Revised autism screening tool (M-CHAT-R/F) may allow for earlier diagnosis

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1. The Modified Checklist for Autism in Toddlers Revised with Follow-Up (M-CHAT-R/F) is an effective and reliable test for detecting autism spectrum disorder (ASD) that requires little time and cost to administer. 

2. The M-CHAT-R/F detected ASD at a significantly higher rate than the M-CHAT and allowed for ASD diagnosis by age 2, 2 years earlier than the median age of diagnosis of 4 years. 

Evidence Rating Level: 2 (Good)           

Study Rundown: Autism spectrum disorder (ASD) is characterized by communication and social interaction deficits along with restrictive and repetitive behaviors. As early intervention is known to improve long-term outcomes, the American Academy of Pediatrics (AAP) recommends autism-specific screenings at 18- and 24-month well-child care visits. One widely-used screening tool is a parent-report questionnaire called the Modified Checklist for Autism in Toddlers (M-CHAT). The current study sought to validate the revised version of the M-CHAT (M-CHAT-R) with a follow-up component, the M-CHAT Revised with Follow-Up (M-CHAT-R/F).Through this prospective study, the M-CHAT-R/F was determined to be a valid screening test, detecting ASD at a significantly higher rate than the M-CHAT and allowing for ASD diagnosis by age 2. There are several limitations to this study. First, it is possible that screen-negatives could have been missed at final diagnosis, therefore altering calculated “misses” and testing sensitivity. Also, some parents of children who initially screened positive did not complete the entire study course. Nevertheless, data from this study suggest that the M-CHAT-R/F is an effective and reliable screening tool for ASDs in a low-risk pediatric sample. Steps must be taken to ease its implementation at well-child visits.

Click to read the study published today in Pediatrics

Relevant Reading: Identification and Evaluation of Children with Autism Spectrum Disorders

Study Author, Dr. Diana L. Robins, PhD, talks to 2 Minute Medicine: Associate Professor of Psychology and Neuroscience, Georgia State University.

“Autism spectrum disorders (ASD) are severe developmental disorders. However, children who receive intensive early intervention have the best prognosis. Standardized ASD-specific screening can reduce the age of ASD detection by two years, compared to the national median age of diagnosis. The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) is a 2-stage screening tool designed for use during toddler well-child care visits to pediatricians and other healthcare providers. Parents complete initial questions in about 5 minutes, and if results indicate ASD risk, parents complete the Follow-Up questions. Of children who continue to show ASD risk on the 2-stage M-CHAT-R/F, 95% are diagnosed with a developmental delay or concern about development, including ASD. This highlights the confidence physicians and healthcare providers have that referrals are needed when children screen positive on the 2-stage M-CHAT-R/F.”

In-Depth [prospective cohort study]: A total of 15 612 toddlers in metropolitan Atlanta or Conneticut were included in this study (mean age = 20.95 + 3.30 months, 7570 female). Of this group, 263 children screened positive for ASD and underwent a thorough diagnostic evaluation. First, parents completed the M-CHAT-R/F and those whose children screened positive were then contacted by telephone to complete the follow up, which consisted of structured questions with a clinician. Continued positive screens resulted in a full diagnostic evaluation. Across all M-CHAT-R items, internal consistency was below the threshold for adequate (*Cronbach’s α = .63), although when the 2-stage screen was examined, internal consistency was adequate (Cronbach’s α = .79). Of children with a total score on the screening tool of ≥3 initially and ≥2 at follow-up, 47.5% were diagnosed with ASD and 94.6% had some developmental delay or other concerns. Total score was more effective than alternative scores. The M-CHAT-R/F detected ASD at a significantly higher rate than the M-CHAT (67 cases per 10,000 using the M-CHAT-R/F vs. 45 cases per 10,000 using the M-CHAT; X² = 8.63; P = .003) and allowed for ASD diagnosis by age 2.

*Cronbach’s α is a coefficient of internal consistency used to measure the reliability of a psychometric test. For example, an α value ≥ 0.9 could indicate “excellent” internal consistency, 0.7-0.9 is “good”, 0.6-0.7 is “acceptable”, 0.5-0.6 is “poor”, and α < 0.5 is “unacceptable.”

By Cordelia Y. Ross and Leah H. Carr

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