Researchers report an Indonesian autism screening tool performed well in a specialist clinic
The brief observational tool was assessed in 174 referred children, but its usefulness outside similar Indonesian specialist settings is uncertain.
Low evidenceHuman studySome caution advised
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
The study examined whether an Indonesian version of a brief observation-based autism assessment could help specialists assess children when more resource-intensive instruments are not readily available. The children were aged 18 months to 18 years and were assessed using the Indonesian tool, an Indonesian version of the Childhood Autism Rating Scale-2, and a specialist clinical diagnosis based on DSM-5 criteria.
The Indonesian tool showed high agreement between raters and across repeat assessments. A score of 6 or higher had reported sensitivity of 88.9% and specificity of 94.7% in this referred specialist-clinic sample. These results indicate potentially useful performance in the setting studied, but they do not show that the tool alone can establish an autism diagnosis or improve outcomes.
What the study looked at
This human cross-sectional diagnostic-accuracy study adapted the Autism Mental Status Exam into Indonesian using a published cross-cultural adaptation process. Researchers then evaluated the Indonesian version in 174 children aged 18 months to 18 years who had been referred to a developmental specialist clinic. Each child received the Indonesian assessment, the Indonesian Childhood Autism Rating Scale-2, and a best-estimate clinical diagnosis based on DSM-5 criteria from an experienced consultant who was blinded to the Indonesian tool's score. The researchers assessed reliability, several forms of validity, and diagnostic accuracy using receiver operating characteristic analysis.
What researchers observed
The Indonesian tool had excellent reported inter-rater reliability (intraclass correlation coefficient 0.97) and test-retest reliability (0.96). Internal consistency was moderate (0.66), which the researchers described as consistent with a tool covering multiple aspects of autism-related behavior. Agreement with the Childhood Autism Rating Scale-2 was strong (correlation 0.85), and content-validity ratings were excellent. In this specialist-clinic sample, the area under the receiver operating characteristic curve was 0.98. Using a cutoff score of 6 or higher, reported sensitivity was 88.9%, specificity was 94.7%, positive predictive value was 95.7%, and negative predictive value was 86.6%. These are measures of performance in the studied sample and setting, not proof that the tool performs the same way in other populations.
Who this is relevant to
The findings may be relevant to specialists evaluating children referred to secondary or tertiary developmental services in Indonesia, particularly settings with limited access to comprehensive assessment instruments. They should not be assumed to apply to unselected children in the community, primary-care settings, adults, people outside Indonesia, or services with different training and referral patterns. The tool is described as pre-diagnostic and should not be interpreted from this study as a standalone diagnosis or a substitute for a comprehensive clinical assessment.
The significance
Some specialist services in Indonesia and other lower- and middle-income settings may have limited access to costly or highly trained assessments such as the Autism Diagnostic Observation Schedule-2. A structured, shorter observation tool could provide additional information during specialist assessment where resources are constrained. However, this study examined test performance only; it did not show that using the tool changes access to services, leads to earlier support, or improves health or developmental outcomes.
Limitations & evidence assessment
The sample was limited to 174 children referred to a developmental specialist clinic, so it may not represent children in the general population, primary care, schools, or other countries. Because the study was cross-sectional, it does not assess performance over time or show whether use of the tool improves outcomes. The reported clinical diagnosis was used as the comparison standard, but the abstract provides limited detail about the diagnostic process, participant characteristics, and how many children did or did not have autism. The study also does not report independent validation in a separate sample, and the abstract does not establish whether results would remain similar when trained clinicians, referral patterns, or autism prevalence differ.
Why this evidence level: This was a cross-sectional diagnostic-accuracy study in 174 children referred to one developmental specialist clinic, rather than a randomized trial or large population study. The results provide useful information about test performance in a specific specialist setting, but they may not generalize to other clinics, countries, or children who were not referred for evaluation.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
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