自闭症谱系障碍的早期筛查工具

doi:10.3724/SP.J.1042.2022.00738

摘要/Abstract

摘要：

基于35项实证研究, 遵循诊断准确性研究的质量评估(QUADAS-2)的循证程序对自闭症谱系早期预警特征筛查工具开展质量评估, 包括婴儿阶段(10个筛查工具, 159388人)、幼儿阶段(14项筛查工具, 11712人), 旨在为自闭症谱系风险的早期识别提供全面的理解。结果表明：幼儿阶段的筛查工具的分类准确性要高于婴儿阶段, 在婴儿阶段达到良好水平的筛查工具有M-CHAT-R/F、PDQ-1; 在幼儿阶段达到优秀水平的筛查工具有OERA、TIDOS。其中, “改良的幼儿自闭症检查表-有修订的后续随访” (M-CHAT-R/F)是目前最具潜力的自闭症谱系风险筛查工具之一。最后, 我们探讨了应用QUADAS-2评估研究质量的局限性, 强调需要规范工具的质量评估标准与进一步验证研究的必要性。

关键词: 自闭症, 筛查工具, 诊断敏感性和特异性, QUADAS-2

Abstract:

The purpose of screening research is to provide a comprehensive understanding about the risks of early identification of autism spectrum disorder. This study comprehensively and systematically reviewed the commonly-used screening tools for early detection of autism in infants and preschool children. Under the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA), we queried the topic “screening tools for autism spectrum disorder” against the three major literature retrieval databases (WOS, Scopus, PubMed) and obtained 175 articles, of which 35 articles and 18 corresponding screening tools were further evaluated to comply with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. These tools were analyzed from the aspects of application level, psychometric and measurement properties, cultural adaptability, diagnostic criteria and classification accuracy. From the aspect of application level, the screening tools were categorized into three levels based on the types of screening samples, wherein Level- I screening tools, totaling up to 4, focus on general-purpose screening of population and the examination of other developmental disorders, and the evaluation is mainly based on the reports from parents; Level-II screening tools, totaling up to 8, were mainly based on the clinical reports from well-trained clinicians or the observations from the interactions between trained professionals and children; the hybrid-level screening tools, totaling up to 6, were based on the Level-I general population and the Level-II clinical samples. From the aspect of psychometric and measurement properties, existing studies only adopted several metrics of reliability and validity, e.g., internal consistency reliability, rater reliability, test-retest reliability and criterion validity, to evaluate the psychometric properties of screening tools,, whereas the other metrics such as split half reliability, measurement error, content validity, structural validity, cross-cultural validity and hypothesis test were seldom adopted except in only a few studies, and one-third studies did not carry out any psychometric evaluation, potentially resulting in the high-risk bias of QUADAS-2. From the aspect of cultural adaptability, the series of M-CHAT tools（M-CHAT, M-CHAT/F,M-CHAT-R/F）, subjected to extensive evaluation in multiple languages, have demonstrated obvious cultural adaptability, and were recognized as the most widely-used and the most famous screening tool based on parent reports. However, there is an increasing trend that screening tools developed to be localized to the culture and languages in communities or countries with scarce resources. From the aspect of diagnostic standards, the DSM-IV or DSM-IV-TR (accounting for 43%) were still used as the main reference standard instead of the DSM-5 manual (accounting for 34%). It was concluded from sensitivity and specificity that the tools for preschool children outperform those for infants in terms of classification accuracy. The tools rated as good level for infants include M-CHAT-R/F and PDQ-1, and the tools rated as excellent level for children include OERA and TIDOS, wherein M-CHAT-R / F is one of the most promising screening tools for estimating the risks of autism spectrum disorder. Lastly, we discussed the limitations of QUADAS-2 and the necessity of choosing stringent quality assessment measures and the importance of further validating these measurements.

Key words: autism spectrum disorder, screening tools, the diagnostic sensitivity and specificity, QUADAS-2

中图分类号:

R395

陈光华, 陶冠澎, 翟璐煜, 白学军. (2022). 自闭症谱系障碍的早期筛查工具. 心理科学进展 , 30(4), 738-760.

CHEN Guanghua, TAO Guanpeng, ZHAI Luyu, BAI Xuejun. (2022). Early screening tools for Autism Spectrum Disorder in infancy and toddlers. Advances in Psychological Science, 30(4), 738-760.

