Yuen T, Penner M, Carter MT, Szatmari P, Ungar WJ. Assessing
the accuracy of the Modified Checklist for Autism in Toddlers: a systematic
review and meta-analysis. Dev Med Child Neurol. 2018 Jul 11 [Epub ahead of
print].
Abstract
AIM:
The Modified Checklist for Autism in Toddlers (M-CHAT) could
be appropriate for universal screening for autism spectrum disorder (ASD) at 18
months and 24 months. Validation studies, however, reported differences in
psychometric properties across sample populations. This meta-analysis
summarized its accuracy measures and quantified their change in relation to
patient and study characteristics.
METHOD:
Four electronic databases (MEDLINE, PsycINFO, CINAHL, and
Embase) were searched to identify articles published between January 2001 and
May 2016. Bayesian regression models pooled study-specific measures.
Meta-regressions covariates were age at screening, study design, and proportion
of males.
RESULTS:
On the basis of the 13 studies included, the pooled
sensitivity was 0.83 (95% credible interval [CI] 0.75-0.90), specificity was
0.51 (95% CI 0.41-0.61), and positive predictive value was 0.53 (95% CI
0.43-0.63) in high-risk children and 0.06 (95% CI <0.01-0.14) in low-risk
children. Sensitivity was higher for screening at 30 months compared with 24
months.
INTERPRETATION:
Findings indicate that the M-CHAT performs with low to
moderate accuracy in identifying ASD among children with developmental
concerns, but there was a lack of evidence on its performance in low-risk
children or at age 18 months. Clinicians should account for a child's age and
presence of developmental concern when interpreting their M-CHAT score.
WHAT THIS PAPER ADDS:
The Modified Checklist for Autism in Toddlers (M-CHAT)
performs with low-to-moderate accuracy in children with developmental concerns.
There is limited evidence supporting its use at 18 months or in low-risk
children.
Takeaway
An autism screening tool commonly used in toddlers shows
low-moderate accuracy in children who have shown developmental signs, according
to this meta-analysis.
Clinicians should take age and risk into account when using
this screen, the Modified Checklist for Autism in Toddlers (M-CHAT).
Why this matters
Studies assessing the effectiveness of the M-CHAT have had
design weaknesses that have left evidence gaps.
These authors say that given their findings, the M-CHAT
might be better used as a second-line screening tool, with developmental
surveillance foregrounded.
Key results
Pooled results:
Sensitivity: 0.83 (95% credible interval [CrI]), 0.75-0.90);
range, 0.64-0.96 in high-risk children.
Specificity: 0.51 (95% CrI, 0.41-0.61); range, 0.27-0.67 in
high-risk children.
Positive predictive value (PPV) in high-risk children: 0.53
(95% CrI, 0.43-0.63).
PPV in low-risk children: 0.06 (95% CrI, <0.01-0.14).
Better screening sensitivity in older (30 months; 0.69 [95%
CrI, 0.19-0.86]) vs younger (24 months; 0.55 [95% CrI, 0.02-0.84]) toddlers.
All studies had bias risk, including volunteer bias, lack of
blinding.
Few studies (n=3) included low-risk children.
Study design
Meta-analysis, systematic review, 13 studies.
Funding: Canadian Institutes of Health Research Autism
Research Training Program; others.
Limitations
Criteria changed in study time frame (January 2001-May
2016).
Limitations of the included studies.
____________________________________________________________________________
Øien RA, Schjølberg S, Volkmar FR, Shic F, Cicchetti DV,
Nordahl-Hansen A, Stenberg N, Hornig M, Havdahl A, Øyen A-S, Ventola P, Susser
ES, Eisemann MR, Chawarska K. Clinical Features of Children With Autism Who
Passed 18-Month Screening. Pediatrics. 2018 May 21 [Epub ahead of print].
Abstract
OBJECTIVES:
We compared sex-stratified developmental and temperamental
profiles at 18 months in children screening negative for autism spectrum
disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but
later receiving diagnoses of ASD (false-negative group) versus those without
later ASD diagnoses (true-negative group).
METHODS:
We included 68 197 screen-negative cases from the Norwegian
Mother and Child Cohort Study (49.1% girls). Children were screened by using
the 6 critical items of the M-CHAT at 18 months. Groups were compared on
domains of the Ages and Stages Questionnaire and the Emotionality Activity
Sociability Temperament Survey.
RESULTS:
Despite passing M-CHAT screening at 18 months, children in
the false-negative group exhibited delays in social, communication, and motor
skills compared with the true-negative group. Differences were more pronounced
in girls. However, with regard to shyness, boys in the false-negative group
were rated as more shy than their true-negative counterparts, but girls in the
false-negative group were rated as less shy than their counterparts in the true-negative
group.
CONCLUSIONS:
This is the first study to reveal that children who pass
M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays
in core social and communication areas as well as fine motor skills at 18
months. Differences appeared to be more pronounced in girls. With these
findings, we underscore the need to enhance the understanding of early markers
of ASD in boys and girls, as well as factors affecting parental report on early
delays and abnormalities, to improve the sensitivity of screening instruments.
Takeaway
Children missed by a common autism screening tool share some
features, including social and communication and fine motor delays.
Girls are more often overlooked.
An editorial accompanies the study.
Why this matters
The Modified Checklist for Autism in Toddlers (M-CHAT) is
used at age 18 months.
Earlier developmental windows may be more amenable to
mitigating some delays associated with autism.
These authors say that they know of no other such study.
Key results
228/68,197 children with negative M-CHAT later diagnosed
with autism.
Only 15.8% of missed children were boys.
Affected domains at age 18 months included:
Social: significant diagnosis-by-sex interaction (P=.001);
false-negative boys and girls both rated as “less social” vs true-negative
groups (P<.001 and .007, respectively);
Communication: significant diagnosis-by-sex interaction
(P=.002); significant communication skills difference for both false-negative
boys and girls vs true-negative groups (both P<.001);
Motor: for gross motor, significant diagnosis-by-sex
interaction and difference for both false-negative boys and girls vs
true-negative groups (P<.001 for all); for fine motor, significant
difference for false-negative boys and girls vs true-negative group (P<.001,
both).
Study design
Norwegian Mother and Child Cohort.
Funding: Norwegian government; US National Institute of
Environmental Health Sciences.
Limitations
No concurrent direct measures of verbal development.
http://univadis.com/player/ykqbqkjuc?cid=2122
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