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The Clinical Utility of the Modified Checklist for Autism in Toddlers with High Risk 18–48 Month Old Children in Singapore

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Abstract

The modified checklist for autism in toddlers (M-CHAT) is a tool developed for 16–30 month old children to screen for autism spectrum disorders (ASD). It is a well-researched tool, but little is known about its utility with Singaporean toddlers and with older children referred for developmental concerns. This study investigated the M-CHAT’s performance with 18–30 month old (N = 173) and >30–48 month old (N = 407) developmentally at-risk Singaporean children, when used with three recommended scoring methods i.e., the total, critical and Best7 scoring methods. The results indicate that the critical and Best7 scoring methods detected most true cases of ASD without inflating the false positive rates in toddlers, and that only the total scoring method performed acceptably for the older children.

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Notes

  1. The psychometric properties of the M-CHAT were reported separately for each of the 3 scoring methods, instead of combined as in previous studies (i.e., failing either total or critical 6; and failing either total or Best 7). Combining the scoring methods was likely to increase sensitivity, but to decrease specificity, which was not desirable for screening a population already at risk of developmental issues. Further analyses only briefly reported here also indicated that values of sensitivity (Sn), specificity (Sp), PPV and NPV of using the combined scoring methods were very similar to those obtained from the total scoring method alone for both age groups, except that there was a slight increase in sensitivity for the scoring method of either total or Best 7 in the younger age group. For younger age group, either total or critical scoring method yielded Sn: 0.89, Sp: 0.58, PPV: 0.49, NPV: 0.92; either total or Best 7 scoring method yielded Sn: 0.93, Sp: 0.58, PPV: 0.50, NPV: 0.95. For the older age group, either total or critical 6 scoring method yielded Sn: 0.76, Sp: 0.71, PPV: 0.59, NPV: 0.84; and either total or Best 7 scoring method yielded Sn: 0.77, Sp: 0.71, PPV: 0.59, NPV: 0.85.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • Bayley, N. (2006). Bayley Scales of Infant and Toddler Development. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Canal-Bedia, R., García-Primo, P., Martín-Cilleros, M. V., Santos-Borbujo, J., Guisuraga-Fernández, Z., Herráez-García, L., et al. (2011). Modified checklist for autism in toddlers: Cross-cultural adaptation and validation in Spain. Journal of Autism and Developmental Disorders, 41(10), 1342–1351.

    Article  PubMed  Google Scholar 

  • Department of Statistics, Singapore. (2012). Population trends 2012. Retrieved 29 May 2013, from Statistics Singapore website: http://www.singstat.gov.sg/.

  • Eaves, L. C., Wingert, H., & Ho, H. H. (2006). Screening for autism: Agreement with diagnosis. Autism, 10, 229–242.

    Article  PubMed  Google Scholar 

  • Elliott, C. D. (2007). Differential ability scales (2nd ed.). San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Fawcett, T. (2006). An introduction to ROC analysis. Pattern Recognition Letters, 27(8), 861–874.

    Article  Google Scholar 

  • George, D., & Mallery, P. (2003). SPSS for windows step by step: A simple guide and reference. 11.0 update (4th ed.). Boston: Allyn & Bacon.

    Google Scholar 

  • Glascoe, F. P. (2005). Screening for developmental and behavioural problems. Mental Retardation and Developmental Disabilities Research Reviews, 11(3), 173–179.

    Article  PubMed  Google Scholar 

  • Inada, N., Koyama, T., Inokuchi, E., Kuroda, M., & Kamio, Y. (2010/2011). Reliability and validity of the Japanese version of the Modified Checklist for Autism in Toddlers (M-CHAT). Research in Austism Spectrum Disorders, 5(1), 330–336.

    Google Scholar 

  • Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H. C., Esser, E. L., et al. (2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827–839.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • Lung, F.-W., Chiang, T.-L., Lin, S.-J., & Shu, B.-C. (2011). Autism-risk screening in the first 3 years of life in Taiwan Birth Cohort Pilot Study. Research in Autism Spectrum Disorders, 5(4), 1385–1389.

    Article  Google Scholar 

  • Magiati, I., Tay, X. W., & Howlin, P. (2012). Early comprehensive behaviourally based interventions for children with autism spectrum disorders: A summary of findings from recent reviews and meta-analyses. Neuropsychiatry, 2(6), 543–570.

    Article  Google Scholar 

  • Norris, M., & Lecavalier, L. (2010). Screen accuracy of level 2 autism spectrum disorder rating scales. A review of selected instruments. Autism, 14, 263–284.

