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Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F
Raymond Sturner1, Barbara Howard2, Paul Bergmann3
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Promotion of Child Development through Primary Care, Baltimore, Maryland; rsturner@childhealthcare.org.
Insights
Primary care pediatricians can reliably use the Modified Checklist for Autism in Toddlers With Follow-up Interview (M-CHAT/F) during well-child visits to improve autism detection in toddlers. This method increases the positive predictive value (PPV) without missing cases.
Area of Science:
- Developmental Pediatrics
- Screening Tools
- Autism Spectrum Disorder Diagnosis
Background:
- Autism spectrum disorders (ASDs) are frequently missed in toddlers.
- The M-CHAT/F improves autism detection and reduces over-referrals.
- Evidence for pediatrician administration of M-CHAT/F during routine visits is limited.
Purpose of the Study:
- To evaluate the feasibility, validity, and reliability of M-CHAT/F administration by primary care pediatricians (PCPs).
- To assess PCP performance with online prompts during positive M-CHAT screens.
- To determine if PCPs can effectively use the M-CHAT/F in primary care settings.
Main Methods:
- Forty-seven PCPs from 22 clinics administered 197 M-CHAT/Fs via a secure web platform.
- A second M-CHAT/F was administered by research assistants (RAs) for comparison.
- Criterion measures included the Autism Diagnostic Observation Schedule, Second Edition, and Mullen Scales of Early Learning.
Main Results:
- PCPs achieved 86.6% agreement with RAs (Cohen's κ = 0.72).
- Sensitivity, specificity, PPV, and overall accuracy were equivalent between PCPs and RAs.
- PCP administration significantly improved PPV compared to the M-CHAT alone.
Conclusions:
- Minimally trained PCPs can reliably administer the M-CHAT/F during well-child visits.
- This approach is efficient and increases PPV without compromising autism detection.
- PCP-administered M-CHAT/F is a viable strategy for early identification of ASDs.
Background And Objective:
Autism spectrum disorders (ASDs) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up Interview (M-CHAT/F) has been shown to improve detection and reduce over-referral. However, there is little evidence supporting the administration of the interview by a primary care pediatrician (PCP) during typical checkups. The goal of this study was to evaluate the feasibility, validity, and reliability of the M-CHAT/F by PCPs with online prompts at the time of a positive M-CHAT screen.
Design:
Forty-seven PCPs from 22 clinics completed 197 M-CHAT/Fs triggered by positive M-CHAT screens via the same secure Web-based platform that parents used to complete M-CHATs before an 18- or 24-month well-child visit. A second M-CHAT/F was administered live or by telephone by trained research assistants (RAs) at the Kennedy Krieger Institute Center for Autism and Related Disorders. The Autism Diagnostic Observation Schedule, Second Edition, and the Mullen Scales of Early Learning were administered as criterion measures. Measures of agreement between PCPs and RAs were calculated, and measures of test performance compared.
Results:
There was 86.6% agreement between PCPs and RAs, with a Cohen's κ of 0.72. Comparison of sensitivity, specificity, positive predictive value (PPV), and overall accuracy for M-CHAT/F between PCPs and RAs showed significant equivalence for all measures. Use of the M-CHAT/F by PCPs resulted in significant improvement in PPV compared with the M-CHAT alone.
Conclusions:
Minimally trained PCPs can administer the M-CHAT/F reliably and efficiently during regular well-child visits, increasing PPV without compromising detection.
