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Autism Screening in High-Likelihood Children in a Community Early Intervention Setting: A Hybrid

Georgina Perez Liz1, Diana Thao1, Katelyn Reeb1

  • 1Drexel University, Philadelphia, PA, USA.

Focus on Autism and Other Developmental Disabilities
|December 5, 2025
PubMed

Insights

Early intervention (EI) programs in the U.S. screened few preschool children for autism using the M-CHAT-R/F. Referrals for autism evaluation relied more on clinical judgment than screening results.

Area of Science:

  • Developmental Psychology
  • Pediatric Healthcare
  • Public Health Interventions

Background:

  • Early identification of autism spectrum disorder (ASD) is crucial for timely intervention.
  • The U.S. early intervention (EI) system aims to identify children with developmental delays, including autism.
  • The effectiveness and implementation of autism screening tools within EI settings require further investigation.

Purpose of the Study:

  • To examine the impact of administering the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during EI intake.
  • To assess the performance of autism screeners in preschool children with high likelihood of autism.
  • To identify barriers to implementing autism screening in EI services.

Main Methods:

  • An effectiveness-implementation hybrid type 1 study was conducted.
  • Data were collected from 2,661 educational records of preschool children in the EI system.
  • The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) administration was analyzed.

Main Results:

  • Only 42.8% of children received the M-CHAT-R/F screening.
  • Only 14.0% of screen-positive children were referred for autism evaluation.
  • A high percentage (94.8%) of referred children received an autism diagnosis, irrespective of screening status, indicating reliance on clinical judgment.

Conclusions:

  • Implementation of autism screening tools like the M-CHAT-R/F in EI settings is inconsistent.
  • Referrals for autism evaluations appear to be driven by clinical judgment rather than solely by screening results.
  • Training and protocol integration are essential for effective autism screening and detection within EI services.

Keywords:
M-CHAT-R/Fautismautism screeningcommunity settingearly interventioneffectiveness-implementation

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