In the Journals

Screening tool for primary care pediatricians accurately detects ASD

The Modified Checklist for Autism in Toddlers Follow-up Interview provided accurate and timely outcomes when primary care pediatricians performed an evaluation for autism spectrum disorders during patients’ routine well visits, according to a study data.

“The [Modified Checklist for Autism in Toddlers (M-CHAT)] has replaced the original Checklist for Autism in Toddlers, which demonstrated adequate specificity but inadequate sensitivity,” Raymond Sturner, MD, director of the Center for Promotion of Child Development through Primary Care in Baltimore, and colleagues wrote. “Initial studies of the M-CHAT suggested that the modifications improved sensitivity but required a follow-up telephone interview for positive screens to clarify and/or correct parental responses to reduce over-referral rates [for ASD].”

To assess the feasibility, validity and reliability of the M-CHAT with Follow-up Interview (M-CHAT/F) performed by a primary care pediatrician (PCP) during routine well visits, Sturner and colleagues compared outcomes between PCP results and telephone interviews performed by trained autism center research assistants (RA). The study included 47 PCPs from 22 Maryland clinics who administered M-CHAT/F evaluations (n = 197) triggered by positive M-CHAT screenings completed by parents of children, aged 18 or 24 months, at well visits. After the PCPs completed M-CHAT/F via an online system, RAs conducted an in-person or telephone evaluation. Outcomes were compared by scoring efficiencies, Autism Diagnostic Observation Schedule and Mullen Scales of Early Learning.

M-CHAT was used to screen 5,071 children, of which 341 children tested positive for ASD and underwent M-CHAT/F. Scoring analyses showed “moderately high agreement (86.6%)” and similarities for sensitivity (P = .01), specificity (P = .04), positive predictive value (PPV; P =.02) and overall accuracy (Cohen’s kappa coefficient, 0.72) between PCPs and RAs who conducted M-CHAT/F. A significant improvement in PPV correlated strongly with M-CHAT/F by PCPs compared with M-CHAT alone.

“This study confirms the previous finding of improved PPV of the M-CHAT using the M-CHAT/F,” the researchers wrote. “It also confirms previous studies showing that most children with false-positive screens have developmental difficulties of a degree that would make them eligible for early intervention.” – by Kate Sherrer

Disclosure: Sturner is the director of the Center for Promotion of Child Development through Primary Care, which conducted the study along with its for-profit subsidiary, Total Child Health. Please see the full study for a list of all other authors’ relevant financial disclosures.

The Modified Checklist for Autism in Toddlers Follow-up Interview provided accurate and timely outcomes when primary care pediatricians performed an evaluation for autism spectrum disorders during patients’ routine well visits, according to a study data.

“The [Modified Checklist for Autism in Toddlers (M-CHAT)] has replaced the original Checklist for Autism in Toddlers, which demonstrated adequate specificity but inadequate sensitivity,” Raymond Sturner, MD, director of the Center for Promotion of Child Development through Primary Care in Baltimore, and colleagues wrote. “Initial studies of the M-CHAT suggested that the modifications improved sensitivity but required a follow-up telephone interview for positive screens to clarify and/or correct parental responses to reduce over-referral rates [for ASD].”

To assess the feasibility, validity and reliability of the M-CHAT with Follow-up Interview (M-CHAT/F) performed by a primary care pediatrician (PCP) during routine well visits, Sturner and colleagues compared outcomes between PCP results and telephone interviews performed by trained autism center research assistants (RA). The study included 47 PCPs from 22 Maryland clinics who administered M-CHAT/F evaluations (n = 197) triggered by positive M-CHAT screenings completed by parents of children, aged 18 or 24 months, at well visits. After the PCPs completed M-CHAT/F via an online system, RAs conducted an in-person or telephone evaluation. Outcomes were compared by scoring efficiencies, Autism Diagnostic Observation Schedule and Mullen Scales of Early Learning.

M-CHAT was used to screen 5,071 children, of which 341 children tested positive for ASD and underwent M-CHAT/F. Scoring analyses showed “moderately high agreement (86.6%)” and similarities for sensitivity (P = .01), specificity (P = .04), positive predictive value (PPV; P =.02) and overall accuracy (Cohen’s kappa coefficient, 0.72) between PCPs and RAs who conducted M-CHAT/F. A significant improvement in PPV correlated strongly with M-CHAT/F by PCPs compared with M-CHAT alone.

“This study confirms the previous finding of improved PPV of the M-CHAT using the M-CHAT/F,” the researchers wrote. “It also confirms previous studies showing that most children with false-positive screens have developmental difficulties of a degree that would make them eligible for early intervention.” – by Kate Sherrer

Disclosure: Sturner is the director of the Center for Promotion of Child Development through Primary Care, which conducted the study along with its for-profit subsidiary, Total Child Health. Please see the full study for a list of all other authors’ relevant financial disclosures.