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Positive screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in extremely low gestational age
Karl C K Kuban1, T Michael O'Shea, Elizabeth N Allred
1Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, MA 02118, USA. karl.kuban@bmc.org
Insights
Children born preterm with motor, cognitive, or sensory impairments are significantly more likely to screen positive for autism spectrum disorder on the M-CHAT. Even without these, preterm infants show elevated M-CHAT positive rates.
Area of Science:
- Developmental Pediatrics
- Neurodevelopmental Disorders
- Neonatology
Background:
- Autism spectrum disorder (ASD) screening is crucial for early intervention.
- Preterm birth is a known risk factor for neurodevelopmental issues.
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool.
Purpose of the Study:
- To investigate the association between preterm birth and positive M-CHAT screening for ASD.
- To determine the contribution of specific impairments to M-CHAT positive rates in preterm infants.
Main Methods:
- Comparison of M-CHAT positive rates between preterm infants with and without specific impairments (cerebral palsy, cognitive, vision, hearing).
- Analysis of M-CHAT scores relative to motor milestones, cerebral palsy severity, and cognitive function (Mental Development Index).
Main Results:
- Preterm infants with severe motor impairments (unable to sit/stand independently) had a 23-fold increased odds of positive M-CHAT screening.
- Quadriparesis and hemiparesis were associated with 13-fold and 4-fold increased odds, respectively.
- Major vision/hearing impairments increased odds 8-fold; low MDI scores (<55) increased odds 13-fold.
Conclusions:
- Motor, cognitive, visual, and hearing impairments explain over half of positive M-CHAT screens in extremely preterm infants.
- Even after accounting for these impairments, preterm infants showed a nearly doubled rate of positive M-CHAT screens (10%).
- These findings highlight the heightened risk for ASD in preterm populations and the need for targeted screening and support.
Objective:
To test the hypothesis that children born preterm are more likely to screen positive on the M-CHAT for an autism spectrum disorder.
Study Design:
We compared the M-CHAT positive rate of those with cerebral palsy, cognitive impairment, and vision and hearing impairments to those without such deficits.
Results:
Relative to children who could walk, the odds for screening positive on the M-CHAT were increased 23-fold for those unable to sit or stand independently and more than 7-fold for those requiring assistance to walk. Compared with children without a diagnosis of cerebral palsy, those with quadriparesis were 13 times more likely to screen positive, and those with hemiparesis were 4 times more likely to screen positive. Children with major vision or hearing impairments were 8 times more likely to screen positive than those without such impairments. Relative to those with a Mental Development Index (MDI) of >70, the odds for screening positive were increased 13-fold for those with an MDI of <55 and more than 4-fold for those with an MDI of 55 to 69.
Conclusions:
Major motor, cognitive, visual, and hearing impairments appear to account for more than half of the positive M-CHAT screens in extremely low gestational age newborns. Even after those with such impairments were eliminated, 10% of children--nearly double the expected rate--screened positive.