    Article  PubMed  Google Scholar 

  • Pandey, J., Verbalis, A., Robins, D., Boorstein, H., Klin, A., Babitz, T., et al. (2008). Screening for autism in older and younger toddlers with the modified checklist for autism in toddlers. Autism, 12(5), 513–535.

    Article  PubMed  Google Scholar 

  • Perera, H., Wijewardena, K., & Aluthwelage, R. (2009). Screening of 18–24-month-old children for autism in a semi-urban community in Sri Lanka. Journal of Tropical Pediatrics, 55(6), 402–405.

    Article  PubMed  Google Scholar 

  • Robins, D. L. (2008). Screening for autism spectrum disorders in primary care settings. Autism, 12(5), 537–556.

    Article  PubMed  Google Scholar 

  • Robins, D. L., & Dumont-Mathieu, T. (2006). Early screening for autism spectrum disorders: Update on the modified checklist for autism in toddlers and other measures. Journal of Developmental & Behavioural Pediatrics, 27(Supplement 2), S111–S119.

    Article  Google Scholar 

  • Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–144.

    Article  PubMed  Google Scholar 

  • Robins, D. L., Pandey, J., Chlebowski, C., Carr, K., Zaj, J. L., Arroyo, M., Barton, M. L., Green, J., & Fein, D. A. (2010, May). M-CHAT Best7: A new scoring algorithm improves positive predictive power of the M-CHAT. Paper presented at the International Meeting for Autism Research (IMFAR) in Philadelphia, USA.

  • Seif Eldin, A., Habib, D., Noufal, A., Farrag, S., Bazaid, K., Al-Sharbati, M., et al. (2008). Use of M-CHAT for a multinational screening of young children with autism in the Arab countries. International Review of Psychiatry, 20(3), 281–289.

    Article  PubMed  Google Scholar 

  • Snow, A. V., & Lecavalier, L. (2008). Sensitivity and specificity of the modified checklist for autism in toddlers and the social communication questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism, 12(6), 627–644.

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Cicchetti, D., & Balla, D. (2005). Vineland adaptive behavior scales-II. Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Wallis, K. E., & Pinto-Martin, J. (2008). The challenge of screening for autism spectrum disorder in a culturally diverse society. Acta Paediatrica, 97(5), 539–540.

    Article  PubMed  Google Scholar 

  • Weschler, D. (2002). Wechsler preschool and primary scale of intelligence (3rd ed.). San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Wong, V., Hui, L. H., Lee, W. C., Leung, L. S., Ho, P. K., Lau, W. L., et al. (2004). A modified screening tool for autism (checklist for autism in toddlers [CHAT-23]) for Chinese children. Pediatrics, 114(2), e166–e176.

    Article  PubMed  Google Scholar 

  • Woolfenden, S., Sarkozy, V., Riddley, G., & Williams, K. (2012). A systematic review of the diagnostic stability of autism spectrum disorder. Research in Autism Spectrum Disorders, 6(1), 345–354.

    Article  Google Scholar 

  • Yama, B., Freeman, T., Graves, E., Yuan, S., & Campbell, K. (2012). Examination of the properties of the modified checklist for autism in toddlers (M-CHAT) in a population sample. Journal of Autism and Developmental Disorders, 42, 23–34.

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge Charissa Wong who participated in data collection for the study. We would like to thank Tang Hui Nee, Yang Phey Hong, and Cheong Wan Mui, who provided valuable advice during the course of the research. Special mention also goes to Jennifer Tan, Suraya Amir, and other administrative staff of the Department of Child Development, KK Women’s and Children’s Hospital, who kindly assisted with the data collection process.

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Authors and Affiliations

  1. Department of Child Development, KK Women’s and Children’s Hospital, Women’s Tower Level 5, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Hwan Cui Koh, Hong Huay Lim & Sylvia Henn Tean Choo

  2. Department of Psychology, National University of Singapore, Singapore, Singapore

    Si Huan Lim, Gifford Jiguang Chan, Marisa Bilin Lin & Iliana Magiati

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  1. Hwan Cui Koh
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  2. Si Huan Lim
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  3. Gifford Jiguang Chan
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  4. Marisa Bilin Lin
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  5. Hong Huay Lim
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  7. Iliana Magiati
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Correspondence to Hwan Cui Koh.

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Koh, H.C., Lim, S.H., Chan, G.J. et al. The Clinical Utility of the Modified Checklist for Autism in Toddlers with High Risk 18–48 Month Old Children in Singapore. J Autism Dev Disord 44, 405–416 (2014). https://doi.org/10.1007/s10803-013-1880-1

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  • DOI: https://doi.org/10.1007/s10803-013-1880-1

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