图/表 8

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测量名称(简称)	测量的结构	适用年龄		项目数	计分	时间分钟	可获得性	测量方式	临界值	研究数量
1. 改良的幼儿自闭症检查表(the Modified Checklist for Autism in Toddlers, M-CHAT)	7个领域: 社会利益, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		23	是/否	5~10	免费	主要照顾者完成问卷	对于6个关键项目中2分及以上答案为否; 或者3分及以上条目答案为否时, 为阳性结果, 怀疑为自闭症患儿	4项研究 Carbone等(2020) Toh等(2018) Stenberg等(2014) Koh等(2014)
2. 改良的幼儿自闭症检查表-有后续随访(the Modified Checklist for Autism in Toddlers with Follow-up Interview, M-CHAT/F)	7个领域: 社会兴趣, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		23	是/否	10~15	免费	主要照顾者完成问卷, 如果孩子的筛查结果呈阳性, 附加专业人员随访	对于6个关键项目中2分及以上答案为否; 或者3分及以上条目答案为否时, 为阳性结果, 怀疑为自闭症患儿	6项研究 Guthrie等(2019) Kerub等(2020) Baduel等(2017) Sturner等(2016) Srisinghasongkram等(2016) Kamio等(2014)
3. 改良的幼儿自闭症检查表-有修订的后续随访(Modified Checklist for Autism in Toddlers- Revised with follow-up, M-CHAT-R/F)	7个领域: 社会兴趣, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		20	通过/不通过	10~20	免费	主要照顾者完成问卷, 如果孩子的筛查结果大于3分, 专业人员开展结构化的后续问题,	0~2分: 低风险, 无需进一步评估, 除非存在其他风险因素 3~7分: 中等风险, 需要进行随访以确定是否需要转诊 8~20分: 高风险, 立即转诊进行评估和干预	5项研究 Coelho-Medeiros等(2019) Magán-Maganto等(2020) Guo等(2019) Robins等(2014) Tsai等(2019)
4. 幼儿自闭症定量检查表(Qualitative Checklist for Autism in Toddlers, Q-CHAT)	3个部分: 社会交往; 行为; 语言	18~24个月		25	5点利克特量表	15~20	免费	主要照顾者完成问卷	Q-CHAT: 27分 Q-CHAT-10: 3分	2项研究 Raza等(2019) Ruta等(2019)
5. 儿童行为检查表(the Child Behavior Checklist, CBCL)	7个症状量表(情绪反应、焦虑/抑郁、躯体抱怨、退缩、睡眠问题、注意力问题和攻击行为)和5个DSM导向的量表(情感问题、焦虑问题、PDP、注意力缺陷/多动问题和对立违抗问题)	学龄前版本(1.5~5岁)		100	3点利克特量表	15~20	免费	主要照顾者完成问卷	临床意义: 症状量表和DSM导向量表的T分数为65~69分以上; 内化、外化和总问题量表为60~63分以上	4项研究 Rescorla等(2019) Limberg等(2017) Narzisi等(2013) Havdahl等(2016)
6. 婴幼儿自闭症筛查第1部分(The Baby and Infant Screen for Children with a UtIsm Traits— Part1, BISCUIT-Part1)	3个因素: 社会化/非语言交流、重复行为/兴趣和交流受限	17~37个月	62		3点利克特量表	15	免费	主要照顾者完成问卷	17分以下: ASD/非典型发展 17~39分: ASD/PDD-NOS 39分或以上: ASD/autism	1项研究 Horovitz和Matson (2014)
7. 婴儿自闭症父母筛查(The Autism Parent Screen for Infants, APSI)	包括眼神接触、视觉跟踪、对姓名的反应、模仿、语言、社会发展、共同注意、手势、游戏、物体视觉检查和情绪调节的损伤	6~24个月	26		3点利克特量表	10~15	免费	主要照顾者完成问卷	15分	1项研究 Sacrey等(2018)
