M-CHAT-R/F - Translation & Validation in Hindi

Background: Internationally, many validated tools are available for screening, diagnosing, and characterizing individuals on the autism spectrum. However, use of these measures is limited in non-English speaking countries, such as South Asia. India is a country of many languages, and based on the Indian Census data, Hindi is the primary language of over 41% of the Indian population. Translation into regional languages and validation is the first step towards establishing clinical and research standards in India and other South Asian countries. The Modified Checklist for Autism in Toddlers – Revised with Follow up (M-CHAT-R/F) is a freely available tool that is used widely to screen for autism spectrum conditions and other developmental delays in toddlers within the age group of 16 – 30 months. In a low resource country like India, having a freely accessible autism screening tool in the local language is crucial to identify young children on the spectrum and ultimately impact the access to intervention and prognosis of children with autism.

Objectives: To translate the M-CHAT-R/F to Hindi and to validate the translated version of M-CHAT-R.

Methods: The translation process involved the 4 step procedure namely – translation of the English M-CHAT-R/F into Hindi by two independent teams fluent in both the languages, compilation in to one document by a third team, blind back-translations and finally getting the translation edited and reviewed. The blind back translations were done by independent language experts, and were then evaluated by bilingual members of the research team. This cycle was repeated until the blind back translations were close to the original tool. In order to validate the translated Hindi version of the tool, it was administered with parents of 53 toddlers from New Delhi. Of the 53 toddlers, 32 children showed typical development and 21 toddlers had a diagnosis of autism spectrum disorder.

Results: An independent samples t-test showed significantly different mean scores (t =24.1, df = 7.77, P = 0.00) for autism (M = 8.61, SD = 4.21) and the typically developing group (M = 1.12, SD = 1.57). 20 out of the 21 children with autism screened positive on M-CHAT-R. Of the typically developing sample, 91% screened at low risk, 6% were found to be at medium risk and the remaining sample of 3% screened at high risk. The follow up indicated a negative screening for all typically developing toddlers who screened at medium or high risk on M-CHAT-R.

Conclusions: This holds direct implications for improving diagnosis of autism, by clinicians within the Hindi speaking population in India and other South Asian countries.