Development of a Short Screening Questionnaire for Early Identification of Autism Spectrum Disorders in Serbia
Abstract
The selection of appropriate screening instruments and the availability of resources are among the key challenges in the identification of autism spectrum disorder (ASD). Recognizing the need for the continuous development of tools to identify this complex neurodevelopmental condition, the aim of this paper is to present the first two phases of the development of a screening tool that preceded the psychometric evaluation of a brief instrument for the early recognition of ASD in Serbia, titled “Minute for Autism”. For the purposes of this study, a literature review was conducted, followed by a content analysis of 26 screening questionnaires identified through the search. The analysis assessed content validity, examined the thematic areas covered by the questionnaires, and evaluated the alignment of the items with the diagnostic criteria of the DSM- 5 and ICD-11. By analyzing the items in the selected screening instruments, the forms of behavior and skills most frequently targeted by these tools were identified. The development of the short screening questionnaire involved selecting the most representative domains and formulating relevant items. This process resulted in a prototype intended for use by both parents and professionals working with young children. The questionnaire comprises 15 yes/no questions addressing key domains relevant to social communication and interaction, speech and language development, repetitive behaviors and interests, atypical sensory processing, and behavioral and emotional regulation. The instrument presented in this paper represents a preliminary step in the authors’ efforts to develop a brief screening tool that can be used by a broad range of professionals working with young children.
References
Пејовић Милованчевић, М. (ур.) (2023). Смернице за скрининг, дијагностику и интервенцију код деце и одраслих са поремећајима из спектра аутизма. Београд: Институт за ментално здравље.
Светска здравствена организација. (2019). Међународна класификација болести (11. ревизија). https://icd.who.int/browse11/l-m/en
Allison, C., Auyeung, B., & Baron-Cohen, S. (2012). Toward brief “red flags” for autism screening: The short autism spectrum quotient and the short quantitative checklist in 1,000 cases and 3,000 controls. Journal of the American Academy of Child & Adolescent Psychiatry, 51(2), 202–212. https://doi.org/10.1016/j.jaac.2011.11.003
Allison, C., Matthews, F. E., Ruta, L., Pasco, G., Soufer, R., Brayne, C., Charman, T., & Baron-Cohen, S. (2021). Quantitative checklist for autism in toddlers (Q-CHAT). A population screening study with follow-up: The case for multiple time-point screening for autism. BMJ Paediatrics Open, 5(1), Article e000700. https://doi.org/10.1136/bmjpo-2020-000700
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Barbaro, J., & Dissanayake, C. (2013). Early markers of autism spectrum disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study. Autism, 17(1), 64–86. https://doi.org/10.1177/1362361312442597
Bong, G., Kim, J. H., Hong, Y., Yoon, N. H., Sunwoo, H., Jang, J. Y., Оh, M., Lee, K., Jung, S., & Yoo, H. J. (2019). The feasibility and validity of autism spectrum disorder screening instrument: Behavior development screening for toddlers (BeDevel)—A pilot study. Autism Research, 12(7), 1112–1128. https://doi.org/10.1002/aur.2117
Brewer, N., Young, R. L., & Lucas, C. A. (2020). Autism screening in early childhood: Discriminating autism from other developmental concerns. Frontiers in Neurology, 11, Article 594381. https://doi.org/10.3389/fneur.2020.594381
Bryson, S. E., Zwaigenbaum, L., McDermott, C., Rombough, V., & Brian, J. (2008). The autism observation scale for infants: Scale development and reliability data. Journal of Autism and Developmental Disorders, 38, 731–738. https://doi.org/10.1007/s10803-007-0440-y
Cederlund, M. (2022). Parent questionnaires in the evaluation of pre-school children referred for neuropsychiatric assessment. Journal of Autism and Developmental Disorders, 52(4), 1742–1751.
Charman, T., & Gotham, K. (2013). Measurement issues: Screening and diagnostic instruments for autism spectrum disorders—Lessons from research and practise. Child and Adolescent Mental Health, 18(1), 52–63. https://doi.org/10.1111/j.1475-3588.2012.00664.x
Dereu, M., Warreyn, P., Raymaekers, R., Meirsschaut, M., Pattyn, G., Schietecatte, I., & Roeyers, H. (2010). Screening for autism spectrum disorders in Flemish day-care centres with the checklist for early signs of developmental disorders. Journal of Autism and Developmental Disorders, 40, 1247–1258. https://doi.org/10.1007/s10803-010-0984-0
Dow, D., Guthrie, W., Stronach, S. T., & Wetherby, A. M. (2017). Psychometric analysis of the systematic observation of red flags for autism spectrum disorder in toddlers. Autism, 21(3), 301–309. https://doi.org/10.1177/1362361316636760
Eadie, P. A., Ukoumunne, O., Skeat, J., Prior, M. R., Bavin, E., Bretherton, L., & Reilly, S. (2010). Assessing early communication behaviours: Structure and validity of the communication and symbolic behaviour scales—Developmental profile (CSBS‐DP) in 12‐month‐old infants. International Journal of Language & Communication Disorders, 45(5), 572–585. https://doi.org/10.3109/13682820903277944
Flavian, H. (2024). Transdisciplinary Teaching in Inclusive Schools: Promoting Transdisciplinary Education for Learners with Special Needs. Cham: Springer International Publishing.
