Journal
PEDIATRICS
Volume 131, Issue 4, Pages E1121-E1127Publisher
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2012-1525
Keywords
autism; M-CHAT; screening; toddlers; diagnosis
Categories
Funding
- National Institutes of Health (NIH) [R01 HD039961]
- National Institute of Mental Health [F31 MH12550-1-2]
- Maternal and Child Health Bureau [R40 MC00270]
- US Department of Education student
- Centers for Disease Control and Prevention-Georgia State University seed grant in the social and behavioral sciences
- National Association for Autism Research
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OBJECTIVE: The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening instrument in a large, geographically diverse pediatrics-based sample. METHODS: The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18 989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation. RESULTS: Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of >= 3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of >= 7. CONCLUSIONS: This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.
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