![]() Evaluations were conducted by a team consisting of a licensed psychologist/developmental pediatrician supervising a graduate student and research assistants team members were research reliable on all measures they administered. Research staff contacted parents of screen-positive children to complete the follow-up by telephone children who continued to screen positive on the M-CHAT-R/F or whose physician had concerns were offered a diagnostic evaluation. Completed M-CHAT-R forms were scored at GSU or UConn. Pediatricians were asked to indicate concern about ASD, based on their clinical judgment, by checking a box at the top of the screener. Parents completed the M-CHAT, Revised (M-CHAT-R), and provided informed consent and demographic characteristics during their child’s 18- or 24-month WCC visit (41 sites at GSU, 44 sites at UConn). A threshold based on total score had strong psychometric properties and was more parsimonious than combinations of total and alternative scorings (see Supplemental Information).Ĭlinical measures included the Autism Diagnostic Observation Schedule, 16 Childhood Autism Rating Scale–2, 17 the Toddler Autism Symptom Interview, 18 Mullen Scales of Early Learning, 19 Vineland Adaptive Behavior Scales–II, 20 Behavioral Assessment System for Children–2, 21 and a developmental history form. 12 The current study tested several scoring methods. ![]() 15 However, analyses of larger samples indicated that the critical score did not improve sensitivity above the total score. The original M-CHAT recommended a threshold of ≥3 items total or ≥2 critical items identified through discriminant function analysis. For example, “Does your child ever use his/her index finger to point…” was rephrased as “Does your child point with one finger….” Finally, examples provided developmental context and clarity. Language was simplified to improve comprehension. The items that comprised the Best7 score (see Supplemental Information) were placed within the first 10 items. The remaining 20 items were reorganized to remove agreement bias. Three items that performed poorly were dropped (peek-a-boo, playing with toys, and wandering without purpose). 13 The M-CHAT-R/F 14 incorporated 5 modifications to improve utility. Initially, parents answer 20 yes/no questions, which takes <5 minutes if children screen positive, parents are asked structured follow-up questions to obtain additional information and examples of at-risk behaviors, which takes ∼5 to 10 minutes with a professional (ie, nurse or physician’s assistant). The M-CHAT-R/F is a 2-stage screener (see and Supplemental Appendix), which is free for clinical, research, and educational use and requires little or no training for health care professionals. The current study validates the M-CHAT, Revised with Follow-Up (M-CHAT-R/F), in a low-risk sample. The purpose of revising the M-CHAT was to reduce the number of cases who initially screen positive and need the follow-up, while maintaining high sensitivity. The M-CHAT with Follow-Up (M-CHAT/F) has been shown to have adequate sensitivity and specificity 10, 11 in a sample of nearly 19 000 toddlers aged 16 to 30 months, 12 54% of children classified as at risk on the basis of the M-CHAT/F were diagnosed with ASD, and 98% of screen-positive cases presented with developmental delay or concerns. The Modified Checklist for Autism in Toddlers (M-CHAT) 6 is currently one of the most widely used ASD screening instruments both in the United States and internationally, 7, 8 providing an accessible, low-cost 9 option for universal toddler screening. 4 However, the median age of diagnosis is after the fourth birthday 2 and even later for children of low socioeconomic status or minority backgrounds. 3 Because ASD can often be detected before a child’s third birthday, the American Academy of Pediatrics recommends autism-specific screening at 18- and 24-month well-child care (WCC) visits. ![]() 2 Aggressive early intervention leads to the best long-term prognosis. 1 The prevalence of ASD has increased in recent years and is now estimated at 1 in 88 children. ![]() The current validation study indicates that the M-CHAT-R/F improves the ability to detect autism spectrum disorders in toddlers screened during well-child care visits.Īutism spectrum disorder (ASD) is a neurodevelopmental disorder identified by impairments in social interaction and communication and the presence of repetitive and restricted behaviors/interests. The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), simplifies wording of the original M-CHAT.
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