ESAT and M-CHAT as screening instruments for autism spectrum disorders at 18 months in the general population: issues of overlap and association with clinical referrals
- 704 Downloads
The Modified Checklist for Autism in Toddlers (M-CHAT) and the Early Screening of Autistic Traits (ESAT) were designed to screen for autism spectrum disorders in very young children. The aim of this study was to explore proportions of children that screened positive on the ESAT or the M-CHAT and to investigate if screening positive on the ESAT and M-CHAT is associated with clinical referral by 18 months and other aspects of children’s development, health, and behavior. In this study, the mothers of 12,948 18-month-old children returned a questionnaire consisting of items from the ESAT and M-CHAT, plus questions about clinical and developmental characteristics. The M-CHAT identified more screen-positive children than the ESAT, but the ESAT was associated with more clinical referrals and tended to identify more children with medical, language, and behavioral problems. A post hoc analysis of combining the two instruments found this to be more effective than the individual instruments alone in identifying children referred to clinical services at 18 months. Further analysis at the level of single items is warranted to improve these screening instruments.
KeywordsASD M-CHAT ESAT Early screening Development Infants
The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (Contract No. N01-ES-75558), NIH/NINDS (Grant No. 1 UO1 NS 047537-01 and Grant No. 2 UO1 NS 047537-06A1). We are grateful to all the participating families in Norway who take part in this ongoing cohort study.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 18.Stoltenberg C, Schjolberg S, Bresnahan M, Hornig M, Hirtz D, Dahl C, Lie KK, Reichborn-Kjennerud T, Schreuder P, Alsaker E, Oyen AS, Magnus P, Suren P, Susser E, Lipkin WI (2010) The autism birth cohort: a paradigm for gene-environment-timing research. Mol Psychiatry 15(7):676–680PubMedCentralPubMedCrossRefGoogle Scholar
- 20.Kristiansen JE, Sandnes T (2006) Women and men in Norway. What the figures say. Statistics Norway, OsloGoogle Scholar
- 21.Kleinman JM, Robins DL, Ventola PE, Pandey J, Boorstein HC, Esser EL, Wilson LB, Rosenthal MA, Sutera S, Verbalis AD, Barton M, Hodgson S, Green J, Dumont-Mathieu T, Volkmar F, Chawarska K, Klin A, Fein D (2008) The Modified Checklist for Autism in Toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord 38(5):827–839PubMedCentralPubMedCrossRefGoogle Scholar
- 26.Stenberg N, Bresnahan M, Gunnes N, Hirtz D, Hornig M, Lie KK, Lipkin WI, Lord C, Magnus P, Reichborn-Kjennerud T, Schjolberg S, Suren P, Susser E, Svendsen BK, von Tetzchner S, Oyen AS, Stoltenberg C (2014) Identifying children with autism spectrum disorder at 18 months in a general population sample. Paediatr Perinat Epidemiol. doi: 10.1111/ppe.12114 PubMedGoogle Scholar
- 28.Dietz C, Swinkels S, van Daalen E, van Engeland H, Buitelaar JK (2006) Screening for autistic spectrum disorder in children aged 14–15 months. II: population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings. J Autism Dev Disord 36(6):713–722PubMedCrossRefGoogle Scholar
- 29.Buitelaar JK, van Daalen E, Dietz C, van Engeland H, van der Gaag RJ, van Steijn D, Swinkels SHN (2009) ESAT—screening van ASS op jonge leeftijd. Bohn Stafleu van Loghum, HoutenGoogle Scholar
- 36.Buss AH, Plomin R (1984) Temperament: early developing personality traits. Lawrence Erlbaum, HillsdaleGoogle Scholar
- 39.Houwelingen JC, Stijnen T, van Strik R (1993) Inleiding tot de medische statistiek. Bunge, UtrechtGoogle Scholar
- 40.Petrie A, Sabin C (2005) Medical statistics at glance, 2nd edn. Blackwell, MaldenGoogle Scholar
- 41.Team RDC (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 42.Fox J (2007) Polycor: polychoric and polyserial correlations. R Package Version 0.7-5. Available at http://cran.r-project.org/
- 43.Drasgow F (1986) Polychoric and polyserial correlations. In: Kotz S, Johnson N (eds) The encyclopedia of statistics, vol 7. Wiley, New York, pp 68–74Google Scholar
- 45.Uebersax JS (2006) The tetrachoric and polychoric correlation coefficients. Statistical Methods for Rater Agreement web site. http://john-uebersax.com/stat/tetra.htm
- 46.Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, HillsdaleGoogle Scholar
- 47.Centers for Disease Control and Prevention (2009) Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, United States 2006. Surveillance summaries, December 18, 2009. MMWR 58(SS-10):1–24Google Scholar