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. 2014 Jan;133(1):37-45.
doi: 10.1542/peds.2013-1813. Epub 2013 Dec 23.

Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F)

Diana L Robins  1 , Karís Casagrande, Marianne Barton, Chi-Ming A Chen, Thyde Dumont-Mathieu, Deborah Fein
Affiliations

Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F)

Diana L Robins et al. Pediatrics. 2014 Jan.

Abstract

Objective: This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT.

Methods: Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated.

Results: The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis.

Conclusions: The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.

Keywords: autism; screening; toddlers.

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Figures

FIGURE 1
FIGURE 1
Flowchart indicating screening results. aEvaluations based on cases detected through STAT screen positive (n = 20), physician concern (n = 18), and alternate scoring (n = 4). bDetected through STAT (n = 6), physician concern (n = 9), and alternate scoring (n = 3). Neg, negative; Pos, positive.
FIGURE 2
FIGURE 2
A: ROC curve for 2-stage M-CHAT-R/F. AUC, area under the curve; ROC, receiver operating characteristic. B: Table showing sensitivity and specificity for each M-CHAT-R/F total score.
FIGURE 3
FIGURE 3
Recommended algorithm based on 2-stage M-CHAT-R/F screening.
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