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Using the modified checklist for autism in toddlers in a well-child clinic in Turkey: adapting the screening method
Bülent Kara1, Nahit Motavalli Mukaddes, Isılay Altınkaya
11Kocaeli University, Turkey.
Insights
The Modified Checklist for Autism in Toddlers (M-CHAT) is useful for screening pervasive developmental disorders in Turkey. However, health-care staff administering the M-CHAT interview improves accuracy in Turkish culture.
Area of Science:
- Child Psychology
- Developmental Pediatrics
- Cross-Cultural Psychiatry
Background:
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used screening tool for autism spectrum disorder.
- Cultural adaptation is crucial for the accurate application of diagnostic tools in diverse populations.
- Previous studies indicated a high false-positive rate when the M-CHAT was self-administered by parents in Turkey.
Purpose of the Study:
- To adapt and evaluate the Modified Checklist for Autism in Toddlers (M-CHAT) for use in Turkish culture.
- To determine the diagnostic accuracy of the M-CHAT when administered by healthcare professionals versus self-administration by parents.
- To assess the M-CHAT's utility in screening for pervasive developmental disorders in primary care settings in Turkey.
Main Methods:
- A two-phase study involving 191 parents initially completing the M-CHAT independently.
- A second phase involved health-care staff administering the M-CHAT via interview to high-risk (n=80) and low-risk (n=538) groups.
- Diagnostic power was assessed against clinical diagnosis and the Childhood Autism Rating Scale (CARS).
Main Results:
- The M-CHAT demonstrated a high initial screen-positive rate.
- The positive predictive value of the M-CHAT was found to be 75% when administered by healthcare staff.
- Two screen positives were identified in the low-risk group, and all in the high-risk group were invited for clinical evaluation.
Conclusions:
- The M-CHAT is a valuable tool for screening pervasive developmental disorders in Turkish primary care.
- Administering the M-CHAT via a healthcare professional interview enhances its accuracy in the Turkish cultural context.
- This study underscores the importance of culturally adapting screening tools and considering the administration setting.
Abstract:
We aimed to adapt the Modified Checklist for Autism in Toddlers to Turkish culture. The Modified Checklist for Autism in Toddlers was filled out independently by 191 parents while they were waiting for the well-child examination of their child. A high screen-positive rate was found. Because of this high false-positive rate, a second study was done in which the Modified Checklist for Autism in Toddlers was administered by health-care staff in a short interview with two groups of parents. The first group (the high-risk group) comprised 80 children aged 18-36 months, who were initially diagnosed with pervasive developmental disorders. The second group (the low-risk group) comprised 538 children of the same age, who were followed regularly by the well-child clinic. Two screen positives were found in the low-risk group. These two children, a random sample of 120 children from the low-risk group, and all the high-risk group were invited to a clinical evaluation. The diagnostic power of the Modified Checklist for Autism in Toddlers was assessed against clinical diagnosis and the Childhood Autism Rating Scale. The positive predictive value of the Modified Checklist for Autism in Toddlers was found to be 75%. Our findings led us to conclude that the Modified Checklist for Autism in Toddlers is a useful tool in Turkey for screening of pervasive developmental disorders in primary care, but in our culture, it is completed more accurately when health-care personnel ask the parents the questions. This study shows that Modified Checklist for Autism in Toddlers screening should be adapted based on culture and setting.
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