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Modified Checklist for Autism in Toddlers in a Neonatal High-Risk Population
Benjamin Lassebro1,2, Matilda Morin3, Weiyao Yin3
1Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Insights
The Modified Checklist for Autism in Toddlers (M-CHAT) shows high specificity but moderate sensitivity for detecting autism spectrum disorder (ASD) in high-risk neonates. Additional tools are needed to improve early ASD detection in this population.
Area of Science:
- Neurodevelopmental Disorders
- Pediatric Health
- Diagnostic Accuracy Studies
Background:
- Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with significant genetic and environmental influences.
- Early detection and intervention are critical for improving outcomes in children with ASD.
- Neonatal high-risk populations may benefit from targeted screening for early identification of developmental differences.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the Modified Checklist for Autism in Toddlers (M-CHAT) in a cohort of high-risk neonates.
- To compare M-CHAT performance against established clinical diagnoses of ASD.
- To identify factors influencing M-CHAT accuracy within this specific neonatal group.
Main Methods:
- A prospective, population-based cohort study in Sweden included neonates born between 2013-2019.
- Children underwent M-CHAT screening at 16-30 months corrected age.
- ASD diagnoses were tracked via the National Patient Register until December 2022.
Main Results:
- The study included 2178 high-risk neonates; 12.1% had positive M-CHAT screens.
- Overall M-CHAT sensitivity was 62.4%, specificity 91.2%, positive predictive value 31.4%, and negative predictive value 97.4%.
- Extremely preterm infants showed the highest rates of positive screens and ASD diagnoses.
Conclusions:
- The M-CHAT demonstrates high specificity but only moderate sensitivity for ASD detection in high-risk neonates.
- Current screening may miss a significant proportion of affected infants, necessitating complementary diagnostic approaches.
- Further research is needed to enhance early ASD identification in vulnerable neonatal populations.
Importance:
Autism spectrum disorder (ASD) is a chronic neurodevelopmental condition with both genetic and environmental origins. Early detection is crucial for successful clinical intervention, improving future health, and adaptive functioning.
Objective:
To assess the diagnostic accuracy of the Modified Checklist for Autism in Toddlers (M-CHAT) in a neonatal high-risk population using subsequent clinical ASD diagnoses as the reference standard and to identify factors associated with the checklist's accuracy within this group.
Design, Setting, And Participants:
This prospective, population-based cohort study identified children born in Sweden between January 1, 2013, and December 31, 2019, from the Swedish Neonatal Quality Register. Children were included if they were screened for autism using the checklist at corrected age 16 to 30 months. Follow-up for ASD in the National Patient Register extended from the day after inclusion or chronologic age 2 years, whichever occurred last, until December 31, 2022. Data were analyzed between June 6, 2024, and June 16, 2025.
Exposure:
Autism screening with the M-CHAT at 24-month neonatal follow-up.
Main Outcomes And Measures:
The primary outcome was the first recorded ASD diagnosis within the Swedish health care system among children categorized into the following neonatal high-risk groups: extremely preterm, small for gestational age, morphologic brain damage, neonatal encephalopathy, or other severe morbidity at birth. Diagnostic accuracy of the checklist was estimated using sensitivity, specificity, positive predictive value, and negative predictive value.
Results:
Among the 2178 children included in the study (median [IQR] corrected age at assessment, 26 [23-30] months; 1210 boys [55.6%]), 263 (12.1%) had positive screens. The overall sensitivity of the checklist was 62.4% (95% CI, 54.3%-69.7%); specificity, 91.2% (95% CI, 90.1%-92.4%), positive predictive value 31.4% (95% CI, 26.0%-37.1%), and negative predictive value 97.4% (95% CI, 96.7%-98.0%). Within the neonatal high-risk groups, children born extremely preterm had the highest proportion of positive screens and ASD diagnoses.
Conclusions And Relevance:
This cohort study found that in high-risk neonates, the M-CHAT had high specificity but moderate sensitivity when evaluated against later ASD diagnoses, highlighting the need for additional tools to improve detection.
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