Validation of the Spanish Version of the M-CHAT-R/F within the Public Health System
Different studies have shown that the M-CHAT is among the best screening tools for ASD in general populations studied so far (McPheeters et al., 2015), while the proportion of recognizing that identified ASD cases in the studies remains lower than the prevalence estimated by the CDC. Besides the M-CHAT can have a high rate of cases with suspected ASD initially requiring subsequent telephone follow-up.
A new version of the M-CHAT questionnaire, the M-CHAT-R / F is available (Robins et al., 2014) which includes a structured monitoring and referral and to apply a risk-based algorithm system levels, reducing the number of cases that require follow-up phone call. The M-CHAT-R / F seems to have better psychometric properties, but information about the feasibility and validity of this tool in a general population-based study is still necessary.
The main objective of this work is to validate the Spanish version of the M-CHAT-R/F. Furthermore, to describe the possibility of integrating the ASD screening practice, that has up till now been focused on research, into the national health system, as a standard practice for pediatricians who are responsible for well-child visits.
The M-CHAT-R/F was translated into Spanish and a cross-cultural adaptation was performed. A population-based ASD screening programme using MCHAT-R/F Spanish version was established in two Spanish regions. Parents of 18 months and/or 24 months aged children were asked to fill in this questionnaire at the outpatient public health services (compulsory vaccination programme and well-child check-up programme respectively). The original MCHAT-R/F criteria and a refining procedure for the phone call were adopted after agreement with the MCHAT authors. The identification of false negatives is coordinated with the ASD early intervention centres, and the Hospital diagnosis units in both regions.
A total of 2970 questionnaires were administered to 2560 children from April 2014 to October 2015. Of the positive screening cases, 7 children have been diagnosed with ASD; 8 with non ASD disorders following the DSM-5 criteria; 3 with typical development; and 13 children that have not yet been evaluated. Only 10 families of the 62 positive cases from the questionnaire were unreachable during the item verification stage. The sensitivity and specificity obtained were 0.857 and 0.997, respectively. Positive predictive value was 0.429 and negative 0.999. Updated results will be presented in May 2016.
The M-CHAT-R/F shows promise as a screening tool for developmental disorders in the general population. This work is an important contribution to ongoing research into identification of ASD at a young age. Although there have been many advances in the screening process, the tools used, and strategies to detect false negatives and reduce false positive rates, ongoing study is needed to continue improving the early detection of autism.