Autism Screening Using Parent's Observations of Social Interactions (POSI) in High-Risk Infants.

purposeThe Parent's Observations of Social Interactions (POSI) is a brief, targeted screening measure for autism spectrum disorder (ASD). There is minimal data on its use in infants at high risk for developmental delays. The objective was to evaluate the use of the POSI as an ASD screener in a cohort of infants at high risk for neurodevelopmental impairments. Our hypothesis was that positive POSI scores would be associated with developmental delays and the later diagnosis of ASD.

methodsThis retrospective cohort study included toddlers born between 2016 and 2019 assessed using the POSI and Bayley Scales of Infant and Toddler Development (BSITD) at 18-33 months corrected age. Children with positive and negative POSI screens were compared for developmental delays, cerebral palsy, and later diagnoses of ASD by a developmental pediatrician as noted in the electronic health record.

resultsPositive POSI scores were noted in 106/291 (36.4%) children, with 25/291 (8.6%) subsequently diagnosed with ASD. Toddlers with a positive score were more likely to have developmental delays and cerebral palsy compared with those with negative scores. The sensitivity of a positive POSI score for a later diagnosis of autism was 76% with a specificity of 66.7%.

conclusionsThe POSI was a feasible method of ASD screening for high-risk children, in conjunction with other developmental evaluations. Due to low specificity, future research is warranted to improve the accuracy of early ASD screening in high-risk infants and long-term follow up.