Modified Checklist For Autism In Toddlers, Revised With Follow-Up Research Articles

Challenging Case: Family Navigation for Autism Spectrum Disorder.

Leo is a 28-month-old boy from a monolingual Spanish-speaking family who was referred to a developmental-behavioral pediatrics (DBP) clinic for concerns regarding autism. His parents migrated to the United States 8 years ago and currently live and work on a farm. He was born in a US hospital after an uncomplicated pregnancy and has been generally healthy. His parents first became concerned about his development when he was 16 months old. He stopped saying mama/dada in Spanish and started lining up random objects. He had frequent temper tantrums and was difficult to console during unexpected changes in his routine. He screened positive on the Modified Checklist for Autism in Toddlers,Revised with Follow-Up (M-CHAT-R/F) at his 18-month well-child visit, and his pediatrician referred him to the local early intervention program. Calls from the early intervention program to his parents were unanswered. At his 24-month well-child visit, he again screened positive on the M-CHAT-R/F, and his pediatrician placed a referral for a DBP consultation. During the DBP visit at 28 months of age, developmental testing indicated his receptive and expressive language skills to be in the extremely low range, with significant scatter in his cognitive and adaptive skills. Behavioral observations were consistent with parental history and showed differences in social communication and interaction, the presence of repetitive behaviors, and extreme distress with transitions. He was diagnosed with autism spectrum disorder. Recommendations, including referral to early intervention, applied behavior analysis therapy, speech and language therapy, audiology evaluation, and genetic testing, were discussed with his parents through an interpreter. An autism packet, written in Spanish, with detailed information about autism and community resources was given to the family. By the time of a follow-up DBP visit 6 months later, Leo had not started on any early intervention or therapeutic services. Where do you go from here?

The Impact of Using Standardized Autism Screening on Referral to Specialist Evaluation for Young Children on the Autism Spectrum: A Cluster-Randomized Controlled Trial

We tested whether the implementation of standardized, high-fidelity screening for autism during routine well-child check-ups results in the following: increasing the number of children with suspected autism referred to diagnostic evaluation; lowering the age at which they are referred; and facilitating autism diagnosis for children across a more diverse range of demographic backgrounds and clinical presentations, including those with subtle manifestations. As part of a multi-site cluster randomized trial, pediatric practices were randomly assigned to an experimental condition involving training and supervision in the universal, standardized, high-fidelity implementation of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), or a usual care condition. Children in both conditions identified as having a high likelihood of autism during well-child visits were referred to a diagnostic evaluation conducted by clinicians naive to referral source. Children referred to the diagnostic evaluation from the practices in the experimental condition were more numerous (n= 186) and younger (mean age= 20.65 months) than those referred from the practices in the usual care condition (n= 39; mean age= 23.58 months). Children referred by experimental practices who received an autism diagnosis had milder clinical presentations across measures of cognitive, language, adaptive, and social-communication functioning, compared to those referred from usual care practices. Demographic characteristics were similar across groups. Standardized, high-fidelity implementation of autism screening during pediatric well-child visits facilitates the identification of children with high autism likelihood at a younger age, including those presenting with more subtle clinical manifestations. Promoting Positive Outcomes for Individuals With ASD: Linking Early Detection, Treatment, and Long-term Outcomes; https://clinicaltrials.gov/; NCT03333629.

Autism screening and diagnostic outcomes among toddlers bornpreterm.

To examine the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), with follow-up screening and diagnostic outcomes for children born preterm. A secondary aim was to examine diagnostic evaluation attendance after screening to inform clinical practice. Using a cross-sectional design, 9725 toddlers (4951 males; 4774 females) whose gestational age was reported were screened at 15-month, 18-month, or 24-month well-child visits; screen-positive children were invited for an autism evaluation. Screening measure performance and diagnostic outcomes were evaluated according to preterm classification (Screening: nExtPreterm = 111; nVeryPreterm = 186; nModPreterm = 1122; nFullTerm = 8306; Evaluation: nExtPreterm = 27; nVeryPreterm = 21; nModPreterm = 86; nFullTerm = 301). Screen-positive rates were highest for children born extremely preterm (51.35%) and lowest for children born at term (6.95%). Evaluation attendance for screen-positive cases did not differ according to preterm classification. Rates of autism diagnoses differed depending on preterm birth status: for children born extremely preterm, it was 16.05%; for children born very preterm, it was 2.00%; for children born moderately preterm, it was 2.89%; and for children born at term, it was 1.49%. M-CHAT-R/F sensitivity decreased with increasing gestational age, whereas specificity improved with increasing gestational age. Positive predictive value was highest for children born extremely preterm and children born at term. Negative predictive value was consistently strong across all groups. The likelihood ratio for positive screening increased with gestational age. The sensitivity and specificity of the M-CHAT-R/F are acceptable in toddlers born preterm. Autism screening-positive rates and prevalence increased with earlier preterm birth. Those born extremely preterm showed the greatest likelihood of an autism diagnosis; screening should not be delayed based on adjusted age.

