Autism diagnosis in children and adolescents: A systematic review and meta-analysis of test accuracy

Accurate diagnosis of Autism Spectrum Disorder (ASD) is essential for appropriate care. This systematic review evaluated the accuracy of standardized structured tools in diagnosing ASD in children and adolescents. Searches were conducted on PubMed/MEDLINE, Embase, PsycINFO, Cochrane Library, and references. Certainty of evidence was evaluated according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Thirty-two studies were included. Pooled data indicated different degrees of sensitivity (Se) and specificity (Sp) for Autism Diagnostic Interview-Revised (Se:.60 and Sp:.84), Autism Diagnostic Observation Schedule (Se:.91 and Sp:.74), Autism Diagnostic Observation Schedule -Second Edition (Se:.90 and Sp:.69), Autism Spectrum Rating Scales (Se:.66 and Sp:.86), Childhood Autism Rating Scale (Se:.85 and Sp:.94), Checklist for Autism Spectrum Disorder (Se:.91 and Sp:.98), Developmental, Dimensional and Diagnostic Interview-11 (Se:.96 and Sp:.50), and Gilliam Autism Rating Scale (Se:.50 and Sp:.78). Overall, certainty of the evidence was low and very low except for ADOS-2 (moderate). The results indicate a discrepancy between clinical judgment and the assessment derived from a standardized test when applying their thresholds, suggesting that the tests may not always fully align with the clinician's evaluation. Clinicians should apply diagnostic tools while considering their limitations in terms of their sensitivity, specificity, and certainty of evidence. Diagnostic tools should be regarded as adjunctive aids rather than comprehensive substitutes for diagnosis.