8. 第一年调查(The First Year Inventory, FYI)	2个领域: 社会沟通和感官调节	12个月	63		3点利克特量表	10~15	免费	主要照顾者完成问卷	总风险得分: 19.2分(等于或高于96百分位) 社会沟通领域: 22.5分(第94个百分位) 感觉-调节领域: 14.75分(第88百分位)	1项研究 Turner-Brown等(2013)
9. 心理发展问卷-1(the Psychological Development Questionnaire-1, PDQ-1)	2个领域: 社会参照和交流表达	18~36个月	10		3点利克特量表	2	免费	主要照顾者完成问卷	12分	1项研究 Zahorodny等(2018)
10. 自闭症谱系评定量表中文修订版(the revised Chinese version of the autism spectrum rating scale, RC_ASRS)	2大因素: 社交、异常行为	2~5岁	62		4点利克特量表	20	付费	主要照顾者完成问卷	60分	1项研究 Zhou等(2018)
11. 自闭症图片评估清单(the pictorial autism assessment schedule, PAAS)	2个领域: 异常的游戏行为和社交互动困难。清单的前20项都配了一张照片, 用文字说明了信息, 21项是文本信息	18~48个月	21		是否计分	15~20	免费	主要照顾者完成评估清单	4分	1项研究 Perera等(2017)
12. 发展性登记(The Developmental Check-In, DCI)	4个领域: 交流、游戏、社交和行为。28个项目每一个都被描绘成一幅线条图和一张照片。添加了简短的描述标签。	24~60个月	28		是否计分	NR	NR	主要照顾者完成的问卷	7.5分	1项研究 Janvier等(2019)
13. 两岁儿童自闭症筛查测验(Screening Tool for Autism in 2-Year-Olds, STAT)	4个社会交际领域: 游戏, 请求、共同注意、模仿	24~35个月	12		通过或失败	20	免费	专业人员对儿童进行游戏互动观察、判断	0到4分之间分数越高, 障碍越严重。 24个月以下儿童: 2.5分 24个月以上儿童: 2.75分	2项研究 Wu等(2020) Chiang等(2013)
14. 儿童早期自闭症检测(the Autism Detection in Early Childhood, ADEC)	5个部分: 社会互动、言语和非言语交流、活动或兴趣受限、对感官刺激固着性反应	12~36个月	16		3点利克特量表	10~15	NR	专业人员对儿童进行观察、判断	0~10分: ASD低风险 11~13: ASD中风险 14~19: ASD高风险大于19分: 非常高风险	1项研究 Hedley等(2015)
15. 自闭症心理状态检查(the Autism Mental Status Exam, AMSE)	4个方面: 社会, 沟通, 自闭症的行为标记和症状	3~6岁	8		3点利克特量表	NR	NR	专业人员基于儿童互动的观察和照顾者访谈	7.5分	1项研究 Cederlund (2019)
16. 三项直接观察的自闭症筛查(The Three- Item Direct Observation Screen, TIDOS)	3个项目: 叫名反应; 共同注意; 眼神接触	18~60个月	3		前两项0~2分, 后一项0~1计分	15~20	免费	专业人员的观测	1分	1项研究 Oner等(2014)
17. 幼儿自闭症快速互动筛查测试(the Rapid Interactive Screening Test for Autism in Toddlers, RITA-T)	5个方面: 共同注意、社会意识、情绪反应、人类能动性意识和一些基本认知技能。	18~36个月	9个活动项目最高30分		是/否计分	10	免费	专业人员对互动活动“触发儿童的特定行为进行观察	15分	1项研究 Choueiri和Wagner (2015)
18. 自闭症追踪的结构化观察(Observação estruturada para rastreamento de Autism, OERA) [葡萄牙语]	2个领域: 缺乏社交技能和限制性、重复性的行为或兴趣	3~10岁	13		是否计分	10~15	免费	专业人员使用一套标准化的物品和玩具与孩子玩耍并观察	5分	1项研究 Paula等(2018)