Brief Report: Relationships Between Caregiver-Reported Externalizing and Internalizing Behaviors and the Modified Checklist for Autism in Toddlers.

Early detection and intervention are associated with improved outcomes for autistic children. Thus, it is important to understand factors influencing early screening tools designed to detect autism. This study examined the relationship between caregiver-reported emotional and behavioral symptoms and children's scores on a commonly used autism screening questionnaire, the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F). Toddlers were recruited from four primary care clinics between 2018 and 2021. Their caregivers completed the M-CHAT-R/F as well as the Child Behavior Checklist (CBCL), a well-validated, normed measure of emotional and behavioral functioning. Correlational and group analyses were evaluated to examine relationships between CBCL scales and M-CHAT-R/F scores. 1765 toddlers were recruited for the study. CBCL scores for the internalizing, externalizing, autism, ADHD, and anxiety scales were all modestly positively correlated with M-CHAT-R/F scores. Compared to toddlers with elevated autism scale scores only, toddlers with elevations in both autism and ADHD/externalizing scales had higher M-CHAT-R/F scores. In contrast, no significant difference in scores were found between toddlers with elevated autism scale scores only compared to those with elevated scores on both autism and internalizing scales. Findings suggest that, for children with elevated autism behaviors, the presence of externalizing symptoms, including ADHD-related concerns, is associated with elevated scores on the M-CHAT-R/F. In contrast, internalizing symptoms did not show an association with elevated M-CHAT-R/F scores among toddlers with elevated autism-related behaviors. Interpretation of the M-CHAT-R/F should include consideration of co-occurring psychiatric conditions, especially externalizing conditions such as ADHD.

Improving Completion Rates for Autism Screening - A Quality Improvement Project

Introduction: Autism spectrum disorder (ASD) may be the most well-known and most studied neurocognitive disorder responsible for developmental delay. The medical community, in response to the noted increase in prevalence, emphasized the importance of routine screenings at 18 months and 24 to 30 months of age. Ascension St. John Children’s Hospital Resident Clinic utilizes the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) or MCHAT for short, validated for ages 16 through 30 months. It was noted that screening is frequently missed or undocumented. Because of the need for timely diagnosis and intervention, these missed opportunities can be costly for children and their families. Purpose: To improve compliance with the American Academy of Pediatrics’ (AAP) recommendation to screen all children for ASD at 18 and 24 months of age. Methods: An educational lecture was provided to the pediatric residents to screen all children in the above age group being seen for a well-child visit. A visual reminder red pen mark was also applied to eligible patient charts as they were checked in. Baseline completion rates in two three month periods, one year before and three months after the intervention, were compared. Results: A total of 337 charts were reviewed with similar baseline characteristics between pre- and post-intervention groups. Overall MCHAT completion rates were lower after the intervention: 64% pre- vs. 49% post-intervention (p <0.05). Subgroup analysis of visits where screening was directly indicated (excluding ages 16-17 months, >24 month olds where a screen was already passed at a 24 month well visit, or children already diagnosed with autism, n = 281), had similar completion rates (67.5% and 64.5% respectively, p = 0.59). Conclusion: MCHAT completion did not improve after the combined intervention of a single, in-person lecture and visual reminder chart marking.

Development of a school-age extension of the Modified Checklist for Autism in Toddlers through expert consensus and stakeholder input.

