Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review Susan E. Levy, MD, MPH, a Audrey Wolfe, MPH, b Daniel Coury, MD, c,d John Duby, MD, e Justin Farmer, BA, c Edward Schor, MD, f Jeanne Van Cleave, MD, g Zachary Warren, PhD h abstract CONTEXT: Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). OBJECTIVES: We systematically reviewed evidence for universal screening of children for ASD in PC. DATA SOURCES: We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. STUDY SELECTION: We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. DATA EXTRACTION: At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS: We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for $48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and a constrained search. CONCLUSIONS: ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs. 1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge. 3,4 a Center for Autism Research, Department of Pediatrics, The Children’ s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; b Spaulding Rehabilitation Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; c Autism Intervention Research Network on Physical Health and Autism Treatment Network, MassGeneral Hospital for Children, Boston, Massachusetts; d Department of Pediatrics, Nationwide Children’ s Hospital and School of Medicine, The Ohio State University, Columbus, Ohio; e Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; f Lucille Packard Foundation for Children’ s Health, Palo Alto, California; g General Pediatrics, Children’ s Hospital Colorado and University of Colorado Anshutz Medical Campus, Aurora, Colorado; and h Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders, Departments of Pediatrics, Psychiatry, and Special Education, Vanderbilt University, Nashville, Tennessee PEDIATRICS Volume 145, number s1, April 2020:e20191895H SUPPLEMENT ARTICLE by guest on July 22, 2020 www.aappublications.org/news Downloaded from