Autism screening validation evidence misses key psychometric properties

A systematic review of age-dependent screening scales for autism spectrum disorder found that validation research has focused primarily on content validity and hypothesis testing, while often overlooking or inadequately reporting reliability, measurement error, cross-cultural validity and other key psychometric properties. The analysis identified 12 distinct screening tools and categorized them by the age group for which they were intended to support diagnosis: up to 24 months, 24–30 months and over 30 months. Examples included CHAT-23 in the youngest group, M-CHAT-R/F in the middle group and BISCUIT in the group for children over 30 months.

The researchers followed PRISMA guidelines and searched PubMed, Scopus and Web of Science through June 2024, with Google Scholar also checked. From 6,146 initial records, they included studies that psychometrically validated autism spectrum disorder screening tools. Methodological quality was assessed with the COSMIN checklist, and data were extracted systematically.

Reporting across the instruments was uneven. Content validity was reported for 87.5% of the screening tools, and hypothesis testing was reported for 62.5%. Far fewer studies addressed the properties required for a broader psychometric evaluation.

Measurement error was assessed for only 6.25% of the instruments, while test–retest reliability was reported for 12.5%. Cross-cultural validity and internal consistency each appeared in 18.75% of the instruments. Interpretability and responsiveness were not evaluated in any of the included studies.

No included study used a more comprehensive approach such as Item Response Theory. The authors concluded that the existing validation literature has a skewed emphasis on content validity and hypothesis testing. Important gaps remain in the assessment of score reliability, measurement error and cross-cultural validity, limiting the strength of evidence available for selecting screening tools and for judging how widely their results can be generalized.

Future research should use comprehensive, standardized validation frameworks such as COSMIN, according to the review, so that critical psychometric properties are assessed more consistently. The article was published in Discover Mental Health as an open-access review and was initially shared in an accepted version subject to further editorial changes before the final version of record.

Subject of Research: Psychometric validation of age-dependent autism spectrum disorder screening scales

Article Title: A systematic review on age-dependent screening scales for autism spectrum disorders

Article References: Bashirian, S., Etesamifard, T., Khoshravesh, S., Ayubi, E., & Jenabi, E. (2026). A systematic review on age-dependent screening scales for autism spectrum disorders. Discover Mental Health. https://doi.org/10.1007/s44192-026-00626-x

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00626-x

Keywords: autism screening, psychometric validation, COSMIN, screening scales, measurement error, test–retest reliability, cross-cultural validity, internal consistency, age-dependent screening, systematic review, systematic, review