The American Academy of Pediatrics recommends universal screening to identify children at higher likelihood for autism at 18- and 24-month well-child visits. There are many children, however, that are missed during this toddler age who do not get diagnosed until much later in development, delaying access to autism-specific interventions. Currently, brief measures for universal autism screening for school-age children, however, are lacking. In this project, we adapted a commonly used autism screener for toddlers, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), to be used for school-age children. This measure, called the M-CHAT-School (M-CHAT-S), is a parent- and teacher-report questionnaire to be used to screen for autism in school-age children aged 4 to 8 years of age. M-CHAT-S was developed through feedback from autism experts, as well as interviews with parents and teachers to provide input on the items. Two versions of M-CHAT-S were developed, one for verbally fluent and one for minimally verbal school-age children. M-CHAT-S is a brief measure, with updated items to reflect changes in the way experts think and talk about autism, making it a useful measure to use for autism screening in elementary aged children. The next steps include further testing to ensure that M-CHAT-S performs well in identifying children with increased likelihood of autism, after which it will be made available to parents, educators, and other professionals.

Use of Web-Based Surveys to Collect Long-Term Pediatric Outcomes in Patients With Twin-Twin Transfusion Syndrome Treated With Fetoscopic Laser Photocoagulation: Observational Study.

In the United States, patients with monochorionic diamniotic twins who undergo in utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost. The aim of this study was to collect long-term pediatric outcomes in patients who underwent FLP for TTTS. We assessed the feasibility of using a web-based survey designed in REDCap (Research Electronic Data Capture; Vanderbilt University) to collect parent-reported outcomes in children treated for TTTS at a single center during 2011-2019. Patients with ≥1 neonatal survivor were invited via email to complete 5 possible questionnaires: the child status questionnaire (CSQ); fetal center questionnaire (FCQ); Ages & Stages Questionnaires, Third Edition (ASQ-3); Modified Checklist for Autism in Toddlers, Revised With Follow-Up (M-CHAT-R/F); and thank you questionnaire (TYQ). The R programming language (R Foundation for Statistical Computing) was used to automate survey distribution, scoring, and creation of customized reports. The survey was performed in 2019 and repeated after 12 months in the same study population in 2020. A total of 389 patients in 26 different states and 2 international locations had an email address on file and received an invitation in 2019 to complete the survey (median pediatric age 48.9, IQR 1.0-93.6 months). Among surveyed mothers in 2019, the overall response rate was 37.3% (145/389), and the questionnaire completion rate was 98% (145/148), 87.8% (130/148), 71.1% (81/100), 86.4% (19/22), and 74.3% (110/148) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. In 2020, the overall response rate was 57.8% (56/97), and the questionnaire completion rate was 96.4% (54/56), 91.1% (51/56), 86.1% (31/36), 91.7% (11/12), and 80.4% (45/56) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. This is the first study to use both REDCap and computer automation to aid in the dissemination, collection, and reporting of surveys to collect long-term pediatric outcomes in the field of fetal medicine.

A Direct Comparison of Three Screening Methods for Autism Spectrum Disorder in a High-Likelihood Sibling Population.

Targeted screening of children at increased likelihood of autism is recommended. However, autism screening tools are usually validated for use mainly in low-likelihood populations. This study compared the accuracy of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), the ASDetect app, and the Social Attention and Communication Surveillance, Revised (SACS-R). Siblings of autistic children underwent autism screening at 12, 18 and 30months old. At each visit, caregivers completed the M-CHAT-R/F and ASDetect while trained nurses tested the siblings using the SACS-R. At 36 to 48months, the siblings underwent an Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) assessment. 189 siblings were screened, 141 completed the study, and 32 were confirmed to have autism. Although not validated for use at 12months, the M-CHAT-R/F had the best sensitivity among the three tools for this age group, suggesting that early signs are already apparent to caregivers. The M-CHAT-R/F had overall better sensitivity (0.72-0.83) across all age groups, but with overall lower specificity (0.55-0.77). The SACS-R and ASDetect had better positive predictive values at 18 and 30months (0.60-0.68), while the M-CHAT-R/F was 0.43-0.48. Negative predictive values were generally high across all three tools across all age groups (0.78-0.93). Targeted screening of children at high likelihood of autism yielded a detection rate of 22.7% and should therefore be implemented routinely to facilitate early detection and intervention. The performance of autism screening tools should be examined in higher-likelihood populations for targeted screening of these children.

