Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening

Area of Science:

• Developmental Pediatrics
• Child Psychology
• Diagnostic Screening

Background:

• The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a widely used global screening tool for autism spectrum disorder (ASD).
• Accurate psychometric properties are essential for reliable ASD diagnosis following screening.

Approach:

• A systematic review and meta-analysis of studies published between January 2014 and November 2021.
• Included studies utilized the M-CHAT-R/F, standard scoring, diagnostic ASD assessment, and reported psychometric properties.
• Data extraction and quality assessment followed PRISMA guidelines, with random-effects modeling for pooled estimates.

Key Points:

• Analysis of 15 studies (18 samples, 10 countries, 49,841 children) revealed a pooled positive predictive value (PPV) of 57.7%.
• PPV was higher in high-risk (75.6%) versus low-risk samples (51.2%).
• Pooled sensitivity was 82.6%, specificity 45.7%, and negative predictive value 72.5%.

Conclusions:

• The M-CHAT-R/F demonstrates utility as a screening tool for ASD.
• Caregiver communication regarding positive screens should incorporate the moderate PPV to manage expectations for ASD diagnosis.
• Limitations include small sample sizes for screen-negative children affecting some psychometric calculations.