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Thursday, May 7, 2009: 2:50 PM
Northwest Hall Room 5 (Chicago Hilton)
Background: The American Academy of Pediatrics recommends all children be screened for autism spectrum disorders (ASDs) at 18- and 24-month well child visits unless a risk factor (parent, provider, or caregiver concern or a sibling with ASD) suggests earlier screening. Two relevant screening instruments include the Modified Checklist for Autism in Toddlers (M-CHAT; Robins et al., 2001) and Communication and Symbolic Behavior Scales Infant Toddler Checklist (CSBS- ITC; Wetherby & Prizant, 2002).
Objectives: We used both measures to examine the rates of positive and negative screens within one sample.
Methods: The EACH CHILD Study collaborated with a large community pediatric practice to implement systematic screening for ASD in toddlers. Over the six-month period of the study, 817 (81%) of eligible toddlers were screened. The screened group reflects the ethnic and socioeconomic diversity statewide. Both the M-CHAT and CSBS-ITC were administered. Authors’ guidelines for cutoff scores were used to determine positive results for each measure (indicating concern for ASD). Researchers scored all questionnaires and contacted parents of children who screened positive. The M-CHAT phone interview protocol was followed for children with positive M-CHATs. Individual domains on the CSBS- ITC that were failed were re-administered by phone. If a child continued to screen positive after phone follow-up, an in-person screening with the Autism Diagnostic Observation Schedule (Lord et al., 2000) and Mullen Scales of Early Learning (Mullen, 1995) was offered. All forms were available in Spanish, and a Spanish speaker administered phone follow-up and in-person evaluations when appropriate.
Results: Results for the M-CHAT alone indicated that 14.6% children screened positive on the parent questionnaire, and 2.1% continued to screen positive after the phone follow-up (7.1% could not be contacted). In this group, of those who participated in the in-person evaluation, 7 (54%) showed significant early signs of autism by clinical judgment. Results for the CSBS-ITC indicated that 16.8% of children screened positive on the parent questionnaire, with 4.6% continuing to screen positive after the phone follow-up (5.9% could not be contacted). After in-person screening, 11 (48%) were believed to show significant early signs of autism. Two more children with significant signs of autism were not picked up by either the M-CHAT or CSBS-ITC, but were seen in person because of parent concerns, and found to have significant signs of autism by clinical judgment.
Conclusions: This is the first study to our knowledge to use both the M-CHAT and CSBS- ITC in the same sample. Children identified as showing early signs of autism were most likely to screen positive on both screeners, but 4 children screened positive on the CSBS-ITC alone. Phone follow-up reduced the number of false positives for both measures. The 2 cases identified as false negatives suggest that parent, caregiver, or provider concern is a valid reason for referral even if initial screeners show negative results.
Objectives: We used both measures to examine the rates of positive and negative screens within one sample.
Methods: The EACH CHILD Study collaborated with a large community pediatric practice to implement systematic screening for ASD in toddlers. Over the six-month period of the study, 817 (81%) of eligible toddlers were screened. The screened group reflects the ethnic and socioeconomic diversity statewide. Both the M-CHAT and CSBS-ITC were administered. Authors’ guidelines for cutoff scores were used to determine positive results for each measure (indicating concern for ASD). Researchers scored all questionnaires and contacted parents of children who screened positive. The M-CHAT phone interview protocol was followed for children with positive M-CHATs. Individual domains on the CSBS- ITC that were failed were re-administered by phone. If a child continued to screen positive after phone follow-up, an in-person screening with the Autism Diagnostic Observation Schedule (Lord et al., 2000) and Mullen Scales of Early Learning (Mullen, 1995) was offered. All forms were available in Spanish, and a Spanish speaker administered phone follow-up and in-person evaluations when appropriate.
Results: Results for the M-CHAT alone indicated that 14.6% children screened positive on the parent questionnaire, and 2.1% continued to screen positive after the phone follow-up (7.1% could not be contacted). In this group, of those who participated in the in-person evaluation, 7 (54%) showed significant early signs of autism by clinical judgment. Results for the CSBS-ITC indicated that 16.8% of children screened positive on the parent questionnaire, with 4.6% continuing to screen positive after the phone follow-up (5.9% could not be contacted). After in-person screening, 11 (48%) were believed to show significant early signs of autism. Two more children with significant signs of autism were not picked up by either the M-CHAT or CSBS-ITC, but were seen in person because of parent concerns, and found to have significant signs of autism by clinical judgment.
Conclusions: This is the first study to our knowledge to use both the M-CHAT and CSBS- ITC in the same sample. Children identified as showing early signs of autism were most likely to screen positive on both screeners, but 4 children screened positive on the CSBS-ITC alone. Phone follow-up reduced the number of false positives for both measures. The 2 cases identified as false negatives suggest that parent, caregiver, or provider concern is a valid reason for referral even if initial screeners show negative results.