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Large-scale use of the modified checklist for autism in low-risk toddlers
Colby Chlebowski1, Diana L Robins, Marianne L Barton
1Department of Psychiatry, University of California, San Diego, San Diego, California, USA. cchlebowski@ucsd.edu
Insights
The Modified Checklist for Autism in Toddlers (M-CHAT) effectively screens toddlers for autism spectrum disorder (ASD) in primary care. A score of 7 or higher on the M-CHAT warrants immediate referral for evaluation and intervention.
Area of Science:
- Developmental Pediatrics
- Autism Spectrum Disorder Screening
- Child Psychology
Background:
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used screening tool for autism spectrum disorder (ASD).
- Accurate and efficient screening is crucial for early intervention in toddlers.
- Previous studies have established the M-CHAT's utility, but updated data in large, diverse samples are valuable.
Purpose of the Study:
- To evaluate the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening tool.
- To assess the M-CHAT's effectiveness in a large, geographically diverse pediatric sample.
- To provide updated data supporting the M-CHAT's use in primary care settings.
Main Methods:
- Screened 18,989 toddlers using the M-CHAT and M-CHAT Follow-Up (M-CHAT/F) during well-child visits.
- Pediatricians directly referred children to identify potential missed screening cases.
- Children screening positive on M-CHAT received M-CHAT/F; persistent positive screens led to diagnostic evaluation.
Main Results:
- 54% of screen-positive children were diagnosed with autism spectrum disorder (ASD).
- 98% of screen-positive children had developmental concerns requiring intervention.
- An M-CHAT total score cutoff of ≥7 is recommended for immediate referral, bypassing the M-CHAT/F.
Conclusions:
- The M-CHAT is an effective screening instrument for ASD in primary care settings.
- The 2-step screening process using M-CHAT and M-CHAT/F supports population screening for ASD.
- Updated scoring recommendations facilitate M-CHAT use and interpretation by clinical providers.
Objective:
The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening instrument in a large, geographically diverse pediatrics-based sample.
Methods:
The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18,989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation.
Results:
Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of ≥3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of ≥7.
Conclusions:
This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.
