Screening for Autism Spectrum Disorders in Childcare Centers Using the M-CHAT-R/F

Background:   Early detection of autism spectrum disorders (ASD) leads to early intervention which in turn leads to better outcomes. The average age of diagnosis is 4 years old. Pediatricians are mandated to complete ASD specific screenings at 18 and 24 months, but with the multitude of tasks that must be performed during a short check-up, ASD specific screenings may not be offered. Early Childhood Education Providers (ECEPs) may be an ideal source to increase access to screening.

Objectives:  

1. Assess the feasibility and acceptability of autism screening in childcare centers.
2. Evaluate the concordance of M-CHAT-R/F results from parents and teachers.

Methods: A mixed method approach included focus groups to serve as a needs assessment and to provide data on acceptability of screening completed by ECEPs.

Ten childcare sites were recruited; ECEPs participated in a 90-minute training about symptoms of ASD, a demonstration of the web-based system, and an interactive discussion. A questionnaire was administered to ECEPs to understand perceptions about developmental screening and monitoring. To support screening, researchers attended parent events, and were available at pick-up and drop-off times to help parents complete the M-CHAT-R/F. ECEPs also completed M-CHAT-R/F. Children that screened positive were invited for a diagnostic evaluation; parents received oral and written feedback about their child.

Results:  

Nine primary caregivers (mean age=42, SD=12.8, range:20-56 years) of young children participated in the first focus group. Participants were predominately African American (88.89%), and 44% of participants held some type of college degree. Approximately one-third of participants voiced familiarity with autism. Caregivers felt benefits of childcare included socialization and learning foundational skills. Caregiver concerns about ECEPs included lack of training and familiarity, and lack of a relationship with their children.

Seven ECEPs participated in the second focus group; they were enthusiastic about the role of childcare providers in developmental monitoring and screening, and endorsed use of continuous monitoring for children. 57.1% of participants held an advanced degree. Methods for monitoring varied across centers. 28% reported using the Ages and Stages Questionnaire, 14% reported a mixture of methods, but 57% consider their monitoring techniques to be “informal”.

Over half of ECEPs (n=57) who completed pre-study questionnaires indicated they have experience monitoring development of children in the classroom, yet over 25% have never talked with parents about concerns related to their child’s development.

Although more than 700 children within our qualifying age range were enrolled across all 10 childcare centers, uptake has been low. Of the 95 children who have completed screening, 10 children screened positive: 6 based on parent report, 3 based on teacher report, and 1 child screened positive on both reports. Concordance for screening results was 76%.

Conclusions:   ECEPs are accepting of screening for ASD, but low participation rates among parents indicate barriers to screening in childcare settings. Concordance among ECEPs and parents is high when children are screened by multiple informants. With strong teacher support, screening is more widely accepted by parents, and the use of M-CHAT-R/F can contribute to the early detection of autism.