2 Infant Imitation: Detecting Risk in the First Year with PediaTrac™

Objective:Imitation has pervasive associations with social and communicative development. However, few methods have been developed to measure this construct in typically developing infants, and even less is available for at-risk populations, such as infants born preterm. Autism spectrum disorder (ASD), a particular risk of premature birth, is associated with atypical imitation and social communication. Although imitation emerges in infancy, most current screening and diagnostic tools for ASD cannot be utilized prior to 12 months. The present study aimed to develop and validate a caregiver-report measure of infant imitation, characterize imitation profiles at 4, 6, and 9 months in term and preterm infants, and explore the relationship between imitation and scores on an ASD screening questionnaire at 18 months.Participants and Methods:Participants (N = 571) were recruited from a larger multi-site study of PediaTrac™ v3.0, a web-based tool for monitoring and tracking infant development, and were surveyed longitudinally at birth, 2, 4, 6, 9, 12, 15, and 18 months. Participants completed the online PediaTrac™ survey and several reliable and validated questionnaires via pen-and-paper format. For the purposes of this study, only the Ages and Stages Questionnaire (3rd ed.; ASQ-3), Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP), Brief Infant Sleep Questionnaire (BISQ), and the Modified Checklist for Autism in Toddlers - Revised with Follow-Up (M-CHAT-R/F) were examined. The following hypotheses were tested: (1) proposed imitation items will represent a unitary latent construct, for which convergent and discriminant validity will be demonstrated, (2) there will be measurement invariance between term status groups at each assessment period, (3) preterm infants will obtain lower caregiver-reported imitation scores compared to term infants, and (4) imitation abilities at the assessment period with the most robust imitation factor will predict M-CHAT-R/F scores at 18 months.Results:Distinct imitation factors at 4, 6, and 9 months were modeled with confirmatory and exploratory factor analyses. Relationships between the factors and established measures of infant communication (CSBS; ASQ) and sleep (BISQ) revealed convergent and discriminant validity, respectively. Strict measurement invariance was demonstrated for the 4- and 9-month factors, and metric invariance for the 6-month measure. Full term infants scored higher on imitation at 9 months, though variance in this outcome was related to term status differences in sensorimotor skills. Lastly, the 9-month imitation factor, coupled with 6-month sensorimotor skills, predicted 18-month ASD risk over and above gestational age.Conclusions:This study provides support for the assessment of infant imitation, utilizing imitation to detect risk in preterm infants, and extending the age of identification for ASD risk into the first year. PediaTrac™ imitation, in combination with the PediaTrac™ sensorimotor domain, may be useful in detecting developmental risk, and specifically risk for ASD, within the first year, leading to earlier initiation of intervention. Further, with its minimal completion time and ease of dissemination through digital platforms, this measure can expand access to care and improve long-term outcomes for children and families.

Validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in primary care clinics in Singapore.

Systematic screening for autism in early childhood has been suggested to improve eventual outcomes by facilitating earlier diagnosis and access to intervention. However, clinical implementation of screening has to take into account effectiveness and feasibility of use within a healthcare setting for accurate diagnosis of autism. In Singapore, autism screening using a structured screening tool is not currently employed as a part of routine well-child visits for children in primary care clinics. In this study, 5336 children (aged 17-20 months) were screened for autism using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during their 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by nursing staff at each clinic. Children screened positive and a portion of those screened negative then underwent diagnostic assessments to determine whether they met the diagnostic criteria for autism. In total, 113 (2.1%) were screened positive, of which 54 (1.0%) met the criteria for autism. Children who screened positive and received a diagnosis accessed autism-specific intervention at an average age of 22 months. Nurses and physicians rated the acceptability and practicality of the M-CHAT-R/F highly. Therefore, the M-CHAT-R/F questionnaire was an effective and feasible tool for autism screening among 18-month-old children in this study. Future studies will be designed to determine the optimal age of screening and role of repeated screening in Singapore, as well as to better understand any potential improved outcomes nationwide compared with pre-implementation of autism screening.

Evaluation of Autism Spectrum Disorder Risk in Infants With Intraventricular Hemorrhage.

