Journal of Autism and Developmental Disorders

, Volume 47, Issue 10, pp 3296–3310 | Cite as

Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months

  • Raymond Sturner
  • Barbara Howard
  • Paul Bergmann
  • Tanya Morrel
  • Rebecca Landa
  • Kejuana Walton
  • Danielle Marks
Original Paper


Accuracy of autism screening using M-CHAT plus the follow-up interview (M-CHAT/F) for children screened positive at 18-months was compared to screening at 24-months. Formal ASD testing was criterion for a community sample of M-CHAT positive children (n = 98), positive predictive value (PPV) was 0.40 for the M-CHAT and 0.58 for the M-CHAT/F. MCHAT/F PPV was 0.69 among children 20+ months compared to 0.36 for <20 months. Multivariate analyses incorporating data from the Ages and Stages Questionnaire, MacArthur-Bates Communicative Development Inventory, M-CHAT and M-CHAT/F results, and M-CHAT items suggest language variables carry greatest relative importance in contributing to an age-based algorithm with potential to improve PPV for toddlers <20 months to the same level as observed in older toddlers.


Autism screening Developmental screening M-CHAT Toddler development 



This project was funded by a grant from the NIMH Grant No. R44MH085399. The participating primary care pediatricians and their office staffs in the state of Maryland are acknowledged for their cooperation during the project and continuing implementation of the screenings described after the conclusion of the project.

Author Contributions

RS and BH conceived of the study, participated in its design and coordination and drafted the manuscript; RL participated in the design and interpretation of the data; TM participated in the design and coordination of the study. KW and DM participated in the coordination of the study and assisted with the measurement; PB participated in the design of the study and performed the statistical analysis; All authors read and approved the final manuscript.

Compliance with Ethical Standards


This study was conducted by the Center for Promotion of Child Development through Primary Care and its for-profit subsidiary, Total Child Health (TCH), Inc. CHADIS, the web-tool used in the study, was developed by Dr. Sturner and his spouse, Dr. Howard. Dr. Sturner is Director of the Center and Dr. Howard is President of TCH. Both are members of the Board of Directors of both entities and are paid consultants to both entities. The terms of the arrangement were managed by The Johns Hopkins University in accordance with its conflict of interest policies.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Raymond Sturner
    • 1
    • 2
    • 10
  • Barbara Howard
    • 1
    • 3
  • Paul Bergmann
    • 4
    • 5
  • Tanya Morrel
    • 3
  • Rebecca Landa
    • 1
    • 6
  • Kejuana Walton
    • 3
    • 7
  • Danielle Marks
    • 1
    • 8
    • 9
  1. 1.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Center for Promotion of Child Development through Primary CareBaltimoreUSA
  3. 3.Total Child HealthBaltimoreUSA
  4. 4.Foresight Logic, Inc.Saint PaulUSA
  5. 5.PrairieCare InstituteMinneapolisUSA
  6. 6.Kennedy Krieger InstituteBaltimoreUSA
  7. 7.Baltimore Healthy StartBaltimoreUSA
  8. 8.Sinai HospitalBaltimoreUSA
  9. 9.Maternal and Child Health Unit, Public Health DivisionWyoming Department of HealthEvanstonUSA
  10. 10.BaltimoreUSA

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