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American Academy of Pediatrics
Article

Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)

Diana L. Robins, Karís Casagrande, Marianne Barton, Chi-Ming A. Chen, Thyde Dumont-Mathieu and Deborah Fein
Pediatrics January 2014, 133 (1) 37-45; DOI: https://doi.org/10.1542/peds.2013-1813
Diana L. Robins
aDepartment of Psychology,
bNeuroscience Institute, Georgia State University, Atlanta, Georgia; and
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Karís Casagrande
aDepartment of Psychology,
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Marianne Barton
cDepartment of Psychology,
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Chi-Ming A. Chen
cDepartment of Psychology,
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Thyde Dumont-Mathieu
cDepartment of Psychology,
dDepartment of Pediatrics, University of Connecticut, Storrs, Connecticut
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Deborah Fein
cDepartment of Psychology,
dDepartment of Pediatrics, University of Connecticut, Storrs, Connecticut
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Abstract

OBJECTIVE: This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT.

METHODS: Toddlers (N = 16 071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated.

RESULTS: The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥3 initially and ≥2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41–0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92–0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis.

CONCLUSIONS: The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.

  • autism
  • screening
  • toddlers
  • Abbreviations:
    ASD —
    autism spectrum disorder
    CI —
    confidence interval
    GSU —
    Georgia State University
    M-CHAT —
    Modified Checklist for Autism in Toddlers
    M-CHAT/F —
    Modified Checklist for Autism in Toddlers with Follow-up
    M-CHAT-R —
    Modified Checklist for Autism in Toddlers, Revised
    M-CHAT-R/F —
    Modified Checklist for Autism in Toddlers, Revised with Follow-up
    PPV —
    positive predictive value
    STAT —
    Screening Tool for Autism in Two-Year-Olds
    UConn —
    University of Connecticut
    WCC —
    well-child care
    • Accepted October 21, 2013.
    • Copyright © 2014 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 133, Issue 1
    1 Jan 2014
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    Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
    Diana L. Robins, Karís Casagrande, Marianne Barton, Chi-Ming A. Chen, Thyde Dumont-Mathieu, Deborah Fein
    Pediatrics Jan 2014, 133 (1) 37-45; DOI: 10.1542/peds.2013-1813

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    Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
    Diana L. Robins, Karís Casagrande, Marianne Barton, Chi-Ming A. Chen, Thyde Dumont-Mathieu, Deborah Fein
    Pediatrics Jan 2014, 133 (1) 37-45; DOI: 10.1542/peds.2013-1813
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