111/j.1469-7610.2010.02246.x.
The Social Communication Questionnaire (SCQ) is a screening instrument with established validity against the Autism Diagnostic Interview-Revised (ADI-R) in children aged 4 years and older. Indices of diagnostic accuracy have been shown to be strong in school-aged samples; however, relatively little is known about the performance of the SCQ in toddlers at risk of autism spectrum disorder (ASD).
This study replicates and extends previous research by Corsello et al. (2007) in a comparatively large (N = 208), substantially younger (20-40 months) sample of children at high risk of ASD. The usefulness of the SCQ as a second-level screening instrument with different cut-off scores was evaluated in relation to IQ, age, and type of ASD diagnosis. The use of the SCQ as compared to the ADI-R was evaluated against clinical diagnosis, both alone and in combination with the ADOS.
The SCQ with different cut-offs consistently showed an unsatisfactory balance between sensitivity and specificity in screening for ASD in high-risk toddlers, with only a few exceptions for specific age, IQ, or diagnostic groups. Even though the SCQ and ADI-R were highly correlated, diagnostic agreement with the best evidence clinical diagnosis was poor for both measures. The ADOS used alone consistently had the highest predictive value. For autism versus not-autism, the combined SCQ and ADOS performed as well as the ADOS alone and notably better than the combination ADI-R and ADOS.
The SCQ is likely to result in a number of false-positive findings, particularly in children with autism symptomatology, and the balance between sensitivity and specificity is poor. The ADOS should be considered the most valid and reliable diagnostic instrument in these very young at-risk children.
社会沟通问卷（SCQ）是一种具有既定有效性的筛查工具，可与 4 岁及以上儿童的自闭症诊断访谈修订版（ADI-R）相对照。在学龄儿童样本中，诊断准确性指数已被证明很强；然而，关于 SCQ 在自闭症谱系障碍（ASD）风险的幼儿中的表现，相对知之甚少。
本研究在 Corsello 等人（2007）先前研究的基础上进行了复制和扩展。在一个相对较大的（N=208）、年龄较小（20-40 个月）的 ASD 高风险儿童样本中，研究了 SCQ 作为二级筛查工具的有效性，不同的截断分数。根据智商、年龄和 ASD 诊断类型，评估了 SCQ 作为不同截断分数的二级筛查工具的有用性。评估了 SCQ 与 ADI-R 单独使用和结合使用时与临床诊断的比较。
在高风险幼儿中，不同截断值的 SCQ 筛查 ASD 的敏感性和特异性之间始终存在不平衡，除了特定年龄、智商或诊断组外，很少有例外。尽管 SCQ 和 ADI-R 高度相关，但与最佳证据临床诊断的诊断一致性对这两种测量都很差。单独使用 ADOS 始终具有最高的预测值。对于自闭症与非自闭症，SCQ 和 ADOS 的组合与 ADOS 单独使用的效果一样好，并且明显优于 ADI-R 和 ADOS 的组合。
SCQ 可能会导致大量假阳性发现，特别是在有自闭症症状的儿童中，并且敏感性和特异性之间的平衡很差。在这些非常年幼的高危儿童中，ADOS 应被视为最有效和最可靠的诊断工具。
