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Open Access 01-12-2022 | Research

Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners

Authors: Raymond Sturner, Barbara Howard, Paul Bergmann, Shana Attar, Lydia Stewart-Artz, Kerry Bet, Carrie Allison, Simon Baron-Cohen

Published in: Molecular Autism | Issue 1/2022

Abstract

Background

Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months.

Methods

This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old.

Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines.

Results

While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10.

Limitations

Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages.

Conclusions

Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age.

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Title: Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners
Authors: Raymond Sturner
Barbara Howard
Paul Bergmann
Shana Attar
Lydia Stewart-Artz
Kerry Bet
Carrie Allison
Simon Baron-Cohen
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: Molecular Autism / Issue 1/2022
Electronic ISSN: 2040-2392
DOI: https://doi.org/10.1186/s13229-021-00480-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners

Abstract

Background

Methods

Results

Limitations

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Limitations

Conclusions

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