POSI score can help pediatricians refer toddlers for autism evaluation
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Key takeaways:
- The POSI questionnaire is administered at well-child visits at ages 18 and 24 months.
- The POSI had an accuracy of more than 76% at both time points.
Toddlers diagnosed with autism by age 3 years were around 3 to 4 times more likely to screen positive at age 18 or 24 months on a parental questionnaire designed to identify a risk for autism, according to a recent study.
The Parent’s Observations of Social Interactions (POSI) is part of the Survey of Well-being of Young Children (SWYC) administered during well-child visits for toddlers. The POSI includes seven questions for parents about their child’s social behavior. The questionnaire is scored with either a zero or one for each question, with a maximum of seven points. Three or more points indicates a positive screen, which means the child is at risk for autism spectrum disorder (ASD).
“Pediatricians often face the dilemma of potentially over-referring — and elevating the anxiety of parents — vs. failing to detect ASD,” Kek Khee Loo, MD, a developmental-behavioral pediatrician at Kaiser Permanente, told Healio.
Pediatricians at Kaiser Permanente Southern California began using the POSI and the SWYC Milestones questionnaires at all 18-month and 24-month well-child visits in October 2021, according to Loo and colleagues.
For their study, Loo and colleagues included children who attended 18-month and 24-month well-child visits between Jan. 1, 2022, and Dec. 31, 2022, at Kaiser Permanente pediatric practices. They followed up 1 to 2 years later to see whether children who screened positive on the POSI were diagnosed with autism.
There were 30,375 children (50.8% boys) who attended 18-month exams and 27,975 children (51.6% boys) who attended 24-month exams. Overall, 26.4% of toddlers screened positive at age 18 months and 21.4% screened positive at age 24 months, according to results published in The Journal of Pediatrics. At both time points, boys made up about 60% of positive screens.
The specificity and positive predictive value of the POSI increased between 18 and 24 months, the researchers reported. At 18 months, the screener had a sensitivity of 77.9% and a specificity of 76.1% The positive predictive value was 13.5%. At 24 months, the sensitivity was 76.5%, the specificity was 81.4% and the positive predictive value was 17.5%.
“The likelihood ratio informed us that children with ASD were 3 to 4 times more likely to have screened positive at 18 and 24 months compared with children who were not diagnosed with ASD,” Loo said.
Loo said pediatricians can feel confident in referring toddlers with positive POSI screenings for further evaluation.
“It was surprising that the POSI’s accuracy did not deteriorate significantly when it was deployed for ‘universal’ autism screening in our large clinical population,” he said. “Future studies should extend the time frame of follow-up beyond the 1 to 2 years of follow-up in our study, as we do not know if the psychometrics will hold up in the longer term.”
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