Background This study evaluates the long-term risk of autism spectrum disorder (ASD) in infants with intraventricular hemorrhage (IVH) using the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F) screening tool. Methods This retrospective cohort study compared IVH (exposed) infants across all gestational age groupswith no-IVH(non-exposed)infants admitted to level IV neonatal intensive care unit (NICU). The M-CHAT-R/F screening tool was used to assess the ASD risk at 16-30 months of age. Discharge cranial ultrasound (CUS) findings also determined the ASD risk. Descriptive statistics comprised median and interquartile range for skewed continuous dataand frequencies and percentages for categorical variables. Comparisons for non-ordinal categorical measures in bivariate analysis were carried out using the χ2test or Fisher exact test. Results Of the 334 infants,167had IVH, and 167 had no IVH. High ASD risk (43% vs. 20%, p = 0.044) and cerebral palsy (19% vs. 5%, p = 0.004) were significantly associated with severe IVH. Infants with CUS findings of periventricular leukomalacia had 3.24 odds of developing high ASD risk (odds ratios/OR: 3.24, 95% confidence interval/CI: 0.73-14.34), and those with hydrocephalus needing ventriculoperitoneal (VP) shunt had 4.75 odds of developing high ASD risk (OR: 4.75, 95% CI: 0.73-30.69). Conclusion Severe IVH, but not mild IVH,increased the risk of ASD and cerebral palsy. This study demonstrates the need for timely screening for ASD in high-risk infants. Prompt detection leads to earlier treatment and better outcomes.

Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits.

Autism spectrum disorder (ASD) is a neurodevelopmental condition made up of enduring challenges in social communication and interaction and the presence of repetitive and restricted behavior patterns. Early diagnosis of autism is crucial for timely intervention and improved long-term outcomes. This review aims to explore some of its signs and symptoms, look into some diagnostic tools, and analyze the benefits and risks associated with an early diagnosis of autism. The symptoms of ASD vary from child to child, some of which are: avoidance of eye contact, lack of response to names, excessive fear, and lack of interactive and pretend play. Early identification of these symptoms by caregivers and healthcare providers facilitates the need for diagnosis and appropriate interventions. Some screening and diagnostic tools that have been found to help make the diagnosis are the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), the Social Communication Questionnaire (SCQ), the Parents' Evaluation of Developmental Status (PEDS), and the Childhood Autism Rating Scale (CARS), amongst others. The benefits of early diagnosis include the opportunity for early intervention, which has been shown to enhance developmental outcomes and improve adaptive skills. Early identification allows for the implementation of specialized interventions tailored to the specific needs of individuals with autism, targeting social communication, language development, and behavioral challenges. Furthermore, early diagnosis enables families to access appropriate support services, educational resources, and community programs, facilitating better coping mechanisms, reducing parental stress, and increasing adult independence. However, early diagnosis of autism also entails certain risks. One significant concern is the potential for labeling and stigmatization, which can impact the child's self-esteem and social interactions. There is a risk of overdiagnosis or misdiagnosis, leading to unnecessary interventions and treatments. Additionally, the diagnostic process can be lengthy, complex, and emotionally challenging for families, requiring comprehensive assessments by multidisciplinary teams. This review highlights the importance of a balanced approach when considering the benefits and risks of early diagnosis. Early identification allows for timely interventions that significantly improve developmental outcomes and quality of life for individuals with autism. To mitigate the risks, it is crucial to ensure accurate and reliable diagnostic procedures, support families throughout the process, and promote societal awareness and acceptance. We also highlighted some future directions in the management of autism, including the use of biomarkers and the use of artificial intelligence and learning for diagnosing ASD.

Neurobehavioral and Medical Correlates of Autism Screening: 2-Year Outcomes for Infants Born Very Preterm

To identify neonatal characteristics and 2-year neurodevelopmental outcomes associated with positive screening for risk of autism. Nine university-affiliated neonatal intensive care units (NICUs) enrolled infants born at <30weeks of gestation. Infants underwent the NICU Network Neurobehavioral Scale examination before discharge and the Bayley Scales of Infant and Toddler Development, Third Edition, the Child Behavior Checklist, and the Modified Checklist for Autism in Toddlers, revised with follow-up (M-CHAT-R/F) at 2 years of corrected age. Generalized estimating equations examined associations between M-CHAT-R/F, neurobehavioral test results, and neonatal medical morbidities. At 2 years of corrected age, data were available for 466 of 744 enrolled infants without cerebral palsy. Infants with hypoaroused NICU Network Neurobehavioral Scale profiles were more likely to screen M-CHAT-R/F-positive (OR2.76, 95% CI 1.38-5.54). Infants with ≥2 medical morbidities also were more likely to screen positive (OR2.65, 95% CI 1.27-5.54). Children with positive M-CHAT-R/F scores had lower Bayley Scales of Infant and Toddler Development, Third Edition, Cognitive (t [451]=5.43, P<.001, d=0.82), Language (t [53.49]=7.82, P<.001, d=1.18), and Motor (t [451]=7.98, P<.001, d=1.21) composite scores and significantly greater ChildBehavior Checklist Internalizing (t [457] -6.19, P<.001, d=-0.93) and Externalizing (t [57.87]=-5.62, P<.001, d=-0.84) scores. Positive M-CHAT-R/F screens at 2years of corrected age were associated with neonatal medical morbidities and neurobehavioral examinations as well as toddler developmental and behavioral outcomes. These findings demonstrate the potential utility of the M-CHAT-R/F as a global developmental screener in infants born very preterm, regardless of whether there is a later autism diagnosis.

