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Construct and Predictive Validity of Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) Taiwan Version for Toddlers in Taiwan
Objectives: The objectives are to 1) explore the factor structure of the M-CHAT-R/F Taiwan version, and to 2) examine predictive validity of the M-CHAT-R/F total score on developmental scores of the Mullen Scales of Early Learning (MSEL) at child’s 30 and 36 months of age.
Methods: Toddlers aged 16-30 months were prospectively enrolled in this study. Children with major sensory, motor or neurological impairment/disorder were excluded. Parents filled out the M-CHAT-R/F at the beginning of the study and received developmental assessments by using the MSEL when child approached 30 and 36 months of age. Exploratory Factor Analysis (EFA) was conducted to investigate the factor structure of the M-CHAT-R/F Taiwan version. Linear regression analysis was used to examine the association between the M-CHAT-R/F total scores and MSEL developmental scores.
Results: One hundreds and seven toddlers were recruited in this study. An Initial analysis showed the Kaiser-Meyer-Olkin statistic was 0.87 (above the threshold of 0.5) and the Bartlett’s Test of Sphericity was significant (p < .0001), indicating that the M-CHAT-R/F data were suitable for EFA. Five factors were derived accounting for 55.6% of the variance (Figure 1): (1) social attention and play (9 items); (2) communication (3 items); (3) interest and imitation (3 items); (4) behavior (3 items); and (5) motor (2 items). All the factor loadings of each item were > 0.3 on the derived factors (ranging 0.45 – 0.84). The results of predictive validity showed the M-CHAT-R/F total scores at child’s early ages were significantly associated with the MSEL scores at child’s 30 and 36 months of ages (β= 112.9, R2=0.209, p<0.001). Children who were classified as high risk or median risk for ASD in the M-CHAT-R/F scores were found to have significantly lower MSEL developmental scores at 30 and 36 months of age (p<0.05).
Conclusions: This study showed a five-factor structure for the M-CHAT-R/F Taiwan Version. The finding of factor structure reflects the DSM-5’s diagnostic criteria for ASD, providing some evidence towards a similar factor structure of autistic traits and related symptoms for toddlers in Taiwan. Furthermore, the associations between the M-CHAT-R/F and MSEL suggests an acceptable predictive validity that the M-CHAT-R/F is predictive of child’s developmental outcome on the MSEL scales.