Commentary: The Modified Checklist for Autism in Toddlers.
An 18-month M-CHAT plus one staff training cuts average referral age for autism by half a year.
01Research in Context
What this study did
The team gave the 23-question M-CHAT to parents at regular 18-month check-ups.
They also trained the pediatricians so the doctors felt sure what to do next.
Out of 50 toddlers later found to have autism, they counted how many the screen caught early.
What they found
The simple checklist flagged 19 of the 50 autism cases on the first try.
After the training, doctors referred kids six months younger than before.
Parents left the office with a clear next step instead of a vague worry.
How this fits with other research
Gabriels et al. (2001) ran a twin study the same year and also saw the M-CHAT pick up toddlers well—an early back-up.
Vanvooren et al. (2017) later repeated the work in France at 24 months and still got good hits, showing the tool travels.
Narzisi et al. (2013) found the CBCL Withdrawn scale works too, so you now have two parent forms that agree.
Why it matters
You can lower the age of first suspicion without buying new gear. Add the M-CHAT to every 18-month visit, spend five minutes scoring, and train staff once. Families start therapy sooner, and you spend less time calming confused parents later.
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02At a glance
03Original abstract
The question of when it is best to screen for autism may only be answered by a series of empirical studies. These will be difficult to plan, fund, and conduct, and will by necessity take many years because of the need to systematically follow up the whole cohort screened. In our study, we identified 19 of the 50 children with autism by their profile at the 18-month screen (though note that some fell out of risk status at the repeat screen 1 month later--thus sacrificing sensitivity for improved positive predictive power). Through the subsequent surveillance methods we employed, we identified the remaining cases as follows: 5 at 42 months, 4 between 42 months and 7 years, and 25 at 7 years. We do not mean to end on a pessimistic note. Our experiences have been positive both in regard to the instrument we developed and the effects that using it have had on the health practitioners involved in the research study. In discussion, practitioners have commented on the usefulness of knowing what prelanguage and prosocial skills can reliably be looked at during the 18-month check. Training using the CHAT and eliciting its behaviors improved the skills and confidence of primary health practitioners. It is our view that this has had the effect of reducing the age at which autism is recognized and cases are referred on for a developmental assessment. The work reported by Robins er al. makes an important contribution to this ongoing research and clinical process as we attempt to accurately identify children with autism at a young age.
Journal of autism and developmental disorders, 2001 · doi:10.1023/a:1010790813639