Grodberg, D., Weinger, P. M., Kolevzon, A., Soorya, L., & Buxbaum, J. D. (2012). Brief report: The autism mental status examination—Development of a brief autism-focused exam. Journal of Autism and Developmental Disorders, 42, 455–459. https://doi.org/10.1007/s10803-011-1255-4
Jagan, V., & Sathiyaseelan, A. (2016). Early intervention and diagnosis of autism. Indian Journal of Health & Wellbeing, 7(12), 1144–1148.
Jovančević, M. (2025). Transdisciplinarni pristup u pedijatriji. Paediatria Croatica, 69(3), 6–8. https://doi.org/10.13112/pc.1038
Kamio, Y., Haraguchi, H., Stickley, A., Ogino, K., Ishitobi, M., & Takahashi, H. (2015). Brief report: Best discriminators for identifying children with autism spectrum disorder at an 18-month health check-up in Japan. Journal of Autism and Developmental Disorders, 45, 4147–4153. https://doi.org/10.1007/s10803-015-2527-1
Linnsand, P., Hermansson, J., Gillberg, C., & Nygren, G. (2023). A feasibility study of a new instrument for detection of autism signs in preschool settings. Psychometric properties of the joint attention observation schedule preschool (JA-OBS preschool). Frontiers in Child and Adolescent Psychiatry, 1, Article 1061451. https://doi.org/10.3389/frcha.2022.1061451
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2001). Autism Diagnostic Observation Schedule. Western Psychological Services.
Magán‐Maganto, M., Jónsdóttir, S. L., Sánchez‐García, A. B., García‐Primo, P., Hellendoorn, A., Charman, T., Roeyers, H., Dereu, M., Moilanen, I., Muratori, F., Posada de la Paz, M., Rogé, B., Oosterling, I. J., Yliherva, A., & Canal‐Bedia, R. (2018). Building a theoretical framework for autism spectrum disorders screening instruments in Europe. Child and Adolescent Mental Health, 23(4), 359–367. https://doi.org/10.1111/camh.12256
Marlow, M., Servili, C., & Tomlinson, M. (2019). A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children: Recommendations for use in low‐and middle‐income countries. Autism Research, 12(2), 176–199. https://doi.org/10.1002/aur.2033
Mayes, S. D. (2018). Brief report: Checklist for autism spectrum disorder—Most discriminating items for diagnosing autism. Journal of Autism and Developmental Disorders, 48(3), 935–939. https://doi.org/10.1007/s10803-017-3401-0
Nah, Y. H., Young, R. L., Brewer, N., & Berlingeri, G. (2014). Autism detection in early childhood (ADEC): Reliability and validity data for a level 2 screening tool for autistic disorder. Psychological Assessment, 26(1), 215–226. https://doi.org/10.1037/a0034472
Neal, D. (2012). Examination of the Reliability and Validity of a New Observation Measure for Autism Spectrum Disorders: The Autism Spectrum Disorder Observation for Children. Louisiana: Louisiana State University, Agricultural & Mechanical College.
Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14(4), 263–284. https://doi.org/10.1177/1362361309348071
Nygren, G., Sandberg, E., Gillstedt, F., Ekeroth, G., Arvidsson, T., & Gillberg, C. (2012). A new screening programme for autism in a general population of Swedish toddlers. Research in Developmental Disabilities, 33(4), 1200–1210. https://doi.org/10.1016/j.ridd.2012.02.018
Oner, P., Oner, O., & Munir, K. (2014). Three-item Direct Observation Screen (TIDOS) for autism spectrum disorder. Autism, 18(6), 733–742. https://doi.org/10.1177/1362361313487028
Ranjan, R., Pradhan, K. R., & Wong, J. (2014). Effect of transdisciplinary approach in group therapy to develop social skills for children with autism spectrum disorder. Theory and Practice in Language Studies, 4(8), 1536–1542. https://doi.org/10.4304/tpls.4.8.1536-1542
Reznick, J. S., Baranek, G. T., Reavis, S., Watson, L. R., & Crais, E. R. (2007). A parent-report instrument for identifying one-year-olds at risk for an eventual diagnosis of autism: The first year inventory. Journal of Autism and Developmental Disorders, 37, 1691–1710. https://doi.org/10.1007/s10803-006-0303-y
Robins, D. L., Casagrande, K., Barton, M., Chen, C. M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45. https://doi.org/10.1542/peds.2013-1813
Rutter, M., LeCouteur, A., & Lord, C. (2003). Autism Diagnostic Interview—Revised. Western Psychological Services.