测量名称(简称)	测量的结构	适用年龄		项目数	计分	时间分钟	可获得性	测量方式	临界值	研究数量
1. 改良的幼儿自闭症检查表(the Modified Checklist for Autism in Toddlers, M-CHAT)	7个领域: 社会利益, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		23	是/否	5~10	免费	主要照顾者完成问卷	对于6个关键项目中2分及以上答案为否; 或者3分及以上条目答案为否时, 为阳性结果, 怀疑为自闭症患儿	4项研究 Carbone等(2020) Toh等(2018) Stenberg等(2014) Koh等(2014)
2. 改良的幼儿自闭症检查表-有后续随访(the Modified Checklist for Autism in Toddlers with Follow-up Interview, M-CHAT/F)	7个领域: 社会兴趣, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		23	是/否	10~15	免费	主要照顾者完成问卷, 如果孩子的筛查结果呈阳性, 附加专业人员随访	对于6个关键项目中2分及以上答案为否; 或者3分及以上条目答案为否时, 为阳性结果, 怀疑为自闭症患儿	6项研究 Guthrie等(2019) Kerub等(2020) Baduel等(2017) Sturner等(2016) Srisinghasongkram等(2016) Kamio等(2014)
3. 改良的幼儿自闭症检查表-有修订的后续随访(Modified Checklist for Autism in Toddlers- Revised with follow-up, M-CHAT-R/F)	7个领域: 社会兴趣, 假装功能性游戏, 共同注意, 原陈述式指点, 模仿, 运动发展, 吵闹式的玩耍	16~30个月		20	通过/不通过	10~20	免费	主要照顾者完成问卷, 如果孩子的筛查结果大于3分, 专业人员开展结构化的后续问题,	0~2分: 低风险, 无需进一步评估, 除非存在其他风险因素 3~7分: 中等风险, 需要进行随访以确定是否需要转诊 8~20分: 高风险, 立即转诊进行评估和干预	5项研究 Coelho-Medeiros等(2019) Magán-Maganto等(2020) Guo等(2019) Robins等(2014) Tsai等(2019)
4. 幼儿自闭症定量检查表(Qualitative Checklist for Autism in Toddlers, Q-CHAT)	3个部分: 社会交往; 行为; 语言	18~24个月		25	5点利克特量表	15~20	免费	主要照顾者完成问卷	Q-CHAT: 27分 Q-CHAT-10: 3分	2项研究 Raza等(2019) Ruta等(2019)
5. 儿童行为检查表(the Child Behavior Checklist, CBCL)	7个症状量表(情绪反应、焦虑/抑郁、躯体抱怨、退缩、睡眠问题、注意力问题和攻击行为)和5个DSM导向的量表(情感问题、焦虑问题、PDP、注意力缺陷/多动问题和对立违抗问题)	学龄前版本(1.5~5岁)		100	3点利克特量表	15~20	免费	主要照顾者完成问卷	临床意义: 症状量表和DSM导向量表的T分数为65~69分以上; 内化、外化和总问题量表为60~63分以上	4项研究 Rescorla等(2019) Limberg等(2017) Narzisi等(2013) Havdahl等(2016)
6. 婴幼儿自闭症筛查第1部分(The Baby and Infant Screen for Children with a UtIsm Traits— Part1, BISCUIT-Part1)	3个因素: 社会化/非语言交流、重复行为/兴趣和交流受限	17~37个月	62		3点利克特量表	15	免费	主要照顾者完成问卷	17分以下: ASD/非典型发展 17~39分: ASD/PDD-NOS 39分或以上: ASD/autism	1项研究 Horovitz和Matson (2014)
7. 婴儿自闭症父母筛查(The Autism Parent Screen for Infants, APSI)	包括眼神接触、视觉跟踪、对姓名的反应、模仿、语言、社会发展、共同注意、手势、游戏、物体视觉检查和情绪调节的损伤	6~24个月	26		3点利克特量表	10~15	免费	主要照顾者完成问卷	15分	1项研究 Sacrey等(2018)
