Lee Yoojeong, Bong Guiyoung, Song Da-Yea, Yoo Heejeong
Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States.
Psychiatry Investig. 2025 Jul;22(7):757-765. doi: 10.30773/pi.2025.0015. Epub 2025 Jun 18.
This study aimed to explore the diagnostic validity of primary screening instruments (Korean version of the Social Communication Questionnaire [K-SCQ] and Korean version of Social Responsiveness Scale second edition [K-SRS-2]) in Korean children aged 10-60 months and to examine patterns of validity across age. Additionally, we aimed to propose new cutoff values specific to age subgroups.
The study included 1,326 children (autism spectrum disorder [ASD], n=822, M=41.79, SD=10.28; non-ASD, n=504, M=32.48, SD=10.88) divided by age (10-17, 18-29, 30-41, 42-53, and 54-60 months) who completed the instruments and underwent clinical best-estimate diagnostic evaluation. An optimal screening strategy was sought by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) based on instrument combinations. Receiver operating characteristic (ROC) analysis was conducted to determine the optimal novel cutoff values for the instruments in each age subgroup.
The validity of individual instruments varied significantly across age subgroups. However, there was some improvement in validity when applying "either K-SCQ or K-SRS-2," especially in children aged 30 months and older (sensitivity, 83.3%-94.9%; specificity, 58.1%-90.9%; PPV, 21.7%-98.5%; NPV, 65.3%-96.2%). Estimated cutoff for K-SCQ were 13.5, 9.5, 10.5, 7.5, and 9.5 for ages 10-17, 18-29, 30-41, 42-53, and 54-60 months respectively (sensitivity, 82.4%-92.2%; specificity, 74.8%-90.9%). Estimated cutoffs for K-SRS-2 were 58.5, 54.5, 55.5, 55.5, and 52.5 for ages 10-17, 18-29, 30-41, 42-53, and 54-60 months, respectively (sensitivity, 50.0%-94.1%; specificity, 80.3%-97.7%).
In children aged 30 to 60 months, the combination of either K-SCQ or K-SRS-2 allowed for accurate screening of ASD. To further improve accuracy, adjusted cutoff values can be applied based on age subgroups.
本研究旨在探讨初级筛查工具（韩国版社会沟通问卷 [K-SCQ] 和韩国版社会反应量表第二版 [K-SRS-2]）在10至60个月大的韩国儿童中的诊断效度，并研究各年龄段的效度模式。此外，我们旨在提出特定年龄亚组的新临界值。
该研究纳入了1326名儿童（自闭症谱系障碍 [ASD] 组，n = 822，M = 41.79，SD = 10.28；非ASD组，n = 504，M = 32.48，SD = 10.88），按年龄（10 - 17、18 - 29、30 - 41、42 - 53和54 - 60个月）分组，这些儿童完成了相关工具的测试并接受了临床最佳估计诊断评估。通过基于工具组合计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来寻求最佳筛查策略。进行受试者操作特征（ROC）分析以确定各年龄亚组中工具的最佳新临界值。
各工具的效度在不同年龄亚组中差异显著。然而，应用“K-SCQ或K-SRS-2二者之一”时效度有所提高，尤其是在30个月及以上的儿童中（敏感性，83.3% - 94.9%；特异性，58.1% - 90.9%；PPV，21.7% - 98.5%；NPV，65.3% - 96.2%）。K-SCQ在10 - 17、18 - 29、30 - 41、42 - 53和54 - 60个月龄时的估计临界值分别为13.5、9.5、10.5、7.5和9.5（敏感性，82.4% - 92.2%；特异性，74.8% - 90.9%）。K-SRS-2在10 - 17、18 - 29、30 - 41、42 - 53和54 - 60个月龄时的估计临界值分别为58.5、54.5、55.5、55.5和52.5（敏感性，50.0% - 94.1%；特异性，80.3% - 97.7%）。
在30至60个月大的儿童中，K-SCQ或K-SRS-2二者之一的组合可实现对ASD的准确筛查。为进一步提高准确性，可根据年龄亚组应用调整后的临界值。
