Improving Autism Detection Through Telemedicine in China: A Comparative Analysis of Multitool-Combined Screening Protocols.

Background: Autism spectrum disorder (ASD) prevalence is rising globally, yet traditional face-to-face screening faces challenges, especially during COVID-19. Telemedicine offers a viable alternative for remote ASD detection. Telemedicine offers a promising alternative for remote ASD screening. This study aimed to enhance ASD screening efficiency through telemedicine by integrating multiple early screening tools and comparing their combined efficacy in China. Methods: A cross-sectional, observational, multicenter study was conducted in three districts of Shanghai, utilizing a telemedicine system, the Early Childhood Development Screening, which includes the Warning Signs Checklist for Screening Psychological, Behavioral, and Developmental Problems of Children (WSC), the Early Behavioral Markers of Autism-Five No's behavior, and section A of the Modified Checklist for Autism in Toddlers-23 (CHAT-23-A). Children aged 18 to 36 months were screened, and the Childhood Autism Rating Scale was used as a diagnostic tool. The study evaluated the sensitivity, specificity, and screening performance of these tools individually and in combination. Results: A total of 1,102 valid cases were screened with an effective rate of 83.30%. The WSC and the Five No's demonstrated high sensitivity (90.9%), while the CHAT-23-A showed higher specificity (88.6%) but lower sensitivity (63.6%). In parallel testing, the combination of WSC and Five No's maintained high sensitivity but reduced specificity. Serial testing improved specificity to 97.6% with the triple test but at the cost of lower sensitivity. The area under the receiver operating characteristic curve and the Youden index were highest for the WSC and Five No's combination in serial testing. Conclusions: The study presents a novel ASD screening combination protocol with good sensitivity and specificity, validated through a telemedicine system. This protocol is expected to enhance the accuracy and efficiency of early ASD screening, improving long-term prognoses for children and contributing to their healthy development.