Samadi, S. A., & McConkey, R. (2015). Screening for autism in Iranian preschoolers: Contrasting M-CHAT and a scale developed in Iran. Journal of Autism and Developmental Disorders, 45, 2908–2916. https://doi.org/10.1007/s10803-015-2454-1
Skuse, D. H., Mandy, W. P., & Scourfield, J. (2005). Measuring autistic traits: Heritability, reliability and validity of the social and communication disorders checklist. The British Journal of Psychiatry, 187(6), 568–572. https://doi.org/10.1192/bjp.187.6.568
Soto, S., Linas, K., Jacobstein, D., Biel, M., Migdal, T., & Anthony, B. J. (2015). A review of cultural adaptations of screening tools for autism spectrum disorders. Autism, 19(6), 646–661. https://doi.org/10.1177/1362361314541012
Stevanovic, D., Costanzo, F., Fucà, E., Valeri, G., Vicari, S., Robins, D. L., Samms-Vaughan, M., Ozek Erkuran, H., Yaylaci, F., Desphande, S. N., Deshmukh, V., Arora, N. K., Albores-Gallo, L., García-López, C., Gatica-Bahamonde, G., Gabunia, M., Zirakashvili, M., Prada Machado, F., Radan, M., Ali Samadi, S., Toh, T.-H. et al. (2021). Measurement invariance of the childhood autism rating scale (CARS) across six countries. Autism Research, 14(12), 2544–2554. https://doi.org/10.1002/aur.2586
Stevanovic, D., Robins, D. L., Costanzo, F., Fuca, E., Valeri, G., Vicari, S., Ozek Erkuran, H., Yaylaci, F., Albores-Gallo, L., Gatica-Bahamonde, G., Gabunia, M., Zirakashvili, M., Charman, T., Ali Samadi, S., Toh, T.-H., Gayle, W., Brennan, L., Zorcec, T., Auza, A., De Jonge, M., & Knez, R. (2022). Cross-cultural similarities and differences in reporting autistic symptoms in toddlers: A study synthesizing M-CHAT (-R) data from ten countries. Research in Autism Spectrum Disorders, 95, Article 101984. https://doi.org/10.1016/j.rasd.2022.101984
Stevanović, D., Kovačić, Z., Cvijetić Vukčević, M., Milević, A., Cvetković Brkić, S., Dodić, A. i Mrvić, J. (2025). Kratak skrining upitnik za rano prepoznavanje poremećaja iz spektra autizma u Srbiji: Minut za autizam (MAUT). Medicinski časopis, 59(2), 45–55. https://doi.org/10.5937/mckg59-57347
Stewart, J. R., Vigil, D. C., Ryst, E., & Yang, W. (2014). Refining best practices for the diagnosis of autism: A comparison between individual healthcare practitioner diagnosis and transdisciplinary assessment. Nevada Journal of Public Health, 11(1), 1.
Stroth, S., Tauscher, J., Wolff, N., Küpper, C., Poustka, L., Roepke, S., Roessner, V., Heider, D., & Kamp‐Becker, I. (2021). Identification of the most indicative and discriminative features from diagnostic instruments for children with autism. JCPP Advances, 1(2), e12023. https://doi.org/10.1002/jcv2.12023
Swinkels, S. H., Dietz, C., van Daalen, E., Kerkhof, I. H., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum in children aged 14 to 15 months. I: The development of the Early Screening of Autistic Traits Questionnaire (ESAT). Journal of Autism and Developmental Disorders, 36, 723–732. https://doi.org/10.1007/s10803-006-0115-0
Wetherby, A. M., Guthrie, W., Hooker, J. L., Delehanty, A., Day, T. N., Woods, J., Pierce, K., Manwaring, S., Thurm, A., Ozonoff, S., Petkova, E., & Lord, C. (2021). The early screening for autism and communication disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age. Autism, 25(7), 2112–2123. https://doi.org/10.1177/13623613211012526
Williams, J. G., Allison, C., Scott, F. J., Bolton, P. F., Baron-Cohen, S., Matthews, F. E., & Brayne, C. (2008). The childhood autism spectrum test (CAST): Sex differences. Journal of Autism and Developmental Disorders, 38, 1731–1739. https://doi.org/10.1007/s10803-008-0558-6
Yama, B., Freeman, T., Graves, E., Yuan, S., & Karen Campbell, M. (2012). Examination of the properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in a population sample. Journal of Autism and Developmental Disorders, 42, 23–34. https://doi.org/10.1007/s10803-011-1211-3
The details about the publication policy, including copyright and licensing, are available at: