Utility of the SCQ In Predicting Clinician Concerns for ASD In An Outpatient Sample

Background: The prevalence rate of autism spectrum disorders (ASD) and public awareness of these disorders have increased dramatically increased over the past decade (Rice, 2009). Consequently, clinicians without specialized training in ASD are increasingly involved in the screening and diagnosis of these disorders. Given their increased role in the process of ASD diagnosis, it is important to examine how clinicians without ASD expertise identify children at risk. The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003) is one of the most widely use ASD screening tools. Despite its wide use, the SCQ has been understudied in samples without developmental referral concerns (Chandler et al., 2007).  

 Objectives: The goal of the present study was to evaluate the degree to which the Social Communication Questionnaire (SCQ, 2003) predicted concerns of trained clinicians for ASD in a large, mental health outpatient sample.

 Methods: Participants were 620 children and adolescents, ranging from 4 to 18 years of age, recruited using a consecutive case series design from all intakes at a community mental health clinic. Caregiver and youth pairs participated in an extended assessment of common disorders using the Schedule for Affective Disorders and Schizophrenia for Children (KSADS), as part of a larger battery of instruments. Research assistants were primarily pre-doctoral interns trained to a symptom level Kappa>.85. Final diagnoses were based on the Longitudinal Expert Evaluation of All Available Data process with a licensed clinical psychologist (Spitzer, 1983), including intake information, developmental history, KSADS, and extensive review of records. Diagnoses were masked to the SCQ.  Most youth presented with multiple diagnoses (Mean: 2.6) and most youth had at least one disruptive behavior disorder (67%). Clinicians were only concerned about 12 youth (2%) having ASD.

 Results: The ability of the SCQ to predict clinician concerns for ASD was examined using receiver operating characteristic (ROC) analysis. An Area under the curve (AUROC) of .50 indicates chance performance. The total ASQ score did not significantly predict ASD, AUROC=.63, p=.13. Given the low AUROC for the SCQ total score, separate ROC analyses were run on each of the three factors: social deficits, communication deficits, and stereotyped behavior. Social deficits (AUROC=.40, p=.23) and communication deficits (AUROC=.59, p=.29) did not significantly predict clinician concern about ASD. Caregiver reporting of Stereotyped behaviors significantly predicted ASD clinician concern, (AUROC=.79, p<.001).

 Conclusions: The SCQ total score served as a poor predictor of clinician concerns for ASD in community mental health; however, scores on the stereotyped behavior factor of the SCQ were strong predictors of clinician concerns. The results of this study indicate that stereotyped and repetitive behaviors are associated with clinical concern for ASD, whereas social and communication symptoms did not predict clinical concerns. These results also suggest that the SCQ might not function well outside of developmentally-focused clinical settings, perhaps due to differences in parental knowledge and symptom presentation, or to high rates of other clinical issues generating false positives on scales measuring social or communication deficits.