Does the MCHAT-R Detect Similar Children at Risk for Developmental-Behavioral/Mental Health Problems as Broad-Band Screens like PEDS?

Abstract

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Professional Role & Health Promotion and Disease Prevention, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Purpose A recent American Academy of Pediatrics (AAP) survey revealed that more than 80% of clinicians use a screen for autism spectrum disorders (ASD), with 74%, using the Modified Checklist of Autism in Toddlers (MCHAT)/MCHAT-Revised (MCHAT-R). The AAP recommends administering both broad-band (e.g., Parents’ Evaluation of Developmental Status (PEDS) & narrow-band (e.g., MCHAT-R) screens focused on detecting children at-risk for mental health, behavior, & developmental disorder/delay. Yet, use of broad-band mental health, behavior, & developmental disorder/delay screens is less common: only 50% of pediatric providers and fewer family practice providers report use of validated, accurate broad-band screens. Methods Sites were 197 primary care clinics using PEDS Online, a web-based service focused on identifying mental health, behavior, & developmental disorder/delay in children 0 to 8 years of age via: a) two broad-band validated mental health, behavior, & developmental disorder/delay screens– PEDS & PEDS: Developmental Milestones (PEDS:DM); and b) a narrow-band mental health, behavior, & developmental disorder/delay screen focused on ASD – either MCHAT or MCHAT-R. From the 231,789 encounters in 2014 through 2016, we selected only the 16% (N = 37,608) in which children were administered both broad- and narrow-band screens. We defined children at-risk for mental health, behavior, & developmental disorder/delay as children with at-risk screen results on one or more broad-band screens and/or on a narrow-band ASD screen. Results In 197 clinics representing 24 US States, 66% (N=24,992) of screening occurred in pediatric clinics and 34% (N=12,616) in family practices (including public health/community clinics). Compared to US Census Bureau data, the sample resided more in Southern and Northeast States (86% vs 55% nationally) and parents were less likely to be high school graduates (76% vs 87% nationally). Mean age of children was 24 months (SD = 6.02). Of the 37,608 encounters, 12% (N=4572) of children were identified at-risk for mental health, behavior, & developmental disorder/delay. Of the 4572 with probable mental health, behavior, & developmental disorder/delay, broad-band screens identified 73% (N=3332/4572). The MCHAT/MCHAT-R uniquely identified 27% (N= 1240/4572). There was agreement among broad- and narrow-band measures of 22% (N=984/4572). ASD screens, if used alone, identified only 49% of those with probable mental health, behavior, & developmental disorder/delay (N = 2224/4572). Although ASD screens contribute uniquely to early identification, such tools do not seem to adequately detect most children at-risk for mental health, behavior, & developmental disorder/delays. Conclusions Use of an ASD screen alone would miss about 51% of children at-risk for mental health, behavior, & developmental disorder/delay. Mental health, behavior, & developmental disorder/delay screening should embrace both broad-band and narrow-band measures to best identify children at-risk.