Abstract
Background
The Modified Checklist for Autism in Toddlers (M-CHAT) is a common pediatric screening tool with mixed accuracy findings. Prior evidence supports M-CHAT screening for developmental concerns, especially in toddlers born preterm. This study examined M-CHAT accuracy in a large, nationwide sample.
Methods
3393 participants from the Environmental influences on Child Health Outcomes (ECHO) program were included. Harmonized M-CHAT (M-CHAT-H) results were compared with parent-reported autism diagnosis and autism-related characteristics to assess accuracy for term and preterm children, together and separately. Generalized estimating equations, clustering for ECHO cohort and controlling for demographic covariates, were used to examine associations between developmental and behavioral characteristics with M-CHAT-H accuracy.
Results
Sensitivity of the M-CHAT-H ranged from 36 to 60%; specificity ranged from 88 to 99%. Positive M-CHAT-H was associated with more developmental delays and behavior problems. Children with severe motor delays and more autism-related problems were more likely to have a false-negative M-CHAT-H. Children with fewer behavior problems and fewer autism-related concerns were more likely to have a false-positive screen.
Conclusion
The M-CHAT-H accurately detects children at low risk for autism and children at increased risk with moderate accuracy. These findings support use of the M-CHAT-H in assessing autism risk and developmental and behavioral concerns in children.
Impact
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Previous literature regarding accuracy of the Modified Checklist for Autism in Toddlers (M-CHAT) is mixed but this study provides evidence that the M-CHAT performs well in detecting children at low risk for autism and consistently detects children with developmental delays and behavioral problems. The M-CHAT moderately detects children at increased risk for autism and remains a useful screening tool.
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This study examines M-CHAT accuracy in a large-scale, nationwide sample, examining associations between screening accuracy and developmental outcomes.
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These findings impact pediatric screening for autism, supporting continued use of the M-CHAT while further elucidating the factors associated with inaccurate screens.
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Data availability
Select de-identified data from the ECHO Program are available through NICHD’s Data and Specimen Hub (DASH). Information on study data not available on DASH, such as some Indigenous datasets, can be found on the ECHO study DASH webpage.
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Acknowledgements
The authors wish to thank our ECHO Colleagues; the medical, nursing, and program staff; and the children and families participating in the ECHO cohorts. We also acknowledge the contribution of the ECHO Program collaborators. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding
Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with co-funding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023251 (Alshawabkeh), UH3OD023320 (Aschner), UH3OD023313 (Koinis Mitchell), UH3OD023318 (Dunlop), UH3OD023271 (Karr), UH3OD023347 (Lester), UH3OD023349 (O’Connor), UH3OD023348 (O’Shea), UH3OD023290 (Herbstman), UH3OD023249 (Stanford), UH3OD023279 (Elliott).
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C.S., B.C., J.A.H., R.J., T.O., M.O., S.S., L.C.S., L.M.S. contributed significantly to study design. C.S. conducted data analysis and interpretation of results. C.S., P.B., B.C., J.C., V.D., J.G., J.H., J.A.H., R.J., L.M., T.O., M.O., M.P., S.S., L.C.S., L.M.S., P.C.W., B.L. assisted with critical revisions for important intellectual content and approved of the final version.
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Shuster, C.L., Brennan, P.A., Carter, B.S. et al. Developmental characteristics and accuracy of autism screening among two-year-old toddlers in the ECHO program. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03193-5
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DOI: https://doi.org/10.1038/s41390-024-03193-5