8. 第一年调查(The First Year Inventory, FYI)	2个领域: 社会沟通和感官调节	12个月	63		3点利克特量表	10~15	免费	主要照顾者完成问卷	总风险得分: 19.2分(等于或高于96百分位) 社会沟通领域: 22.5分(第94个百分位) 感觉-调节领域: 14.75分(第88百分位)	1项研究 Turner-Brown等(2013)
9. 心理发展问卷-1(the Psychological Development Questionnaire-1, PDQ-1)	2个领域: 社会参照和交流表达	18~36个月	10		3点利克特量表	2	免费	主要照顾者完成问卷	12分	1项研究 Zahorodny等(2018)
10. 自闭症谱系评定量表中文修订版(the revised Chinese version of the autism spectrum rating scale, RC_ASRS)	2大因素: 社交、异常行为	2~5岁	62		4点利克特量表	20	付费	主要照顾者完成问卷	60分	1项研究 Zhou等(2018)
11. 自闭症图片评估清单(the pictorial autism assessment schedule, PAAS)	2个领域: 异常的游戏行为和社交互动困难。清单的前20项都配了一张照片, 用文字说明了信息, 21项是文本信息	18~48个月	21		是否计分	15~20	免费	主要照顾者完成评估清单	4分	1项研究 Perera等(2017)
12. 发展性登记(The Developmental Check-In, DCI)	4个领域: 交流、游戏、社交和行为。28个项目每一个都被描绘成一幅线条图和一张照片。添加了简短的描述标签。	24~60个月	28		是否计分	NR	NR	主要照顾者完成的问卷	7.5分	1项研究 Janvier等(2019)
13. 两岁儿童自闭症筛查测验(Screening Tool for Autism in 2-Year-Olds, STAT)	4个社会交际领域: 游戏, 请求、共同注意、模仿	24~35个月	12		通过或失败	20	免费	专业人员对儿童进行游戏互动观察、判断	0到4分之间分数越高, 障碍越严重。 24个月以下儿童: 2.5分 24个月以上儿童: 2.75分	2项研究 Wu等(2020) Chiang等(2013)
14. 儿童早期自闭症检测(the Autism Detection in Early Childhood, ADEC)	5个部分: 社会互动、言语和非言语交流、活动或兴趣受限、对感官刺激固着性反应	12~36个月	16		3点利克特量表	10~15	NR	专业人员对儿童进行观察、判断	0~10分: ASD低风险 11~13: ASD中风险 14~19: ASD高风险大于19分: 非常高风险	1项研究 Hedley等(2015)
15. 自闭症心理状态检查(the Autism Mental Status Exam, AMSE)	4个方面: 社会, 沟通, 自闭症的行为标记和症状	3~6岁	8		3点利克特量表	NR	NR	专业人员基于儿童互动的观察和照顾者访谈	7.5分	1项研究 Cederlund (2019)
16. 三项直接观察的自闭症筛查(The Three- Item Direct Observation Screen, TIDOS)	3个项目: 叫名反应; 共同注意; 眼神接触	18~60个月	3		前两项0~2分, 后一项0~1计分	15~20	免费	专业人员的观测	1分	1项研究 Oner等(2014)
17. 幼儿自闭症快速互动筛查测试(the Rapid Interactive Screening Test for Autism in Toddlers, RITA-T)	5个方面: 共同注意、社会意识、情绪反应、人类能动性意识和一些基本认知技能。	18~36个月	9个活动项目最高30分		是/否计分	10	免费	专业人员对互动活动“触发儿童的特定行为进行观察	15分	1项研究 Choueiri和Wagner (2015)
18. 自闭症追踪的结构化观察(Observação estruturada para rastreamento de Autism, OERA) [葡萄牙语]	2个领域: 缺乏社交技能和限制性、重复性的行为或兴趣	3~10岁	13		是否计分	10~15	免费	专业人员使用一套标准化的物品和玩具与孩子玩耍并观察	5分	1项研究 Paula等(2018)

