European Child & Adolescent Psychiatry

, Volume 23, Issue 11, pp 1081–1091 | Cite as

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

  • Karin T. BeukerEmail author
  • Synnve Schjølberg
  • Kari Kveim Lie
  • Sophie Swinkels
  • Nanda N. J. Rommelse
  • Jan K. Buitelaar
Original Contribution


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.


ASD 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.

Supplementary material

787_2014_561_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Karin T. Beuker
    • 1
    • 2
    Email author
  • Synnve Schjølberg
    • 3
  • Kari Kveim Lie
    • 4
  • Sophie Swinkels
    • 1
    • 2
  • Nanda N. J. Rommelse
    • 1
    • 2
  • Jan K. Buitelaar
    • 2
    • 5
  1. 1.Department of Psychiatry (966), Nijmegen Centre for Evidence-Based PracticeRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Karakter Child and Adolescent Psychiatry University CentreNijmegenThe Netherlands
  3. 3.Division of Mental HealthNorwegian Institute of Public HealthOsloNorway
  4. 4.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  5. 5.Department of Cognitive Neuroscience, Nijmegen Centre for Evidence-based PracticeRadboud University Nijmegen Medical CentreNijmegenThe Netherlands

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