International Meeting for Autism Research: The Implementation of the M-CHAT Follow-up Interview in a Community-Based Autism Screening Program in Italy: Preliminary Results

The Implementation of the M-CHAT Follow-up Interview in a Community-Based Autism Screening Program in Italy: Preliminary Results

Thursday, May 20, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
3:00 PM
E. Salomone , Department of Psychology, University of Turin, Torino, Italy
F. Muratori , Division of Child Neurology and Psychiatry, University of Pisa Stella Maris Scientific Institute, Calambrone (Pisa), Italy
A. Narzisi , Division of Child Neurology and Psychiatry, University of Pisa Stella Maris Scientific Institute, Calambrone (Pisa), Italy
A. Pitanti , Department of Child and Adolescent Mental Health, USL 1 Massa e Carrara, Massa, Italy
C. Grassi , Department of Child and Adolescent Mental Health, USL 1 Massa e Carrara, Massa, Italy
R. Tancredi , Division of Child Neurology and Psychiatry, University of Pisa Stella Maris Scientific Institute, Calambrone (Pisa), Italy
P. F. M. Molina , Department of Psychology, University of Turin, Turin, Italy
Background:

Investigations have established that ordinary pediatric check-ups and general surveillance on child development are not sufficient to guarantee an acceptable identification rate for Pervasive Developmental Disorders. General guidelines in pediatrics therefore strongly recommend screening programs for autism at a general population level by means of standardized checklists. Despite this knowledge, there is still a need for a wide implementation of such early detection practices in Italy. To date, the care for autism in Italy has been characterized by late diagnosis (mean age at diagnosis is 4-5 years) and related negative clinical outcomes in social communication and cognitive domains. Investigations have shown that the M-CHAT screening checklist associated with a Follow-Up Interview designed to reduce the false positive rate has good psychometric properties and is effective in early detection; however no data are available on an Italian population. The M-CHAT Checklist and Follow-Up Interview are currently being introduced in a screening program in the Tuscany region of Italy. Both tools are currently being translated, culturally adapted and tested among an Italian population at 18 months and fall within a wider screening process including the administration of the First Year Inventory at 12 months of age.

Objectives:

The purpose of this investigation was to determine to what extent failing the M-CHAT Checklist was associated with a misunderstanding of the checklist items as measured by the number of items which needed clarification in the Follow-Up Interview among an Italian population.

Methods:

The M-CHAT was administered to a preliminary ongoing sample of 108 parents during the pediatric visit at 18 months. Subjects failing the M-CHAT were given a follow-up phone call to receive the M-CHAT Follow-Up Interview. Of the 13 subjects who screened positive on the Checklist, 11 completed the Interview. One subject continued to show risk for autism and is currently under clinical evaluation. For all subjects, failed or missed items at the Checklist that resulted in a “pass” at the Interview were noted and then analyzed by trained independent raters in order to determine whether change in scores was due to child maturation or misunderstanding of the items. Raters had to unanimously agree for final categorization.

Results:

Preliminary results indicate that most frequently failed items were those related to atypical sensory responsiveness and gaze monitoring. In both domains parents had more difficulties in judging their child’s behavior and considered typical patterns of behavior as unusual or abnormal. Lack of concrete examples in the wording of the checklist’s items was considered to be the most likely reason for this misunderstanding.

Conclusions:

Further testing is needed which can establish the efficacy of early screening process including a follow-up in order to reduce false positives cases and addressing the resources to early diagnosis and treatment which is sorely needed in Italy given current practices. Investigations of this type will provide further evidence to multiple level screening processes and will specifically contribute in defining a culturally sensitive screening protocol for the Italian context.

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