工具名称	研究者, 年代	应用水平	心理测量指标		文化适应性		诊断标准
工具名称	研究者, 年代	应用水平	信度	效度	转译和回译	审查与预测试	发育及其他相关测量	诊断工具	诊断标准
M-CHAT (23项)	Carbone等(2020)美国	一级	NR	NR	NR	√	NR	NR	ICD-9 ICD-10
	Toh等(2018)马来西亚	一级	NR	NR	√√	√	NR	NR	DSM-IV-TR
	Stenberg等(2014)挪威	一级	NR	NR	√√	√√	NR	ADI-R ADOS	ICD-10 DSM-IV
	Koh等(2014)新加坡	一级	α: 0.75~0.86	NR	√√	√	Vineland-II Bayley-III WPPSI-III DAS-II	ADOS-G	DSM-IV-TR
M-CHAT/F (23项)	Guthrie等(2019)美国	一级	NR	NR	-	-	NR	NR	ICD-9 ICD-10 DSM-IV DSM-5
	Kerub等(2020)以色列	二级	NR	NR	√√	NR	GDS	NR	DSM-5
	Baduel等(2017)法国	二级	NR	NR	√√	NR	PEP-R VABS	ADOS-G	NR
	Sturner等(2016)美国	一级	评分者信度 r = 0.866 Cohen’s K= 0.72	NR	-	-	MSEL	ADOS-2	DSM-IV
	Srisinghasongkram等(2016)泰国	混合	NR	NR	√√	NR	MSEL CAT/CLAMS或Denver II	NR	DSM-5
	Kamio等(2014)日本	混合	NR	NR	√√	√	TBIS EADT WISC-III	ADI-R ADOS CARS	DSM-IV-TR
M-CHAT-R/F (20项)	Coelho-Medeiros等(2019)智利	混合	α = 0.889	与ADOS-2相关 r = 0.849	√√	NR	NR	ADOS-2	DSM-5
	Magán-Maganto等(2020)西班牙	一级	α: 0.62~0.72	NR	√√	√√	M-PRS VABS	ADOS-G ADOS-2	DSM-5
	Guo等(2019)中国	一级	α = 0.86 重测信度 ICC = 0.759	NR	√√	√	ASQ-3 ASQ-SE CARS	CARS	DSM-5
	Robins等(2014)美国	一级	α = 0.79	NR	-	-	CARS-2 TASI MSEL VABS-II BASC-2 STAT	ADOS	DSM-IV-TR
	Tsai等(2019)中国台湾	混合	α = 0.84 重测信度 K = 0.33~1 ICC = 0.94~0.96	与CBCL/1½- 5相关 r = 0.37~0.63	√√	√√	CBCL/1½-5 MSEL	NR	DSM-5
PDQ-1	Zahorodny等(2018)美国	一级	重测信度 r = 0.997	与ABC相关r = -0.869	-	-	ABC MSEL	ADI-R	DSM-IV-TR
FYI	Turner-Brown等(2013)美国	一级	NR	NR	-	-	SRS-P DCQ MSEL VABS-2	ADOS	DSM-IV
RC_ASRS	Zhou等(2018)中国	一级	α = 0.91	Cohen’s d = 2.27	√√	√√	NR	NR	DSM-5
Q-CHAT	Raza等(2019)加拿大	二级	NR	NR	-	-	MSEL	ADOS ADI-R	DSM-IV
Q-CHAT	Ruta等(2019)意大利	混合	α = 0.84	与CBCL/1½- 5相关ρ为0.29-0.44	√√	√	GMDS CBCL/1½-5	ADOS-2	DSM-5
CBCL/1½-5	Rescorla等(2019)美国	二级	退缩: α = 0.75 PDP: α = 0.80	NR	-	-	CDI MSEL	ADOS-G ADI-R	DSM-IV
	Limberg等(2017)德国	一级	NR	NR	NR	NR	NR	ADOS-G ADI-R	ICD-10
	Narzisi等(2013)意大利	混合	重测信度 r = 0.085 评分者一致性r = 0.61	NR	NR	√	GMDS	ADOS-G CARS	DSM-IV-TR
	Havdahl等(2016)美国	二级	NR	NR	-	-	DAS-II或 MSEL CPRS-R SCAS MASC VABS-II	ADOS ADI-R	DSM-IV-TR
STAT	Wu等(2020)中国台湾	二级	α = 0.9	NR	NR	NR	MSEL	ADOS	DSM-5
STAT	Chiang等(2013)中国台湾	二级	评分者信度 r = 0.90	NR	NR	√	MSEL	ADOS	DSM-IV DSM-IV-TR
APSI	Sacrey等(2018)加拿大	二级	α: 0.77~0.92, 分半信度 r: 0.35~0.94	NR	-	-	AOSI MSEL VABS	ADOS ADI-R	DSM-IV-TR
BISCUIT-Part1	Horovitz和Matson (2014)美国	二级	NR	NR	-	-	BDI-2 M-CHAT	NR	DSM-IV-TR
ADEC	Hedley等(2015)美国	二级	α = 0.8; 评分者信度 ICC = 0.95 K: 0.43~0.89	ADEC总分与CARS2-ST和ADOS-2相关0.58~0.70	-	-	CARS2-ST MSEL ASRS VinelandII BayleyIII	ADOS-2 ADI-R	DSM-5
AMSE	Cederlund (2019)瑞典	二级	NR	NR	-	-	VinelandII WPPSI系列 M-PRS BSITD-3	DISCO-11	ICD-10
RITA-T	Choueiri和Wagner (2015)美国	二级	NR	与ADOS-G相关 r = 0.79	-	-	M-CHAT MSEL	ADOS-G	DSM-IV DSM-5
DCI	Janvier等(2019)美国	二级	NR	NR	-	-	M-CHAT-R SCQ MSEL	ADOS-2	NR
PAAS	Perera等(2017)斯里兰卡	混合	重测信度 r = 0.957	NR	-	-	NR	CARS	DSM-5
TIDOS	Oner等(2014)土耳其	混合	评分者一致性0.80及以上	NR	NR	NR	SCQ VABS	ADOS	DSM-IV DSM-IV-TR
OERA	Paula等(2018)巴西	二级	评分者信度 K:0.652~0.978	NR	-	-	WISC-IV SON-R2½-7 ABC	ADI-R	DSM-5

