{
  "abstract": "Objectives Early screening for autism spectrum disorder (ASD) can enhance educational and health outcomes for affected children. This narrative systematic review explores school-based screening tools used around the world to identify children with ASD and explore the differences across socio-demographic groups.Design Systematic review of electronic databases (EMBASE, MEDLINE, PsycINFO, Cochrane and Scopus) in October 2024 of papers published between 2011 and 2024.Setting Mainstream school-based settings globally.Participants Children aged 4–16 years old attending mainstream school.Interventions School-based screening tools for ASD, including all types of informant and format of tools reported in eligible studies.Primary and secondary outcome measures Primary outcomes included prevalence of screen positives, sensitivity and specificity of the screening tools. Secondary outcomes included participants’ sex, socioeconomic status and ethnicity, and the relation of this to the primary outcomes.Results Of 7765 eligible articles, 14 studies were included in this review. We identified eight different school-based ASD screening tools. Study populations ranged from 103 to 16 556 children, with sensitivity and specificity varying by screening tool used, age group, setting and ASD prevalence. The percentage of children screening positive for ASD ranged from 0.7% to 8.5%. Studies were conducted in Europe (n=6), Western Pacific (n=4), the Americas (n=3) and Eastern Mediterranean (n=1) regions. No studies explicitly explored accuracy or validity outcomes based on ethnicity or socioeconomic status. Half of the 14 studies (n=7) reported the sensitivity and specificity of the screening tools; sensitivity ranged from 58% to 94% and specificity from 61% to 100%. There was insufficient evidence to recommend any single ASD screening tool.Conclusions ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations.",
  "authors": [
    {
      "affiliations": [
        "Department of Twin Research & Genetic Epidemiology, King’s College London, London, UK"
      ],
      "name": "Lucy J McCann"
    },
    {
      "affiliations": [
        "Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK"
      ],
      "name": "Rinad Bakhti"
    },
    {
      "affiliations": [
        "School of Medicine, Faculty of Medicine and Health Sciences, Keele University, staffordshire, UK"
      ],
      "name": "Nishani Fonseka"
    },
    {
      "affiliations": [
        "Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK"
      ],
      "name": "Dasha Nicholls"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Medicine, Imperial College London, London, UK"
      ],
      "name": "Dougal S Hargreaves"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Medicine, Imperial College London, London, UK"
      ],
      "name": "Federica Amati"
    },
    {
      "affiliations": [
        "Central and North West London NHS Foundation Trust, London, UK"
      ],
      "name": "Antonio Ivan Lazzarino"
    },
    {
      "affiliations": [
        "The Giaroli Centre, London, UK"
      ],
      "name": "Ritu Mitra"
    },
    {
      "affiliations": [
        "Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK"
      ],
      "name": "Krishan Narayan"
    },
    {
      "affiliations": [
        "Listen to Act, London, UK"
      ],
      "name": "Alex Weston"
    },
    {
      "affiliations": [
        "School of Public Health, Faculty of Medicine, Imperial College London, London, UK"
      ],
      "name": "Shamini Gnani"
    }
  ],
  "title": "Narrative systematic review for autism spectrum disorders screening tools in school settings",
  "uid": "7d2c1553-dc12-5fa7-86e2-b0256d476297"
}