M-CHAT

Background:  The M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised, with Follow-up) is the newly-revised version of a widely-used screening questionnaire. The M-CHAT is used by health professionals to identify toddlers between 16 and 30 months who present a measurable risk for Autism Spectrum Disorder. The screener has traditionally been administered in paper format, during which a child's parent answers twenty Yes/No questions; depending on the parent’s responses to these questions, additional questions are presented in an interview format. A scoring algorithm is then applied to evaluate the child’s risk.

Objectives:  Build a web application that allows parents to complete the 2-stage M-CHAT-R/F questionnaire online, without an interviewer. The application must be simple enough that a parent can complete the questionnaire without guidance, using any common web browser (on a computer or tablet). It will also be accessible by the child's doctor, who can review the results and discuss them with the parent. Parents will have the option to complete the questionnaire at home or at the doctor's office, with the assurance that their data will remain private and visible only to their child's physician and to research staff. Parents choosing to complete the form at home will have the option to exit and return later to continue where they left off. The child's doctor will be able to submit an opinion about whether the child may have ASD, and research staff will be able to review this data (along with the questionnaire results) and contact children who are candidates for further screening. Parents will have the option to complete an M-CHAT-R at their regular 18-month and 24-month office visits.

Methods:  Prometheus programmed a web-based version of the 2-stage M-CHAT-R/F, incorporating the logic that determines which questions are asked and the algorithm that determines the child's score. Prometheus then built an application that allows a parent to enter contact information, demographic information about their children (who are of qualifying age), and finally the M-CHAT-R/F itself. When the parent completes the questionnaire, the child's doctor accesses the scores via a separate application, the "Doctor's Portal." The doctor completes a "Clinical opinion" form, which is visible to researchers (who have access to all data). The application makes another M-CHAT-R/F available for the child five months after the previous one is completed (assuming the child is still under 30 months old).

Results:  Dr. Robins launched the application at five clinics, with plans to expand to about a dozen more. In the first month of active data collection, 38 questionnaires were completed.

Conclusions:  The M-CHAT-R/F can be administered over the web in a way that is secure and that allows doctors to participate in the assessment of ASD risk. The questionnaire is simple enough for parents to complete quickly, without a trained interviewer.