工具名称	研究者, 年代	应用水平	心理测量指标		文化适应性		诊断标准
工具名称	研究者, 年代	应用水平	信度	效度	转译和回译	审查与预测试	发育及其他相关测量	诊断工具	诊断标准
M-CHAT (23项)	Carbone等(2020)美国	一级	NR	NR	NR	√	NR	NR	ICD-9 ICD-10
	Toh等(2018)马来西亚	一级	NR	NR	√√	√	NR	NR	DSM-IV-TR
	Stenberg等(2014)挪威	一级	NR	NR	√√	√√	NR	ADI-R ADOS	ICD-10 DSM-IV
	Koh等(2014)新加坡	一级	α: 0.75~0.86	NR	√√	√	Vineland-II Bayley-III WPPSI-III DAS-II	ADOS-G	DSM-IV-TR
M-CHAT/F (23项)	Guthrie等(2019)美国	一级	NR	NR	-	-	NR	NR	ICD-9 ICD-10 DSM-IV DSM-5
	Kerub等(2020)以色列	二级	NR	NR	√√	NR	GDS	NR	DSM-5
	Baduel等(2017)法国	二级	NR	NR	√√	NR	PEP-R VABS	ADOS-G	NR
	Sturner等(2016)美国	一级	评分者信度 r = 0.866 Cohen’s K= 0.72	NR	-	-	MSEL	ADOS-2	DSM-IV
	Srisinghasongkram等(2016)泰国	混合	NR	NR	√√	NR	MSEL CAT/CLAMS或Denver II	NR	DSM-5
	Kamio等(2014)日本	混合	NR	NR	√√	√	TBIS EADT WISC-III	ADI-R ADOS CARS	DSM-IV-TR
M-CHAT-R/F (20项)	Coelho-Medeiros等(2019)智利	混合	α = 0.889	与ADOS-2相关 r = 0.849	√√	NR	NR	ADOS-2	DSM-5
	Magán-Maganto等(2020)西班牙	一级	α: 0.62~0.72	NR	√√	√√	M-PRS VABS	ADOS-G ADOS-2	DSM-5
	Guo等(2019)中国	一级	α = 0.86 重测信度 ICC = 0.759	NR	√√	√	ASQ-3 ASQ-SE CARS	CARS	DSM-5
	Robins等(2014)美国	一级	α = 0.79	NR	-	-	CARS-2 TASI MSEL VABS-II BASC-2 STAT	ADOS	DSM-IV-TR
	Tsai等(2019)中国台湾	混合	α = 0.84 重测信度 K = 0.33~1 ICC = 0.94~0.96	与CBCL/1½- 5相关 r = 0.37~0.63	√√	√√	CBCL/1½-5 MSEL	NR	DSM-5
PDQ-1	Zahorodny等(2018)美国	一级	重测信度 r = 0.997	与ABC相关r = -0.869	-	-	ABC MSEL	ADI-R	DSM-IV-TR
FYI	Turner-Brown等(2013)美国	一级	NR	NR	-	-	SRS-P DCQ MSEL VABS-2	ADOS	DSM-IV
RC_ASRS	Zhou等(2018)中国	一级	α = 0.91	Cohen’s d = 2.27	√√	√√	NR	NR	DSM-5
Q-CHAT	Raza等(2019)加拿大	二级	NR	NR	-	-	MSEL	ADOS ADI-R	DSM-IV
Q-CHAT	Ruta等(2019)意大利	混合	α = 0.84	与CBCL/1½- 5相关ρ为0.29-0.44	√√	√	GMDS CBCL/1½-5	ADOS-2	DSM-5
CBCL/1½-5	Rescorla等(2019)美国	二级	退缩: α = 0.75 PDP: α = 0.80	NR	-	-	CDI MSEL	ADOS-G ADI-R	DSM-IV
	Limberg等(2017)德国	一级	NR	NR	NR	NR	NR	ADOS-G ADI-R	ICD-10
	Narzisi等(2013)意大利	混合	重测信度 r = 0.085 评分者一致性r = 0.61	NR	NR	√	GMDS	ADOS-G CARS	DSM-IV-TR
	Havdahl等(2016)美国	二级	NR	NR	-	-	DAS-II或 MSEL CPRS-R SCAS MASC VABS-II	ADOS ADI-R	DSM-IV-TR
STAT	Wu等(2020)中国台湾	二级	α = 0.9	NR	NR	NR	MSEL	ADOS	DSM-5
STAT	Chiang等(2013)中国台湾	二级	评分者信度 r = 0.90	NR	NR	√	MSEL	ADOS	DSM-IV DSM-IV-TR
APSI	Sacrey等(2018)加拿大	二级	α: 0.77~0.92, 分半信度 r: 0.35~0.94	NR	-	-	AOSI MSEL VABS	ADOS ADI-R	DSM-IV-TR
BISCUIT-Part1	Horovitz和Matson (2014)美国	二级	NR	NR	-	-	BDI-2 M-CHAT	NR	DSM-IV-TR
ADEC	Hedley等(2015)美国	二级	α = 0.8; 评分者信度 ICC = 0.95 K: 0.43~0.89	ADEC总分与CARS2-ST和ADOS-2相关0.58~0.70	-	-	CARS2-ST MSEL ASRS VinelandII BayleyIII	ADOS-2 ADI-R	DSM-5
AMSE	Cederlund (2019)瑞典	二级	NR	NR	-	-	VinelandII WPPSI系列 M-PRS BSITD-3	DISCO-11	ICD-10
RITA-T	Choueiri和Wagner (2015)美国	二级	NR	与ADOS-G相关 r = 0.79	-	-	M-CHAT MSEL	ADOS-G	DSM-IV DSM-5
DCI	Janvier等(2019)美国	二级	NR	NR	-	-	M-CHAT-R SCQ MSEL	ADOS-2	NR
PAAS	Perera等(2017)斯里兰卡	混合	重测信度 r = 0.957	NR	-	-	NR	CARS	DSM-5
TIDOS	Oner等(2014)土耳其	混合	评分者一致性0.80及以上	NR	NR	NR	SCQ VABS	ADOS	DSM-IV DSM-IV-TR
OERA	Paula等(2018)巴西	二级	评分者信度 K:0.652~0.978	NR	-	-	WISC-IV SON-R2½-7 ABC	ADI-R	DSM-5