EE284 Exploring the Value of a Novel Health Technology Tool to Support Diagnosis of Autism Spectrum Disorder

To examine the potential cost-utility of a novel screening device for early diagnosis of autism spectrum disorder (ASD) compared to the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F).

Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is used worldwide to screen for autism spectrum disorder (ASD). To calculate psychometric properties of the M-CHAT-R/F for subsequent diagnosis of ASD. Systematic searches of Medline, Embase, SCOPUS, and Trip Pro databases from January 2014 to November 2021. Studies were included if they (1) used the M-CHAT-R/F (2) applied standard scoring protocol, (3) used a diagnostic assessment for ASD, and (4) reported at least 1 psychometric property of the M-CHAT-R/F. Two independent reviewers completed screening, full-text review, data extraction, and quality assessment, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was used to derive pooled estimates and assess for between-study heterogeneity. Of 667 studies identified, 15 with 18 distinct samples from 10 countries (49 841 children) were used in the meta-analysis. Pooled positive predictive value (PPV), was 57.7% (95% confidence interval [CI] 48.6-66.8, τ2 = 0.031). PPV was higher among high-risk (75.6% [95% CI 66.0-85.2]) than low-risk samples (51.2% [95% CI 43.0-59.5]). Pooled negative predictive value was 72.5% (95% CI 62.5-82.4 τ2 = 0.031), sensitivity was 82.6% (95% CI 76.2-88.9) and specificity 45.7% (95% CI 25.0-66.4). Negative predictive value, sensitivity, and specificity were calculated based on small sample sizes because of limited or no evaluation of screen-negative children. These results support use of the M-CHAT-R/F as a screening tool for ASD. Caregiver counseling regarding likelihood of an ASD diagnosis after positive screen should acknowledge the moderate PPV.

Reliability and Concurrent Validity of a Cultural Adaptation and Northern Sotho Translation of the M-CHAT-R/F

Currently, no culturally and linguistically adapted autism screening tools are available in South Africa. The aim was to determine the reliability and concurrent validity of the adapted English and Northern Sotho–translated Modified Checklist for Autism in Toddlers–Revised with Follow-up (M-CHAT-R/F). Reliability was confirmed with near-perfect agreement ( p &lt; .001) between the checklists in a sample of 158 Northern Sotho/English bilingual mothers of children with a low risk for autism. Concurrent validity between the Northern Sotho M-CHAT-R/F and the communication and socialization sub-domains of the Vineland-3 was established with significant association at the 5% level. A third (33.5%) of the children showed a developmental delay. The checklists are valid and reliable, and may improve early identification that will render better long-term outcomes for children with autism in South Africa. Autism screening should be combined with developmental assessment. The study contributes to an emerging body of research on the development of contextually appropriate screening measures.

Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

The Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F)-henceforth referred to as M-CHAT(-R/F)-are the most commonly used toddler screeners for autism spectrum disorder (ASD). Their use often differs from that in the original validation studies, resulting in a range of estimates of sensitivity and specificity. Also, given the variability in reports of the clinical utility of the M-CHAT(-R/F), researchers and practitioners lack guidance to inform autism screening protocols. To synthesize variability in sensitivity and specificity of M-CHAT(-R/F) across multiple factors, including procedures for identifying missed cases, likelihood level, screening age, and single compared with repeated screenings. A literature search was conducted with PubMed, Web of Science, and Scopus to identify studies published between January 1, 2001, and August 31, 2022. Articles were included if the studies used the M-CHAT(-R/F) (ie, original or revised version) to identify new ASD cases, were published in English-language peer-reviewed journals, included at least 10 ASD cases, reported procedures for false-negative case identification, screened children by 48 months, and included information (or had information provided by authors when contacted) needed to conduct the meta-analysis. The systematic review and meta-analysis was conducted within the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality Assessment of Diagnostic Accuracy Studies-2 tool evaluated bias in sample selection. Data extraction and quality assessment were performed by 2 authors independently. The overall diagnostic accuracy of the M-CHAT(-R/F) was assessed with the hierarchic summary receiver operating characteristic (HSROC) model. Sensitivity, specificity, diagnostic odds ratios, and HSROC curves of M-CHAT(-R/F). The review included 50 studies with 51 samples. The pooled sensitivity of M-CHAT(-R/F) was 0.83 (95% CI, 0.77-0.88), and the pooled specificity was 0.94 (95% CI, 0.89-0.97). Heterogeneity analyses revealed greater diagnostic accuracy for low- vs high-likelihood samples, a concurrent vs prospective case confirmation strategy, a large vs small sample size, use of M-CHAT(-R/F) Follow-up, and non-English vs English only. Overall, results of this study suggest the utility of the M-CHAT(-R/F) as an ASD screener. The wide variability in psychometric properties of M-CHAT(-R/F) highlights differences in screener use that should be considered in research and practice.

Sex differences in early autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F).

This study examined a widely used autism screening tool, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up to identify differences in screening for autism between toddler males and females. Examining sex differences in screening for autism in toddlerhood is important as it determines who will be referred for evaluations and receive diagnoses, which is critical for access to autism-specific early intervention. This study found that females were less likely to screen positive and be invited for evaluations compared with males. Females at high likelihood for autism were less likely to be diagnosed with autism, which decreases confidence in the screener's results. Importantly, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identified both males and females with autism. Future research should examine ways to improve accuracy in screening results for females.

Translation into Brazilian Portuguese and validation of the M-CHAT-R/F scale for early screening of autism spectrum disorder.

ABSTRACTObjective:To translate and validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) from English to Brazilian Portuguese, taking transcultural differences into account.Methods:Permission for the translation was obtained from the author of the scale. Translation and back-translation were performed, and the document was then assessed for reference and general equivalence. Specialists in childhood autism evaluated the scale. A preliminary version was prepared and pre-tested in a sample population, and a final version was validated with the target population.Results:Only one question had issues relating to referential equivalence. The 10 individuals questioned in the pre-test all understood most of the instrument, although some suggested substituting certain terms to improve comprehension. The final version was reached following inclusion of pertinent suggestions and was submitted to validation with the target population, indicating a sensitivity of 88.2% for a cutoff point greater than 2 points.Conclusions:A Brazilian version of the M-CHAT-R/F scale, approved by specialists and understandable by the target audience, is now available for use.

Screening Vietnamese Children in the United States for Autism Risk: Examination of the Modified Checklist for Autism in Toddlers–Revision With Follow-Up Vietnamese

Purpose: This study examined the utility of the Vietnamese version of the Modified Checklist for Autism in Toddlers–Revised with Follow-Up (M-CHAT-R/F) for screening Vietnamese children for autism risk. Cultural reasons and/or limited access to health care has resulted in delays in receiving an autism diagnosis for children of racial minorities. Delays in receiving an autism diagnosis may subsequently result in delay in receiving early intervention services. Therefore, this study examined the feasibility of implementing autism screening for Vietnamese American children. Method: The M-CHAT-R/F is a well-validated autism screening test offered in multiple languages such as Vietnamese. It takes approximately 10 min for caregivers to complete 20 yes/no-response items and includes a follow-up interview for initial screen-failed items to reduce false-positive rates. We recruited 205 parents of children aged between 16 and 36 months in Southern California to conduct a broadband screening, not an autism-specific screening. The participants responded to a print or an online Qualtrics version of the M-CHAT-R/F in a language of their choice, either English or Vietnamese. Results: A total of 79 of the 205 participants provided complete responses. Of the 79 participants, 20% of the results were initially screened positive. Seven participants were not available for follow-up interviews. Screen-positive rates were estimated to range from 8% to 15% based on completed follow-ups. Conclusions: The estimated screen-positive rates in this exploratory study were higher than the reported screen-positive rates in a Vietnamese population sample using the Modified Checklist for Autism in Toddlers. Limitations of this study include participant recruitment difficulty, a small sample size, and the inability to conduct follow-up interviews with some participants. Future studies should use larger and more representative samples and examine potential cultural factors possibly impacting interest in screening Vietnamese children for autism risk.