A 3-year-old boy has no words, does not respond to his name, avoids eye contact, engages in repetitive hand flapping, and has restricted interests in spinning objects. He passed all motor milestones. What developmental screening tool is the MOST appropriate FIRST step?
- A Childhood Autism Rating Scale (CARS) ✓
- B Denver Developmental Screening Test (DDST-II)
- C Modified Checklist for Autism in Toddlers Revised (M-CHAT-R)
- D Vineland Adaptive Behavior Scales
Explanation
The Childhood Autism Rating Scale (CARS) is a standardized diagnostic rating scale used for formal autism spectrum disorder (ASD) assessment in a child already demonstrating clear red flags. M-CHAT-R is a SCREENING tool designed for toddlers at 18–24 months in primary care settings to identify those needing further evaluation; by age 3 with prominent features, a diagnostic tool is more appropriate. DDST-II screens for developmental delays across domains but is not autism-specific. Vineland assesses adaptive functioning, useful after diagnosis. At age 3 with clear features, CARS or ADOS-2 (gold standard diagnostic tool) would be used for formal assessment.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.