工具名称	研究者, 年代	样本数量/性别(男:女) /年龄(平均值)		敏感性	特异性	阳性预测值PPV	阴性预测值NPV
M-CHAT(23项)	Carbone等(2020) Koh等(2014) Stenberg等(2014) Toh等(2018)	23966/12264:11702 (1人性别不明)/17.25~26.25 mon		0.46	0.90	0.31	0.98
M-CHAT/F (23项)	Baduel等(2017) Guthrie等(2019) Kamio等(2014) Kerub等(2020) Srisinghasongkram等(2016) Sturner等(2016)	5272/2735:2537/16.74~31.76 mon (22.18)		0.62	0.94	0.49	0.99
M-CHAT-R/F (20项)	Coelho-Medeiros等(2019) Guo等(2019) Magán-Maganto等(2020) Robins等(2014)	6886/3582:3239(259性别不明)/16~26.5 mon (M = 21.08)		0.86	0.92	0.35	1.00
PDQ-1	Zahorodny等(2018)	1959/1009:950/18~36 mon		0.8462	0.9984	0.8800	0.9979
FYI	Turner-Brown等(2013)	699/343:356/12 mon		0.44	0.99	0.31	0.99
STAT	Wu等(2020)	139/91:28/16~24 mon (20人未参加随访)		0.860	0.806	0.803	0.862
BISCUIT-Part1	Horovitz和Matson (2014)	1014/684:326(4人性别不明)/17~23 mon (M = 20.43)		0.9274	0.7593	NR	NR
Q-CHAT-10	Raza等(2019)	172/89:83/18~24 mon		0.73	0.64	0.35	0.90
CBCL/1½-5	Rescorla等(2019)	82/52:30/24 mon	退缩	0.77	0.97	0.83	0.96
CBCL/1½-5	Rescorla等(2019)	82/52:30/24 mon	PDP	0.77	0.99	0.91	0.96
APSI	Sacrey等(2018)	283/162:121/6~24 mon		0.62	0.81	0.67	0.78
小计：10项工具	21项研究	4047^*/3101:1937(4项研究性别有缺失值)/15.62-26.94 mon (M = 20.62)		0.72	0.88	0.59	0.94