The following selection criteria and their psychometric definitions explain the conditions that a screening tool must meet to receive a positive rating and recommendation from First Signs, Inc. Listed below are definitions of the criteria used to rate each recommended screening tool.

Intro | Selection Criteria | Psychometrics | Recommended Tools | References

1. Must have historical/statistical significance

Validated
Developmental screens use developmental milestones
Autism and Asperger screens meet DSM-IV criteria
Established tool
Peer Reviewed
Recognized by a national organization

2. Must provide ease of use by physician/healthcare provider

Can be administered at all well visits, 12 to 36 months
Brief to fill out (under ten minutes)
Easy to tabulate (under five minutes)
Parent report—no observation needed
Easy to store
Easy to maintain
Easy to explain to patient

3. Must be easy for parent/caregiver to use

Caregiver can fill out in under ten minutes
Multiple choice
Written for fourth to sixth grade reading level
Available in other languages
Alternative methods of administration
Can be mailed

4. Must be available at minimal expense for provider

Low cost to maintain

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History/Statistical Significance

Highly Validated: This is the most critical criterion for any screening tool to meet. A screening tool must show sensitivity and specificity of 70% or better to be rated positively in this category. Ideally, the sensitivity of the tool will be the higher measure, over specificity. The section on “Psychometrics” gives further definition for this requirement.

Developmental screening tools use developmental milestones: We have rated developmental tools against whether they use developmental milestones as a measure.

Autism and Asperger screening tools meet DSM-IV Criteria: It is imperative that an autism screening tool meets all three main areas of the DSM-IV’s definition of autism. Asperger Syndrome screening tools must meet all six criteria outlined in the DSM-IV’s definition of Asperger Syndrome.

For more information about DSM-IV criteria, see Psychometric Terms.

Established tool: A screening tool should have been in use for at least two years and widely distributed throughout the U.S. and even internationally. "Standardization" detail under "Psychometrics" gives the size of test populations and the length of time on the market.

Peer Reviewed: A tool has been peer reviewed if it has been critiqued in a peer reviewed medical or psychiatric journal or other professional publication.

Recognized by a national organization: The screening tool will receive a positive rating if it has been recognized by a national professional organization such as the American Academy of Pediatricians (AAP), the American Academy of Neurology (AAN), and other organizations of similar caliber.

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Ease of Use by Physician/Healthcare Provider

Can be administered at all well visits, 12 to 36 months: A screening tool will rate highly if it covers all ages concerned. If a screening tool can only be used at a certain age, this will not disqualify a tool, but will make it necessary to have other tools on hand to address the other age groups. We have found that, as a rule, developmental screening tools cover most well visit ages.

Brief to fill out (under ten minutes): If a physician or healthcare provider must deliver the screening tool as part of its design, it must not exceed ten minutes to be filled out, due to time constraints imposed by insurance companies and other demands on healthcare providers. Most screening tools use parent report as the means to capture information, making direct elicitation necessary only if the parent is unable to answer the questions. Many tools can be completed in five minutes or less.

Easy to tabulate (under five minutes): Similarly, tabulation must not exceed five minutes due to insurance time constraints on healthcare providers' time. Many tools can be tabulated in less than two minutes. Certain tools provide color-coded “cut-offs,” which make it visually easy for the tabulator to determine test outcomes.

Parent report—no observation needed: There are many advantages of parents answering screening tool questionnaires: less office time is required of the physician or healthcare provider, responses can be mailed, parents know their own child best, and, the exercise of thinking through responses to a developmental questionnaires increases a parent’s accuracy.

We have defined “parent report” as a parent’s written response to a screening tool, rather than an interview from a professional (direct elicitation). Parent report answers may be open-ended concerns or structured and prompted answers.

Easy to store: The screening tool must be a standard size and not bulky or unwieldy to store. The preferred tool will fit easily on a shelf or in a file cabinet.

Easy to maintain: The screening tool must be self-contained with minimal upkeep required.

Easy to explain to patient: The screening tool must have brief, easy, accessible, and parent-friendly directions for healthcare providers to use/explain.

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Ease of Use by Parent/Caregiver

Caregiver can fill out in under ten minutes:  A screening tool must not exceed ten minutes to be filled out by a parent or caregiver in either a waiting room or at home due to the many distractions that may prevent thorough completion. Many tools can be completed in 5 minutes or less.

Multiple choice: Screening tool questions are phrased in a variety of different formats. Some capture an open-ended comment, some restrict an answer to a yes/no choice, some provide a range of multiple choice options, and some include a combination of formats.

The open-ended format encourages parent observation and commentary, but is time-consuming for a physician or healthcare provider to review and tabulate. This method does not identify a definitive pass/fail score and relies on interpretation from a healthcare professional. The yes/no response format is much quicker to review and tabulate, but can be frustrating for the respondent, since it is does not accurately reflect the conditional aspects of real life. The multiple range of options format, whereby the respondent has choices (e.g., yes, no, sometimes, rarely, usually, etc.), addresses the time constraints on physicians and the need for parents to qualify their answers. Therefore, this type of brief, but flexible, response is preferred. The combined format of commentary with multiple choice has many of the benefits stated above, but still demands time for extra interpretation from the healthcare professional administering the test.

A screening tool that allows for multiple choice of three or more responses with or without further brief commentary is the recommended format by First Signs. It recognizes the need for brevity and pass/fail scoring as desired by the questionnaire reviewer, but, at the same time, provides for the conditional responses that parents undoubtedly need when describing real life observations. For the sake of simplicity, the screening tool must follow the same format for all its versions. This format will most likely have the best chance of being accepted by physicians and parents alike.

Written for fourth to sixth grade reading level: A screening tool must be simple enough for all parents and caregivers to understand and complete. Fourth-to-sixth grade reading levels include most people. A healthcare provider should assist those who cannot read the survey.

Available in other languages: Similar to reading level, access to a screening tool available in at least English and Spanish will ensure greater coverage of the whole population of parents. Additionally, other languages make the tool accessible nationally and internationally.

Alternative methods of administration: If reading level and language accessibility are not possible, a tool must be delivered by a healthcare provider. For further flexibility and cost effectiveness, it is also preferred that a tool can be administered in multiple settings: in the caregiver's home, in a healthcare center waiting room, at an early intervention center, or in a doctor’s examination room.

Can be mailed: A mailable tool allows for convenience and cost effectiveness. The down side of mailing screening tools to caregivers is that they may be misplaced, delayed, or forgotten. Mailing a screening tool may save time, but it will decrease the potential yield of a screening program. While First Signs recommends the advantages of mailing a screening tool, we also wish to alert physicians and others who opt for a mailing program to these potential pitfalls.

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Expense

Low cost to maintain: The screening tool should require minimal upkeep and out-of-pocket expense in order to be used successfully and continuously by a healthcare provider. A tool will rate positively if costs are contained to photocopying replacements only.

If there are any additional costs required to replenish or use a screening tool effectively (e.g. copy protected refills, mandatory instruction manuals, etc.), this will detract from a screening tool's rating. Many screening tool publishers also sell manuals, informational handouts, related videos and other supplements.

Our current focus is developmental and autism spectrum disorders. Please revisit this Web section in the future as we expand our list of disorders and related screening tools

¹ Since there is no ideal screening tool in any domain (i.e., no tool fully meets all selection criteria), we have recommended screening tools based on the combined weight of all criteria in their overall score.

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