Predictive Validity of the Modified Checklist for Autism in Toddlers (M-CHAT) Born Very Preterm

Area of Science:

• Developmental Pediatrics
• Neonatology
• Child Psychology

Background:

• The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool for autism spectrum disorder (ASD).
• Extremely low gestational age newborns (ELGANs) are at higher risk for developmental disorders, including ASD.
• The predictive validity of the M-CHAT in high-risk preterm populations requires further investigation.

Purpose of the Study:

• To assess the predictive validity of the M-CHAT administered at 24 months for ASD diagnosis at 10 years in ELGANs.
• To determine the influence of sensorimotor, cognitive, socioeconomic, and emotional/behavioral factors on M-CHAT predictive accuracy.

Main Methods:

• A cohort of 827 ELGANs was followed from birth.
• M-CHAT performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
• Predictive parameters were analyzed in relation to developmental impairments, socioeconomic status (SES), and emotional/behavioral dysregulation at age 2 years.

Main Results:

• The M-CHAT demonstrated a sensitivity of 52%, specificity of 84%, PPV of 20%, and NPV of 96% for ASD diagnosis at age 10.
• High false-positive rates were observed in children with hearing/vision impairments, lower SES, and motor/cognitive impairments.
• Emotional/behavioral dysregulation at age 2 also correlated with high false-positive rates.

Conclusions:

• The M-CHAT under-identifies ASD in nearly half of extremely preterm children.
• Sensorimotor and cognitive impairments, SES, and emotional/behavioral issues significantly affect M-CHAT accuracy in this population.
• Clinicians should consider these confounding factors when using the M-CHAT for ASD screening in very preterm toddlers.